LAPORAN PEMANTAUAN TUMBUH KEMBANG ANAK

DENGAN DENVER DEVELOPMENT SCREENING

TEST II DI RUANG POLI TUMBUH KEMBANG
RSUP DR. SARDJITO YOGYAKARTA

OLEH :

MARIA YULIANTI MAU

YUNI LISTIANI

PRODI ILMU KEPERAWATAN DAN NERS

SEKOLAH TINNGI ILMU KESEHATAN WIRA HUSADA
YOGYAKARTA
TAHUN 2017
 LAPORAN PEMANTAUAN TUMBUH KEMBANG ANAK
DENGAN DENVER DEVELOPMENT SCREENING
TEST II DI RUANG POLI TUMBUH KEMBANG
RSUP DR. SARDJITO YOGYAKARTA

Laporan ini telah dibaca, diperiksa pada

Hari/tanggal :

Pembimbing Klinik Mahasiswa Parktikan

(SUTITI MARTAJI, AMK) (MARIA YULIANTI MAU) (YUNI LISTIANI)

Mengetahui
Pembimbing Akademik

(AGNES ERIDA WIJAYANTI, S.Kep., Ns., M. Kep)

 PANDUAN PEMBUATAN LAPORAN PENDAHULUAN (LP)
ASUHAN KEPERAWATAN LENGKAP
KEPERAWATAN ANAK

JUDUL

A. KONSEP DASAR KASUS KELOLAAN

1. Definisi
2. Etiologi
3. Patofisiologi - Pathway
4. Maniffestasi klinik
5. Prognosa
6. Komplikasi
7. Pencegahan
8. Pemeriksaan penunjang
9. Penatalaksanaan

B. KONSEP ASUHAN KEPERAWATAN BERDSARKAN TEORI DARI

KASUS
1. Pengkajian
2. Diagnosa
3. Perencanaan (Diagnosa, Tujuan dan kriteria hasil, Intervensi, Rasional)
4. Discharge Planning
C. Daftar pustaka (minimal 5 daftar pustaka, minimal 10 tahun terakhir, minimal 2
referensi jurnal terkait kasus)

Ketentuan penulisan:
LP diketik pada kertas ukuran folio/ketik (catatan harus memahami apa yang dibuat).
Tidak diperkenankan copy paste dari laporan orang lain, karena akan dianggap belum
membuat LP. Dalam pembuatan LP, silahkan melakukan sintesis dari naskah rujukan
yang saudara pakai. LP yang bukan dari hasil sintesis pribadi, dikurangi dalam
penilaian LP/laporan)
 FORMAT ASUHAN KEPERAWATAN NEONATUS
STASE KEPERAWATAN ANAK
STIKES WIRA HUSADA YOGYAKARTA

Nama mahasiswa :………...……………………………………………….

NIM : ………………...………………………………………
Tempat praktek : …………………………...……………………………
Tanggal : .......................................................................................
Pengkajian : ………………...………………………………………
Praktik : ………………...………………………………………

I. Identitas Pasien
Nama :...............................................................................................................
No Rekam Medis: ............................................................................................
Tempat/tgl lahir :...............................................................................................
Nama Ayah/ Ibu : .............................................................................................
Pekerjaan Ayah : ..............................................................................................
Pendidikan Ayah : ............................................................................................
Pekerjaan Ibu : ..................................................................................................
Pendidikan Ibu : ...............................................................................................
Alamat/no telp : ................................................................................................
Suku : ...............................................................................................................
Agama : ............................................................................................................
Diagnosa medis : ..............................................................................................

