PENGKAJIAN BAYI BARU LAHIR

A. IDENTITAS
Inisial Nama Ibu Bayi :.....................................................................................................
Tanggal / jam pengkajian:.....................................................................................................
Nama Ayah :.....................................................................................................
Pekerjaan :.....................................................................................................
Alamat :.....................................................................................................
B. KEADAAN BAYI BARU LAHIR
Lahir tanggal : ….…............Jam : ….…....................................................
Sex : .................................................................................................
Kelahiran : ....................................................................................................
Berat badan Lahir : ....................................................................................................
Panjang : ….….cm
Heat Rate : ........ x/menit
Pernapasan : .......... x/menit
Suhu : : ........... 0c
C. NILAI APGAR
N
TANDA 0 1 2 JUMLAH
O

1. Frekwensi Tidakada < 100 > 100

jantung
Tidakada Lambat Menangis kuat
2. Usaha nafas

3. Tonus otot Lumpuh Ektrimitas fleksi sedikit Gerakan aktif

4. Refleks Tidak beraksi Gerakan sedikit Reaksi malawan

5. Warna kulit Biru pucat Tubuh kemerahan, Kemerahan

tangan dan kaki biru.

Ket : penilaian menit ke 1 = ....... penilaian menit ke 5 = ........

Tindakan resusitasi :..........................................................................................................
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Keadaan Tali pusat:...........................................................................................................
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 D. PENGKAJIAN FISIK
Umur :.......................
Berat badan : ................gr
Panjang : ............... cm
Antropometri :
BBL: ................. gr
LK : .......... cm
LP : ......... cm
LD : .......... cm
PL : ........... cm
PK : ........... cm
LLA: .......... cm
PB : ......... cm
KEPALA
1) Bentuk : ..............................................................................................................
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2) Ubun – ubun :...............................................................................................................
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3) Mata :...............................................................................................................
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4) Telinga :...............................................................................................................
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5) Mulut :...............................................................................................................
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6) Hidung :...............................................................................................................
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7) Leher :...............................................................................................................
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TUBUH
1) Warna : ………………………………………………………….....................
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2) Pergerakan : …………………………………………………………………….....
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3) Dada: ................................................................................................................................
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4) Vernikkaseosa : ……………………………………………………………………....
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5) Suhu Tubuh Bayi :……………………………………………………………………….
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JANTUNG DAN PARU
1) Bunyi nafas :…………………………………………………………………………
2) Pernafasan : ……………….. X/ menit
3) Hate rate : ……………….. X/ menit
PERUT DAN ABDOMEN
1) Gerakan diagpragmatik:.........................................................................................................
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PUNGGUNG
1) Keadaan punggung : ...............................................................................................................
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2) Lanugo :..................................................................................................................................
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GENITALIA
1) Anus : ....................................................................................................................................
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2) Keadaan :................................................................................................................................
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EKTRIMITAS
1) Jumlah jari tangan :......................................................................................................
1) Jumlah Jari kaki : ..………………………………………………………………..
2) Pergerakan : …………………
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3) Garis telapak kaki : …………………………………………………………………
4) Posisi kaki dan tangan : …………………………………………………………………
STATUS NEUROLOGIS
Refleks – reflleks :
1) Tendon :.....................................................................................................
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2) Moro : …………………………………………………………………
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3) Rooting : …………………………………………………………………
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4) Sucking : …………………………………………………………………
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5) Babinsky : …………………………………………………………………
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6) Palmar graps : …………………………………………………………………
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7) Menangis : ………………………………………………………………...
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8) Asymmetric tonic neck :....................................................................................................

NUTRISI
1) Jenis makanan :.....................................................................................................
2) Diberikan dengan :.....................................................................................................
Jumlah yang diberikan :.....................................................................................................
Rangkuman Masalah :………………………………………………………………….
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Diagnosa Keperawatan
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 RENCANA TINDAKAN KEPERAWATAN

Inisialpasien : ………………… Ruangan : …………………

No. RM : …………………
NO. DIAGNOSA KEPERAWATAN LUARAN KEPERAWATAN INTERVENSI KEPERAWATAN
 IMPLEMENTASI DAN EVALUASI KEPERAWATAN

Inisialpasien : ………………… Ruangan : …………………

No. RM : …………………
No DIAGNOSA TGL/JAM IMPLEMENTASI EVALUASI
KEPERAWATAN