DINAS KESEHATAN KOTA TASIKMALAYA

PUSKESMAS PARAKANNYASAG
KOTA TASIKMALAYA

ASUHAN KEPERAWATAN GIGI DAN MULUT

(ORAL DIAGNOSTIK)

NAMA PETUGAS :........................................................................................

NIP :........................................................................................

HARI/TANGGAL :........................................................................................
 DINAS KESEHATAN KOTA TASIKMALAYA
PUSKESMAS PARAKANNYASAG
KOTA TASIKMALAYA

ASUHAN KEPERAWATAN GIGI DAN MULUT

(ORAL DIAGNOSTIK)

PENGKAJIAN
1. Identitas Pasien
a. Nama Pasien :
b. Tempat/Tanggal Lahir :
c. Agama :
d. Suku Bangsa :
e. Pendidikan Terakhir :
f. Pekerjaan/Sekolah :
g. Golongan Darah :
h. Alamat :
i. Usia saat kunjungan :

Status
2. Kesehatan
a. Pemeriksaan Subyektif
1) Anamnesa
Keluhan Utama :.......................................................................................................................
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Keluhan Tambahan
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2) Riwayat Kesehatan Gigi Sekarang
» Apakah pernah sakit/linu pada gigi ? .....................................................................................
» Gigi mana yang skait/linu ? ...................................................................................................
» Kapan rasa sakit/linu ini mengganggu ?..................................................................................
..........................................................................................................................................
» Apa yang menimbulkan rasa sakit/linunya ?..........................................................................
» Berapa lama rasa sakit/linu bertahan?....................................................................................
» Kapan pertama kali timbul rasa sakit/linu ini ?.......................................................................
» Pada daerah mana dimulainya rasa sakit ini?..........................................................................
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» Apakah rasa saki/linu tersebut dirasakan pada tempat yang sama sebelumnya ?
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» Apakah ada yang menyebabkan rasa sakit/linu itu berkurang?...............................................
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» Apakah rasa sakit itu mengganggu waktu tidur ?.....................................................................
 3) Riwayat Kesehatan Lain
» Penyakit yang pernah dialami
Kanak-kanak :.........................................................................
Kecelakaan :.........................................................................
Pernah dirawat :.....................................................................
(Jenis penyakit dan waktunya)
Operasi :...........................................................................
» Alergi :..............................................................................
» Imunisasi :..............................................................................
» Kebiasaan buruk :...................................................................
Frekuensi menyikat gigi :........................................................
» Obat-obatan yang diminum
Nama dan lamanya :.............................................................
Sendiri/ resep dokter :...........................................................

» Data pemeriksaan fisik

Tekanan darah
Sistole :............ mm
Diastole :............ Hg
Tinggi badan :............ cm
Berat badan :............ kg
IMT :............
Hasil IMT :............
Nadi :............ /menit
Nafas :............ /menit
Suhu :............ ⁰C

b. Pemeriksaan Obyektif
Pemeriksaan dasar gigi
Bengkak Atas :...............
Konsistensi : ..................
Warna Kulit : ..................
Suhu Kulit : .....................
Goyang : ..................... Perkusi : ......................
Warna Gusi : ............... Druk :...........................
Karies Gigi : ................. Palpasi : .....................
Pembengkakan : ........... Status Karies Gigi : .......

Intra Oral
Gigi Indeks

Plak Score Kalkulus Score

OHI-S :....................... ARTINYA.........................

d=
e=
f=
def-t =

D=
M=
F=
DMF-T =
 Masalah Keperawatan Diagnosa
Gigi Inspeksi Termis Sondasi Perkusi Mobility
Gigi Keperawatan Gigi

c. Faktor-faktor yang harus diperhatikan

1) Kedaan gigi/anomali gigi
» Posisi gigi .................................................................................................................
» Jumlah gigi .................................................................................................................
» Bentuk Gigi .................................................................................................................
» Enamel .................................................................................................................

2) Keadaan Mukosa Gigi

» Lidah .................................................................................................................
» Palatum .................................................................................................................
» Pipi .................................................................................................................
» Bibir .................................................................................................................
» Gingiva .................................................................................................................
(warna, bentuk papil, konsistensi, ada inflamasi/tidak)

RENCANA PERAWATAN GIGI

1. Bagian Peningkatan (promotif)
2. Bagian Pencegahan (Preventif)
3. Bagian Pencabutan (Exodontia)
4. Bagian Penambalan (Conservasi)
5. Lain-lain
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KONSUL KE
1. Bagian Pencabutan
2. Bagian Pengawetan
3. Bagian Meratakan Gigi
4. Bagian Gigi Tiruan
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5. Lain-lain :....................................................................................................
ANALISA DATA

MASALAH KEPERAWATAN
DATA KEMUNGKINAN PENYEBAB
GIGI
PERENCANAAN, PELAKSANAAN DAN EVALUASI

DATA/DIAGNOSA PERENCANAAN
KEPERAWATAN PELAKSANAAN EVALUASI
GIGI TUJUAN TINDAKAN RASIONAL