II. Keluhan Utama:

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III. Riwayat Kesehatan Saat ini
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IV. Riwayat kehamilan dan kelahiran
 Prenatal
 Jumlah kunjungan/ANC : ……… kali
 Tempat : Dokter/Bidan/Lainnya
 Penkes yang dipeoleh : …………….……………………
 HPHT : …………………………………
 Kenaikan BB selama hamil : ……… kg
 Komplikasi kehamilan : …………………………………
 Komplikasi obat : …………………………………
 Obat-obatan yang didapat : …………………………………
 Riwayat hospitalisasi : …………………………………
 Golongan darah ibu : A / B / AB / O
 Pemeriksaan kehamilan (maternal screening)
Rubella [ ] Hepatitis [ ] CMV [ ]
GO [ ] Herpes [ ] HIV [ ]
Lainnya:
…………………………………………………………………………

 Intranatal
 Lama persalinan : ……………………………………
 Saat persalinan : Premature/Matur/Serotinus
 Komplikasi persalinan : ……………………………………
 Terapi yang diberikan : ……………………………………
 Cara melahirkan : Pervaginam normal [ ]
Dengan vakum ekstasion [ ]
Operasi Caesar [ ]
Lainnya: ………………………
 Tempat melahirkan : Rumah sakit [ ]
Rumah bersalin [ ]
Rumah [ ]
Lainnya: ………………………
 Postnatal
 Usaha nafas : Dengan bantuan [ ]
Tanpa bantuan [ ]
 Kebutuhan resusitasi :
 Apgar skor : …………………………………………….…………..
Bayi langsung menangis: Ya/Tidak
Tangisan bayi : Kuat/Lemah/Lainnya, sebutkan ……….
Tanda 0 1 2

Denyut jantung
Tidak ada < 100 x/menit >100 x/menit

Pernafasan
Tidak ada Lambat Menangis kuat

Refleks
Lumpuh Ekstremitas Gerakan aktif
fleksi sedikit

Tonus Otot
Tidak bereaksi Gerakan sedikit Reaksi melawan

Warna Kulit Biru/Pucat Tubuh Kemerahan

kemerahan,
tangan dan kaki
biru

Keterangan :
= Penilaian menit ke-1
= Penilaian menit ke-2

Jumlah : Menit ke-1 :.....

Menit ke-2 : ......

 Obat-obatan yang diberikan pada neonatus:

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 Interaksi orang tua dan bayi : Kualitas = ………………………..
Lamanya = ………………………..
  Trauma lahir : Ada [ ] Tidak [ ]
 Narkosis : Ada [ ] Tidak [ ]
 Keluarnya urin/BAB : Ada [ ] Tidak [ ]
 Respon fisiologis atau perilaku yang bermakna:
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V. Riwayat Keluarga
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Genogram

VI. Riwayat Sosial

a. Sistem pendukung/keluarga terdekat yang bisa dihubungi:
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b. Hubungan orang tua dengan bayi
Menyentuh : Ibu [ ], Bapak [ ]
Memeluk : Ibu [ ], Bapak [ ]
Berbicara : Ibu [ ], Bapak [ ]
Berkunjung : Ibu [ ], Bapak [ ]
Kontak mata : Ibu [ ], Bapak [ ]
c. Anak yang lain
Anak ke- Jenis Kelamin Riwayat Persalinan Riwayat
Imunisasi

d. Lingkungan rumah:
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e. Problem social yang penting:
* Kurangnya system pendukung social [ ]
* Riwayat penyalahgunaan zat aditif [ ]
* Keuangan [ ]
, penghasilan/bulan: Rp. ………..
* Lainnya: …………………………………………………………

VII. Keadaan kesehatan saat ini

a. Diagnosa medis : ........................................................................................
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b. Tindakan operasi:........................................................................................
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c. Status nutrisi: ..............................................................................................
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d. Status cairan: ..............................................................................................
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 e. Obat-obatan: ...............................................................................................
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f. Aktivitas: ....................................................................................................
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g. Tindakan keperawatan yang telah dilakukan: .............................................
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h. Hasil laboratorium: .....................................................................................
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i. Pemeriksaan penunjang: .............................................................................
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j. Lain-lain: ....................................................................................................
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VIII. Pemeriksaan Fisik

Keadaan Umum:
 Kesadaran : ……………………………………… GCS: E: V: M:
 Tanda vital : Nadi: ………x/menit Suhu badan: ………..0 C
RR : ………x/menit TD:
Saat lahir Saat ini
1. Barat Badan
2. Panjang Badan
3. Lingkar Kepala
Tonus/aktivitas:
a. Aktif [ ] Tenang [ ] Letargi [ ] Kejang [ ]
b. Menangis keras [ ] Lemah [ ]
Melengking [ ] Sulit menangis[ ]

