ASUHAN KEBIDANAN BAYI BARU LAHIR

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NO. REGISTER : …………………………………………….

TANGGAL MASUK/JAM : …………………………………………….
DIRAWAT DIRUANG : …………………………………………….

I. PENGKAJIAN DATA SUBJEKTIF

Tanggal : Jam :
1. Identitas Orang Tua Ibu Ayah
Nama : ………………………. ……………………….
Umur : ………………………. ……………………….
Agama : ………………………. ……………………….
Suku/Bangsa : ………………………. ……………………….
Pendidikan : ………………………. ……………………….
Pekerjaan : ………………………. ……………………….
Alamat : ………………………. ……………………….
No.Telepon/HP : ………………………. ……………………….

2. Riwayat antenatal
G.....P......A .......Ah.........Umur kehamilan..........minggu.
Riwayat ANC : teratur/ tidak,......kali,di.......oleh...................................
Imunisasi TT : .............kali
TT 1 : tanggal........... TT 2 : tanggal ...................................
TT 3 : tanggal............. TT 4 : tanggal....................................
TT 5 : tanggal...........
Kenaikan BB : ............kg
Keluhan saat hamil :........................................................................................
Penyakit selama hamil : jantung, diabetes melitus, gagal ginjal, hepatitis B,
tuberkulosis, HIV positif, Trauma /penganiayaan.
Kebiasaan makan :...................................................................................
Obat /jamu :....................................................................................
Merokok :....................................................................................
Komplikasi ibu : Hiperemesis, Abortus, Perdarahan, Pre Eklamsia,
Eklamsia, Diabetes Gestasional ,Infeksi.
Janin : IUGR, Polihidramnion/oligohidramnion, Gemelli.
3. Riwayat intranatal
Lahir tanggal : .............................jam.................................................
Jenis persalinan : spontan / tindakan....................................................
Atas indikasi............................................................
 Penolong :...................... di........................................................
Lama persalinan : Kala I .................jam........................................menit
Kala II ................jam.......................................menit
Kala III ...............menit
Kala IV .............. jam
Komplikasi :
a. ibu : Hipertensi/ hipotensi, partus lama, penggunaan obat,infeksi/suhu
badan naik, KPD, Perdarahan.
b. janin : Prematur/posmatur, malposisi, malpresentasi, gawat janin, ketuban
campur mekonium, prolaps tali pusat .
4. Keadaan bayi baru lahir
Jenis kelamin : .................
BB/PB lahir :......................................................................................
Nilai APGAR : 1 menit/ 5 menit/ 10 menit : ............./ .............../...................
No Kriteria 1 menit 5 menit 10 menit
1 Denyut jantung
2 Usaha nafas
3 Tonus otot
4 Reflek
5 Warna kulit
Total

Caput succedanium :...........................................................................................

Cephal hematom :............................................................................................
Cacat bawaan : ..........................................................................................
Resusitasi : Rangsangan : ya/tidak
Penghisapan lendir : ya /tidak
Ambu bag : ya / tidak.............liter / menit
Massase jantung : ya / tidak..............liter /menit
Intubasi Endotrachea: ya /tidak
O2 : ya/ tidak..........liter/ menit

II. PENGKAJIAN DATA OBJEKTIF

1. Pemeriksaan umum
Keadaan umum : .......................... Kesadaran : ...............................
TTV : Nadi : ....x/menit
Suhu : .....0C
Respirasi : .....x/menit
Antropometri :
BB/PB : .................
LK/LD : .................
 2. Pemeriksaan Fisik
a. Kepala : .......................... ..............................................
b. Muka : ..........................................................................
c. Mata : .........................................................................
d. Telinga : .......................... ..............................................
e. Hidung : .........................................................................
f. Mulut : .........................................................................
g. Leher : ........................................................................
h. Klavikula : .......................................................................
i. Lengan tangan : .......................................................................
j. Dada : ........... ...........................................................
k. Abdomen : ......................................................................
l. Genetalia : ........................................................................
m. Tungkai dan kaki :.............................................................................
n. Punggung :..........................................................................
3. Refleks :
Morro :..........................................................................
Rooting :...........................................................................
Walking :...........................................................................
Grasping :...........................................................................
Sucking :............................................................................
Tonicneck :.............................................................................
4. Eliminasi
Miksi :..............................................................................
Mekonium :..............................................................................
5. Pemeriksaan penunjang (bila dilakukan)

III. ANALISA
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IV. PENATALAKSANAAN
Tanggal : Jam :
1. …………………………………………………………………………
Hasil …………………………………………………………………..
2. …………………………………………………………………………
Hasil ……………………………………………………………………
Dst… Sorong,

Pembimbing Klinik Praktikan

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Pembimbing Institusi

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