FAKULTAS KEPERAWATAN DAN KEBIDANAN

PROGAM STUDI KEBIDANAN UNIVERSITAS BINAWAN

Jalan Kalibata Raya No. 25 – 30 Jakarta Timur 13630

Nama Mahasiswi : ...........................................................

NIM : ...........................................................
Lahan Praktik : ...........................................................
Tanggal Pengkajian : ...........................................................

FORMAT

ASUHAN KEBIDANAN PADA BAYI BARU LAHIR

PENGKAJIAN
DATA SUBJEKTIF
IDENTITAS
Nama Bayi : ……………………………………………
Tgl/jam/lahir : ……………………………………………
Jenis Kelamin : ……………………………………………

Nama ibu : Nama Ayah :

Umur : Umur :
Suku/Bangsa : Suku/Bangsa :
Agama : Agama :
Pendidikan : Pendidikan :
Pekerjaan : Pekerjaan :
Alamat : Alamat :

Alamat Kantor : Alamat Kantor :

Anamnesa Pada Tanggal : …………………………… Pukul:

……………………………………..
Pada Ibu
Riwayat Kehamilan Sekarang
Pemeriksaan Ante Natal
Keluhan
 Tri mester I :
………………………………………………………………………………………..

- Riwayat penyakit dalam kehamilan

- Kardiovaskuler :
- Diabeter Melitus :
- TBC :
- Asma :
- Malaria :
- PMS :
- HIV/AIDS :
- Lain-lain :
Riwayat komplikasi kehamilan
a) Pendarahan :
………………………………………………………………………
b) Preeklampsia :
………………………………………………………………………
c) Eklampsia :
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d) Lain-lain :
………………………………………………………………………

Riwayat Persalinan Sekarang

(1) Jenis Persalinan :
………………………………………………………………………
(2) Ditolong Oleh : ………………………………
(3) Lama Persalinan : ………………………………
a.) Kala I :……………Jam……………..Menit
b.) Kala II : ……………Jam……………..Menit
c.) Kala III : ……………Jam……………..Menit
(4) Keadaan bayi saat lahir :
……………………………………………………………………….
(5) Jumlah Air Ketuban :
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(6) Komplikasi Persalinan :
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A. DATA OBJEKTIF
1. Pemeriksaan Umum
a.) Suhu :
……………………………………………………………………………………….
……..
b.) Pernapasan : ………..
…………………………………………………………………………..
c.) Nadi:
……………………………………………………………………………………………
.…..
d.) Keaktifan :……………………………………………………………………………..
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e.) Tangisan: ……………………………………………………………………………..
…………..
2. Pemeriksaan Fisik Secara Sistematis
a) Kepala
……………………………………………………………………………………………
b) Muka
……………………………………………………………………………………………
c) Mata
……………………………………………………………………………………………
d) Hidung
……………………………………………………………………………………………
e) Mulut
……………………………………………………………………………………………
f) Telingga
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g) Leher
……………………………………………………………………………………………
h) Dada
…………………………………………………………………………………………
i) Perut :
……………………………………………………………………………………………
j) Tali pusat
……………………………………………………………………………………………

k) Punggung
……………………………………………………………………………………………
l) Ektremitas
……………………………………………………………………………………………
m) Genetalia
……………………………………………………………………………………………
n) Anus :
……………………………………………………………………………………………
 Reflek
a) Reflekmorro
……………………………………………………………………………………………
Reflek rooting :
……………………………………………………………………………………………
Reflek tonick neck:
……………………………………………………………………………………………
Reflek Graf/Plantar :
……………………………………………………………………………………………
Reflek suching :
……………………………………………………………………………………………
Reflek Babinsky :
……………………………………………………………………………………………

Antropometri
a) Lingkar Kepala :
……………………………………………………………………………………………
b) Lingkar Dada :
……………………………………………………………………………………………
c) Lingkar Lengan Atas :
……………………………………………………………………………………………
d) Berat Badan :
……………………………………………………………………………………………
e) Tinggi Badan :
……………………………………………………………………………………………

Eliminasi
a) Miksi :
……………………………………………………………………………………………
b) Mekonium :
……………………………………………………………………………………………
ANALISA
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 PERENCANAAN
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V. EVALUASI
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 Pembimbing Lahan Mahasiswa

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Pembimbing Pendidikan

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