Kepala/leher:
a. Fontanel anterior
Lunak [ ] Tegas [ ] Datar [ ]
Menonjol [ ] Cekung [ ]
b. Sutura sagitalis
Tepat [ ] Terpisah [ ] Menjauh [ ]
c. Gambaran wajah
Simetris [ ] Asimetris [ ]
d. Molding
Caput succedaneum [ ] Cephalohematoma [ ]

Mata: Bersih [ ] Sekresi[ ]

THT:
a. Telinga
Normal [ ] Abnormal [ ]
b. Hidung
Bilateral [ ] Obstruksi [ ] Cuping hidung [ ]
c. Palatum
Normal [ ] Abnormal [ ]

Thoraks:
a. Simetris [ ] Asimetris [ ]
b. Retraksi:
Derajat I [ ] Derajat II [ ] Derajat III [ ]
c. Klavikula :
Normal [ ] Abnormal [ ]

Paru-paru
a. Suara nafas
Sama kanan kiri [ ] Tidak sama kanan kiri [ ]
Bersih [ ] Ronkhi [ ]
Rales [ ] Sekret [ ]
b. Bunyi nafas
Terdengar di semua lapang paru [ ] Tidak terdengar [ ]
Menurun [ ]
c. Respirasi
Spontan [ ] : ……… x/menit
Sungkup/boxhead [ ] : ……… x/menit
Ventilasi assisted CPAP [ ]
Jantung
a. Bunyi Normal Sinus Rytm [ ] : ………. X/menit
Murmur [ ]
Lainnya: ……………………………
b. Waktu pengisian kapasitas :
Batang tubuh …………………………………….
Ekstremitas ……………………………………...
c. Nadi perifer
Berat Lemah Tidak ada
Brakhial – kanan
Brakhial – kiri
Femoral – kanan
Femoral – kiri

Abdomen:
a. Lunak [ ] Tegas [ ] Datar [ ] Kembung [ ]
b. Lingkar perut : ……… cm
c. Liver : < 2 cm [ ]
> 2 cm [ ]
Umbilikus:
Normal [ ] Abnormal [ ] Inflamasi [ ] Drainase [ ]

Genital:
Perempuan normal [ ] Laki-laki normal [ ] Ambivalen
[ ]

Anus:
Paten [ ] Imperforata [ ]
Spina:
Normal [ ] Abnormal [ ]

Kulit:
a. Warna : Pink [ ] Pucat [ ] Jaundice [ ]
 b. Rash/kemerahan [ ]
c. Tanda lahir [ ]

Ekstremitas:
a. Semua ekstremitas gerak [ ] ROM terbatas [ ]
Tidak dapat dikaji [ ]
b. Ekstremitas atas dan bawah:
Simetris [ ] Asimetris [ ]

Suhu:
a. Lingkungan
Penghangat radian [ ] Pengatur suhu [ ]
Inkubator [ ] Suhu ruang [ ] Boks terbuka [ ]
b. Suhu kulit:

IX. Pemeriksaan Reflek Patologis

Fisiologis:
Moro [ ] Menggenggam [ ] Menghisap[ ]

Patologis
Babinsky [ ] Chaddock [ ] Oppenheim [ ]
Gordon [ ] Schaefffer [ ] Hoffman [ ]
Tromner [ ]

X. Informasi Lain
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XI. Ringkasan Riwayat Keperawatan

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XII. Terapi Medis

 No Nama Obat Dosis Rute Pemberian Indikasi
Jam

XIII. Pemeriksaan Lab dan penunjang

No Jenis Hasil Nilai Interpretasi Indikasi
pemeriksaan Lab Normal
 No Jenis Hasil/interpretasi
Pemeriksaan
Penunjang

XIV. ANALISIS DATA

Nama Klien : RUANG :
No. RM : MAHASISWA :
DATA PROBLEM ETIOLOGI
XV. Diagnosis Keperawatan (Sesuai Prioritas)
1.

