PROGRAM STUDI S1 KEPERAWATAN

FAKULTAS ILMU KESEHATAN

INSTITUT ILMU KESEHATAN
BHAKTI WIYATA KEDIRI

FORMAT PENGKAJIAN ASUHAN KEPERAWATAN INTRANATAL

NAMA MAHASIWA :
NIM :

Tanggal masuk : ……………… Jam masuk : ………………..

Ruang/kelas : ……………… No. RM : ………………..
Pengkajian tanggal : …………........ Jam : ………………..

DATA UMUM KEBIDANAN

1. Kehamilan sekarang direncanakan ( ya / tidak )

2. Status obstetric :G.....P....A..... UsiaKehamilan : ……………
3. HPHT …………. TaksiranPartus :……………..
4. JumlahanakDirumah :
5. Mengikutikelas prenatal
6. Jumlahkunjungan pada kehamilanini
7. Masalahkehamilan yang lalu
8. Masalahkehamilansekarang
9. Rencana KB
10. Makanan bayi sebelumnya ( ASI / PASI / Lain – lain)
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11. Pelajaran apa yang diinginkan saat ini : ( lingkari ) relaksasi pernafasan / manfaat
ASI/ cara memberi minum botol /senam nifas/ metode KB/ perawatan perinium/
perawatan payudara

12. Setelah bayi lahir, siapa yang diharapkan membantu :

Suami / teman/ orang tua
13. Masalah dalam persalinan yang lalu :
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RIWAYAT PERSALINAN SEKARANG

1. Mulai persalinan ( kontraksi / pengeluaran pervaginam ) : tanggal / Jam
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2. Keadaan kontraksi ( frekuensi dalam 10 menit, lamanya. Kekuatan:
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3. Frekuensi dan kualitasdenyutjanyingjanin ...........x/ menit
4. Pemeriksaan fisik
Kenaikan BB selama kehamilan :
Tanda Vital :TD...........mmhg, Nadi...........x/mnt, Suhu...........C.
Pulse...........x/mnt
Kepala dan leher ( normal/tidak ) :...........................................................................
Jantung : .............................................................................................................
Paru – paru :
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Payudara :
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Abdomen :
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Kontraksi:.......................................................DJJ.....................................................
Ektremitas ( edema / tidak ) : ...................................................................................
Refleks : ...............................................................................................................
5. Pemeriksaan dalam pertama: jam................................ Oleh ....................................
Hasil : ........................................................................................................................
6. Ketuban(utuh/pecah),jikasudah pecah tgl/jam ........................warna......................
7. Laboratorium : ..........................................................................................................
DATA PSIKOSOSIAL
1. Penghasilan keluarga setiap bulan : Rp.....................................................................
2. Bagaimana perasaan anda terhadap kehamilan sekarang
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3. Bagaimana perasaan suami terhadap kehamilan sekarang
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4. Jelaskan respon sibling terhadap kehamilan sekarang
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