ASUHAN KEBIDANAN PADA BALITA SAKIT

An. ………. Usia……………………………..

di……………………………………………………………………

No. Register :..................................... Waktu Pengkajian :..........................

Tanggal Pengkajian :.................................. Tempat Pengkajian :..........................

A. DATA SUBJEKTIF
1. Identitas Pasien
Nama Anak : ....................................
Jenis Kelamin :...................................
Tanggal Lahir : ..................................
Nama Ibu : Ny. “…” Nama Ayah : Tn. “…”
Pekerjaan : …. Th Pekerjaan : …. th
Agama : .................................... Agama : ...............................
Pendidikan : .................................... Pendidikan : ...............................
Suku / bangsa: ................................... Suku/Bangsa : ...............................
Alamat : .................................... Alamat : ...............................
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2. Keluhan Utama (Anak)
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3. Riwayat Penyakit sekarang
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4. Riwayat Penyakit Keluarga
Menurun : ......................................................................................................................
Menular : .......................................................................................................................
Menahun : .....................................................................................................................
5. Pola Kebutuhan Sehari-hari
a. Nutrisi saat ini
Makan Teratur / Tidak teratur … kali/hari ………………………………………
Konsumsi air putih ± …… gelas/hari
Tidak ada/ ada masalah

b. Eliminasi
BAB … kali/hari, Teratur / Tidak teratur
BAK … kali/hari, Lancar / Tidak lancar
Tidak ada/ ada masalah …………………………………………………………
 c. Istirahat
Tidur siang / Tidak tidur siang± … jam
Tidur malam ± ….. jam
Tidak ada/ ada masalah…………………………………………………………

d. Aktivitas
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e. Personal Hygiene
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6. Riwayat Obstetri Ibu

Anak ke- Jenis persalinan Petugas Tempat persalianan

B. DATA OBJEKTIF
1. Pemeriksaan Umum
Keadaan umum : Baik/ Cukup Baik/ Buruk
Kesadaran : Compomentis/ Apatis / Delirium / Somnolen / Soporou / Koma
TTV : Tekanan Darah : ........... mmHg Suhu : .......... oC
Nadi : ........... x/menit Pernapasan : .......... x/menit
BB : ........ Kg
TB : ........ cm

2. Pemeriksaan Fisik
a. Kepala
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b. Muka
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c. Mata
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d. Hidung
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e. Telinga
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f. Mulut
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g. Leher
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h. Dada
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i. Axila
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j. Payudara
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k. Abdomen
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l. Genetalia
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m. Ekstremitas
1) Atas : ....................................................................................................
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2) Bawah : ....................................................................................................
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3. Pemeriksaan Penunjang :
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C. ANALISA DATA

Tanggal : ............................................. Jam : ............................

1. Diagnosa Kebidanan
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2. Masalah
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3. Kebutuhan
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D. PENATALAKSANAAN
Tanggal : ............................................. Jam : ......................
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