2.

3.

4.

5.
XVI. RENCANA KEPERAWATAN
Nama Klien : RUANG :
No. RM : MAHASISWA :
Hari/tgl/ jam Diagnosa Keperawatan/
Tujuan (NOC) Intervensi (NIC)
Masalah Kolaborasi
XVII. CATATAN PERKEMBANGAN
Nama Klien : RUANG :
No. RM : MAHASISWA :
No.DP HARI/TGL IMPLEMENTASI EVALUASI TTD

PROSES HASIL
 FORMAT ASUHAN KEPERAWATAN
KEPERAWATAN ANAK (untuk yang berumur lebih dari 28 / 30 hari)
STIKES WIRA HUSADA YOGYAKARTA

Nama mahasiswa :
NIM :
Tempat praktek :
Tanggal Pengkajian :
Tanggal Praktik :
Sumber data :
Metode pengumpulan data :

I. Identitas Pasien
Nama :
No. Rekam Medis :
Tempat/tgl lahir :
Jenis kelamin :
Suku bangsa :
Bahasa yang dimengerti :
Agama :

Nama Ayah/Ibu/Wali :
Pekerjaan Ayah/Ibu/Wali :
Pendidikan Ayah/Ibu/Wali :
Alamat/no telp :
Diagnosa medis :

II. Keluhan Utama

Keluhan utama saat masuk Rumah sakit: ..............................................................
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 Keluhan Utama Saat Pengkajian: ..........................................................................
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III. Riwayat Kesehatan saat ini

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IV. Riwayat Penyakit dahulu
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V. RIWAYAT KEHAMILAN DAN KELAHIRAN

a. Prenatal
Saat hamil : Ibu merokok : Ya / Tidak
: Ibu minum minuman keras : Ya / Tidak
: periksa Kehamilan : Ya / Tidak
: Tempat periksa kehamilan : ......................................................
: Edukasi selama hamil : .....................................................
Keluhan Selama Hamil : ...................................................................................

b. Intra dan postnatal

Intranatal
Lama persalinan :
……………………………………………………
Saat persalinan : Premature/Matur/Serotinus
Komplikasi persalinan :
……………………………………………………
Terapi yang diberikan :
……………………………………………………
Cara melahirkan : Pervaginam normal [ ]
Dengan vakum ekstasion [ ]
Operasi Caesar [ ]
Lainnya: …………………………………………
Tempat melahirkan : Rumah sakit [ ]
Rumah bersalin [ ]
 Rumah [ ]
Lainnya: …………………………………………

Postnatal
Usaha nafas : Dengan bantuan [ ]
Tanpa bantuan [ ]
Kebutuhan resusitasi :
Apgar skor = …………………………………………………………………
Bayi langsung menangis : Ya/Tidak
Tangisan bayi : Kuat/Lemah/Lainnya, sebutkan …………………
Obat-obatan yang diberikan setelah lahir: .......................................................
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 Trauma lahir : Ada [ ] Tidak [ ]
 Keluarnya urin/BAB : Ada [ ] Tidak [ ]
 Respon fisiologis atau perilaku yang bermakna: .........................................
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c. Penyakit yang pernah diderita
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d. Hospitalisasi
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 e. Operasi
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f. Injuri/kecelakaan
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g. Alergi
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h. Imunisasi
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i. Pengobatan
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VI. Riwayat Pertumbuhan
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VII. Tingkat Perkembangan (gunakan format DDST)

a. Social
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b. Motorik halus
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c. Bahasa
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d. Motorik kasar
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VIII. Riwayat Sosial
a. Pengasuh:
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b. Pembawaan secara umum

c. Hubungan dengan anggota keluarga:

d. Hubungan dengan teman sebaya:

IX. Riwayat Keluarga

a. Sosial ekonomi :

b. Lingkungan rumah ;

c. Penyakit keluarga :
 Genogram

X. POLA KESEHATAN
a. Pemeliharaan dan persepsi kesehatan

b. Nutrisi (makanan dan cairan)

