PEMERINTAH KABUPATEN ENDE

DINAS KESEHATAN
PUSKESMAS REWARANGGA
Jln. Sultan Hasanudin KM 6

ASUHAN KEBIDANAN PADA BAYI

A. PENGKAJIAN
Tanggal Pengkajian : .............................................................................................................................
Oleh Bidan : .............................................................................................................................

B. DATA SUBYEKTIF

1. Biodata
  
a. Anak
Nama bayi : ..........................................
Jenis kelamin :...........................................
Tanggal lahir :...........................................
Jam :...........................................
b. Orang Tua
Nama ibu :........................................... Nama ayah :.........................................................
Umur :........................................... Umur :.........................................................
Agama :........................................... Agama :.........................................................

Suku/bangsa :........................................... Suku/bangsa :.........................................................

Pendidikan : .......................................... Pendidikan : ........................................................
Pekerjaan :........................................... Pekerjaan :.........................................................
Alamat Rumah:.......................................... Alamat
Rumah:..........................................
Alamat Rumah:..........................................

2. Riwayat antenatal:

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3. Riwayat Natal
 Umur kehamilan : ...................................................................................................
 Cara persalinan : ...................................................................................................
 Keadaan saat lahir : ...................................................................................................
 Tempat dan penolong persalinan....................................................................................:

 Apgar score : ...................................................................................................

 Berat badan : ...................................................................................................
 Panjang badan : ...................................................................................................
 Lingkar kepala : ...................................................................................................
 Lingkar dada : ...................................................................................................
 Lingkar perut : ...................................................................................................

C.     DATA OBYEKTIF

1. PemeriksaanUmum
KeadaanUmum : ...........................................................................
Kesadaran : ...........................................................................
Ekspresi wajah : ...........................................................................
Tanda vital Sign : ...........................................................................
TekananDarah : .............................. Nadi : ........................................
Pernafasan : .............................. Suhu : ........................................
BB : ...........................................................................
PB : ...........................................................................

2. PemeriksaanFisik
 Kepala : ..................................................................
 Rambut : ..................................................................
 Wajah : ..................................................................
 Mata : ..................................................................
 Telinga : ..................................................................
 Hidung : ..................................................................
 Mulut dan gigi : ..................................................................
 Leher : ..................................................................
 Dada : ..................................................................
  Perut : ..................................................................
 Ekstremitas atas dan bawah : ..................................................................
 Anus : ..................................................................

Refleks:
a. Morro :............................................................
b. Rooting :............................................................
c. Sucking :............................................................
d. Babynsky :............................................................
e. Swallowing :............................................................

3. Pola Eliminasi:
BAB
a. Frekuensi : ..................................................................
b. Warna : ..................................................................
c. Bau : ..................................................................
BAK
a. Frekuensi : ..................................................................
b. Warna : ..................................................................
c. Bau : ..................................................................