Sebelum Sakit: ................................................................................................
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c. Aktivitas termasuk personal hygiene
Sebelum Sakit: ................................................................................................
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Selama Sakit: ..................................................................................................
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d. Tidur dan istirahat
Sebelum Sakit: ................................................................................................
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Selama Sakit: ..................................................................................................
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e. Eliminasi
Sebelum Sakit: ................................................................................................
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Selama Sakit: ..................................................................................................
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f. Pola hubungan
Sebelum Sakit: ................................................................................................
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Selama Sakit: ..................................................................................................
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g. Koping
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h. Kognitif dan persepsi
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i. Konsep diri
Identitas diri.....................................................................................................
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Harga diri.........................................................................................................
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Gambaran diri..................................................................................................
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Ideal diri:..........................................................................................................
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Peran diri..........................................................................................................
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j. Seksual
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k. Nilai
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l. Aktivitas bermain
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XI. Pemeriksaan Fisik

a. Keadaan umum
Tingkat kesadaran :
TD: …... …mmHg Nadi: …….x/menit RR: ….. x/menit
 Suhu badan: ..… 0C
Nyeri.......
BB: ……. Kg TB: ……. cm
LLA: …… cm LK: …… cm LP: …… cm
Status Gizi : (BB/U, TB/U, BB/TB, diinterpretasikan)
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b. Kepala dan Leher
Inspeksi: ..........................................................................................................
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c. Dada
Jantung
Inspeksi: ..........................................................................................................
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Palpasi: ............................................................................................................
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 Perkusi: ...........................................................................................................
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Auskultasi: ......................................................................................................
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Paru-paru
Inspeksi: ..........................................................................................................
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Palpasi: ............................................................................................................
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Perkusi: ...........................................................................................................
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..........................................................................................................................
Auskultasi: ......................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................

d. Abdomen
Inspeksi: ..........................................................................................................
..........................................................................................................................
..........................................................................................................................
Palpasi: ............................................................................................................
..........................................................................................................................
..........................................................................................................................
Perkusi: ...........................................................................................................
 ..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
Auskultasi: ......................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
e. Genitalia
Inspeksi: ..........................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
f. Ekstremitas
Atas:
Inspeksi: ..........................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
.........................................................................................................................
Palpasi: ............................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
Bawah
Inspeksi: ..........................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
.........................................................................................................................
Palpasi: ............................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
 ..........................................................................................................................
..........................................................................................................................

XII. Aspek mental intelektual

a. Intelektual orang tua

b. Support system keluarga

XIII. Pemeriksaan diagnostik Penunjang

Hasil Pemeriksaan Lab
No Jenis pemeriksaan Lab Hasil Nilai Interpretasi Indikasi
Normal
Hasil Pemeriksaan Diagnostik
Jenis Persiapan pre / post prosedur Hasil
XIV. Program pengobatan
Pemberian
No Nama Obat Dosis Rute Indikasi
Jam
XV. Balance Cairan per 8 jam (Selama shift jaga)
Cairan Masuk
Jenis Jam I Jam Jam Jam Jam Jam Jam Jam Jumlah
II III IV V VI VII VII

Jumlah cairan masuk dalam satu shift jaga

Cairan Keluar
Jenis Jam I Jam Jam Jam Jam Jam Jam Jam Jumlah
II III IV V VI VII VII
 Jumlah cairan keluar dalam satu shift jaga
IWL (berdasarkan usia)
0 – 1 bulan /neonatus = 50 cc/kgBB/hari
1 bulan – 1 tahun = 40 cc/kgBB/hari
1 tahun – 5 tahun = 30 cc/kgBB/hari
 5 tahun = 20 cc/kgBB/hari
Setiap ada peningkatan 1 o C, IWL meningkat sekitar 10%nya
IWL pada kasus : (perhatikan hitungan 8 jam/1 shift jaga)
Balance Cairan dalam 1 shift jaga (8 jam)

XVI. ANALISIS DATA

Nama Klien : RUANG :
No. RM : MAHASISWA :
DATA PROBLEM ETIOLOGI
XVII. Diagnosis Keperawatan (Sesuai Prioritas)
1.

2.

3.

4.
XVIII. RENCANA KEPERAWATAN
Nama Klien : RUANG :
No. RM : MAHASISWA :

Hari/tgl/ jam Diagnosa Keperawatan/

Tujuan (NOC) Intervensi (NIC)
Masalah Kolaborasi
 XIX. CATATAN PERKEMBANGAN
Nama Klien : RUANG :
No. RM : MAHASISWA :

EVALUASI
No.DP HARI/TGL IMPLEMENTASI TTD
PROSES HASIL
 FORMAT RESUME
KEPERAWATAN ANAK
STIKES WIRA HUSADA YOGYAKARTA

Nama mahasiswa :
NIM :
Tempat praktek :
Tanggal :

IDENTITAS PASIEN
Nama/Usia :
No. Rekam Medis :
Jenis kelamin :
Bahasa yang dimengerti:
Agama :
Diagnosa medis :
Program therapi hari ini:

S =

O =
A =

P = (Rumuskan dalam tujuan, kriteria hasil, intervensi)

I = Sertakan jam pelaksanaan tindakan

E = SOAP (lakukan di akhir shift jaga)

Yogyakarta, ………………………..
Mahasiswa,

( Maria Yulianti Mau )

 PANDUAN PEMBUATAN ANALISIS JURNAL
KEPERAWATAN ANAK

Nama mahasiswa : …………………………….

Tempat praktik : …………………………….
Tanggal praktik : …………………………….

STROBE Statement—Checklist of items that should be included in reports of

cross-sectional studies

Judul Jurnal yang dikritisi :

Citation :
Critical Appraisal dengan STROBE :
Item
No Recommendation
Title and abstract 1 (a) Menunjukkan desain penelitian dengan
istilah yang umum digunakan dalam judul
atau abstrak
Menyediakan dalam abstrak ringkasan informatif
dan seimbang tentang apa yang dilakukan dan apa
yang ditemukan
Introduction
Background/rationale 2 Explain the scientific background and rationale for
the investigation being reported
Jelaskan latar belakang dan pemikiran ilmiah untuk
investigasi dari apa yang dilaporkan
Objectives 3 State specific objectives, including any
prespecified hypotheses
Tujuan dijelaskan spesifik, termasuk hipotesis
sudah ditentukan
Methods
Study design 4 Present key elements of study design early in the
paper
Elemen kunci desain penelitian disebutkan di awal
laporan
Setting 5 Describe the setting, locations, and relevant dates,
including periods of recruitment, exposure, follow-
 up, and data collection
Dalam laporan penelitian dijelaskan setting, lokasi,
dan tanggal yang relevan, termasuk periode
pengambilan data, paparan, tindak lanjut, dan
pengumpulan data
Participants 6 Dijelaskan bagaimana metode seleksi serta
pemilihan sampel penelitian
Variables 7 Dijelaskan semua variabel outcome, pengganggu
jika ada, cara mengendalikan varibel pengganggu
Data sources/ 8* Untuk setiap variabel yang dinilai, diberikan
measurement sumber data dan rincian metode penilaian
(pengukuran).
Bias 9 Menjelaskan kemungkinan bias yang ada dan cara
mengantisipasi
Study size 10 Menjelaskan bagaimana ukuran sampel yang ada
Quantitative variables 11 Menjelaskan bagaimana variabel ditangani dan
dianalisis
Statistical methods 12 Menjelaskan metode statistik yang digunakan
Results
Participants 13* Melaporkan jumlah sampel yang direkrut, alasan
perekrutan, proses perekrutan, follow, jika ada
yang tidak di foloow up diberikan alasannya,
disediakan alur diagram
Descriptive data 14* Menjelaskan karakteristik subyek penelitian
Outcome data 15* Menjelaskan outcome atau ringkasan pengukuran
Discussion
Key results 16 Menyimpulkan ringkasan point hasil
penelitianberdasarkan tujuan penelitian
Limitations 17 Mendiskusikan keterbatasan penelitian sumber
potensial bias
Generalisability 18 Mendiskusikan generalisasi (validitas eksternal
hasil penelitian
Other information
Funding 19 Menjelaskna sumber pendanaan, peran
penyandang dana
Hasil analisis individu 20 Jelaskan hasil analisanya
berdasarkan jurnal di atas
Note: An Explanation and Elaboration article discusses each checklist item and gives
methodological background and published examples of transparent reporting. The
STROBE checklist is best used in conjunction with this article (freely available on the
Web sites of PLoS Medicine at http://www.plosmedicine.org/, Annals of Internal
Medicine at http://www.annals.org/, and Epidemiology at http://www.epidem.com/).
Information on the STROBE Initiative is available at www.strobe-statement.org.
Referensi
The STROBE checklist is best used in conjunction with this article. www.strobe-
statement.org
............................................... (jurnal yg didapat)

Ketentuan penulisan:
LP boleh dibuat dengan tulis tangan atau diketik pada kertas ukuran folio dengan huruf
arial 11 atau times new roman 12, spasi 1,5. Tidak diperkenankan copy paste dari
laporan orang lain, jurnal harus berhubungan dengan keperawatan anak/bukan
medis/profesi non perawat, jurnal asli dilampirkan, sumber jurnal ilmiah.

Susunan laporannya dalam analisis jurnal :

BAB I : pendahuluan (latar belakang dan tujuan yang mendasari saudara mengambil
jurnal terkait, bisa dilanjutkan / diformulasikan dalam bentuk PICO)
BAB II : Tinjauan kepustakaan teori maupun jurnal
BAB III : Analisa jurnal (pakai pedoman di atas)
BAB IV : Analisa penulis (Implikasi Keperawatan yang dapat diambil/refleksi)
BAB V : Kesimpulan dan saran
Lampiran jurnal yang dianalisis
 PANDUAN PENGKAJIAN DAN PEMBUATAN
SATUAN ACARA PENYULUHAN (SAP)
TERAPI BERMAIN

1. IDENTITAS ANAK
Nama :
Tempat/tanggal lahir :
Jenis kelamin :
Agama :
Alamat :

2. IDENTITAS ORANG TUA

Nama :
Umur :
Jenis kelamin :
Agama :
Pendidikan :
Pekerjaan :
Alamat :

3. RIWAYAT PERTUMBUHAN DAN PERKEMBANGAN

A. Persoal sosial/kemandirian bergaul

B. Motorik halus

C. Bahasa

D. Motorik kasar
4. PERMAINAN YANG DISUKAI DI RUMAH

5. RIWAYAT PENYAKIT DAHULU DAN SEKARANG

6. RIWAYAT KEHAMILAN, PERSALINAN, DAN NIFAS

A. Kelahiran

B. Persalinan

C. Nifas

7. PERMAINAN YANG DISUKAI DI RUMAH

8. PERENCANAAN TERAPI BERMAIN

Tujuan Klasifikasi Alat/Sarana Aktivitas Waktu

Bermain
9. PELAKSANAAN TERAPI BERMAIN

Aktivitas Bermain Respon Anak

10. KESIMPULAN
11. SARAN KEPADA ORANG TUA

Mahasaiswa

1. ………………………………
(……………..)
2. ………………………………
(……………..)

Mengetahui,

Pembimbing Akademik Pembimbing Klinik

(…………………………………) (…………………………………)
 FORMAT LAPORAN DENVER II/SDIDTK
LAPORAN PENILAIAN
DENVER DEVELOPMENTAL SCREENING TEST II/SDIDTK

Nama Mahasiswa : .......................................................

NIM :........................................................
Tanggal : .......................................................
1. Identitas Anak
Nama :........................................................
Tanggal lahir : .......................................................
Jenis Kelamin : .......................................................
Agama : .......................................................
Alamat : .......................................................
2. Identitas Orang Tua
Nama : .......................................................
Umur : .......................................................
Agama : .......................................................
Pendidikan : .......................................................
Pekerjaan : .......................................................
Alamat : .......................................................
3. Riwayat Pertumbuhan dan Perkembangan
a. Personal Sosial :

b. Motorik Halus :

c. Bahasa :

d. Motorik Kasar :

4. Riwayat kehamilan, persalinan dan Nifas

 a. Kehamilan
Trimester I :

Trimester II :

Trimester III :

b. Persalinan

c. Nifas :

5. Pemeriksaan Antropometri
TB :
BB :
LLA :
LD :
LP :
LK :
Perhitungan hasil pertumbuhan :

6. Perhitungan Umur Anak

7. Pelaksanaan Denver II/SDIDTK

No Aspek Yang Pelaksanaan Denver Hasil Denver

 Dinilai II/SDIDTK II/SDIDTK
1 Personal Sosial

2 Motorik halus

3 Bahasa

4 Motorik Kasar

8. Interpretasi Hasil Denver II/SDIDTK untuk tiap sector

9. Kesimpulan

10. Saran Kepada Orang Tua (lampirkan materi, SAP, dan Media)
 11. Lampiran Form Denver II /SDIDTK

LAPORAN PELAKSANAAN MENEJEMEN TERPADU BALITA SAKIT

DI POLI RS/Puskesmas...

1. IDENTITAS ANAK
Nama :
 Tempat/tanggal lahir :
Jenis kelamin :
Agama :
Pendidikan :
Alamat :

2. IDENTITAS ORANG TUA

Nama :
Umur :
Jenis kelamin :
Agama :
Pendidikan :
Pekerjaan :
Alamat :

3. Keluhan Anak/Bayi

4. Hasil Klasisfikasi

5. Tindakan (sesuai Bagan)

6. Lampirkan (Bagan MTBS sesuai usia anak)

 Mahasiswa

(Maria Yulianti Mau)

Pembimbing Klinik Pembimbing Akademik

(...............................) (Agnes Erida Wijayanti, S.Kep.,Ns., M.Kep)

FORMAT PENGKAJIAN UJIAN (SOAPIER)

(JUDUL ASKEP)

Nama mahasiswa : ..................................................

Tempat praktek : ..................................................
Hari /tanggal : ..................................................
I. IDENTITAS KLIEN
Nama : ..................................................
Tanggal masuk RS: ...............................................
Diagnosa Medis : ..................................................
Riwayat Masuk RS :

Program Therapi hari ini :

II. PERNYATAAN SUBYEKTIF KLIEN

III. PERNYATAAN OBYEKTIF KLIEN

IV. ANALISA DATA

No Data Penyebab Masalah

V. DIAGNOSA KEPERAWATAN SESUAI PRIORITAS
1. ......................................................................................................
2. ......................................................................................................
 3. …………………………………………………………………………………
………
4. …………………………………………………………………………………
………
5. …………………………………………………………………………………
………

VI. PLANNING (Landscape)

No Diagnosa Tujuan dan kriteria hasil Intervensi

 Dx

VII. MPLEMENTASI DAN EVALUASI (LANSCAPE)

No Hari/tgl, Implementasi Evaluasi (SOAP)-lakukan di Ttd dan

Dx jam akhir shift jaga saat ujian nama
 perawat

Mahasiswa

(..................................)
Pembimbing Klinik Pembimbing Akademik

(...............................) (Agnes Erida Wijayanti, S.Kep.,Ns., M.Kep)

REKAPITULASI KEGIATAN BIMBINGAN DENGAN PEMBIMBING

AKADEMIK
PRAKTEK STASE KEPERAWATAN ANAK
PN 11 PRODI ILMU KEPERAWATAN DAN NERS
STIKES WIRA HUSADA YOGYAKARTA
NAMA MAHASISWA : ..........................................................
NIM : ..........................................................
TEMPAT : ..........................................................
Nama Pembimbing : .........................................................
Ruang tempat praktek : .........................................................

No Hari / Jenis/Uraian Bimbingan Saran Ttd Ttd

TGL Mhs Pembimbing

Format MTBS
Format MTBS
Format MTBS