PERSALINAN
PROGRAM STUDI PROFESI BIDAN FAKULTAS KEBIDANAN DAN
KEPERAWATAN UNIVERSITAS KADER BANGSA PALEMBANG
Jalan Mayjend H.M. Ryacudu N0.88Telp.(0711)517744-510173
Fax(0711)519827 Email: Info@ukb.ac.id
Website: www.ukb.ac.id
I. PENGKAJIAN DATA
1. Identitas
a. Identitas Pasien
a. Nama : …………………… a. Nama : ……………………
b. Umur : ……………………. b. Umur : ………………
c. Agama : ……………………. c. Agama : ……………….
d. Suku/bangsa : ……………………. d. Suku/bangsa : ……………….
e. Pendidikan : ……………….. e. Pendidikan : ……………
f. Pekerjaan : …………………… f. Pekerjaan : ………………
g. Alamat : ……………… g. Alamat : ………………
h. No telp/HP : ………………… h. No telp/HP : …………………
b. Riwayat Menstruasi :
- Menarche : Umur : …..tahun, teratur / tidak teratur
- Siklus Haid : …….hari, Lamanya :…..hari
- Banyaknya : ........x Ganti Pembalut
c. HPHT : ………………………………………..
d. TP : ………………………………………..
e. Riwayat Kehamilan, Persalinan dan Nifas yang lalu :
LIV :
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Taksiran Berat Janin (TBJ) : (…………..)x155
= ……. gram.
c) Auskultasi : (+)……x/i, Intensitas : ……., Irama : …
: Puntum maximum : ……………………
d) Ano-genital : ……………………………………………
e) Vagina : …………………………………………….
f) Perkusi : Reflek patella Ka/Ki (…/…..)
g) Pemeriksaan Panggul Luar :
Distansia Spinarum : …….. cm
Distansia Cristarum : …….. cm
Konjugata Eksterna : …….. cm
Lingkar Panggul : …….. cm
h) Pemeriksaan Panggul Dalam : Pukul : .............................................
1) Dilakukan Oleh ......................................................................
2) Pukul ......................................................................................
3) Indikasi...................................................................................
4) Hasil :
a. Portio ..........................................................................
b. Pembukaan .................................................................
c. Ketuban .....................................................................
d. Presentasi ..................................................................
e. Penurunan .................................................................
f. Pendataran ..................................................................
g. Molase .......................................................................
V. EVALUASI
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ASUHAN KALA II
Tanggal :
Pukul :
I. PENGKAJIAN
a. Data Subjektif ....................................................................................
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b. Data Objektif......................................................................................
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II. PERUMUSAN DIAGNOSA, DIAGNOSA POTENSIAL, MASALAH
DAN KEBUTUHAN
Diagnosa ...................................................................................................
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Diagnosa Potensial ....................................................................................
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Masalah .....................................................................................................
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Kebutuhan .................................................................................................
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III. PERENCANAAN
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IV. IMPLEMENTASI
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V. EVALUASI
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Tanggal :
Pukul :
I. PENGKAJIAN
a. Data Subjektif
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b. Data Objektif .......................................................................................
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III. PERENCANAAN
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IV. IMPLEMENTASI
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V. EVALUASI
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ASUHAN KALA IV
Tanggal :
Pukul :
I. PENGKAJIAN
1. Data Subjektif ....................................................................................
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2. Data Objektif......................................................................................
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III. PERENCANAAN
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IV. IMPLEMENTASI
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V. EVALUASI
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MONITORING ASUHAN KEBIDANAN PERSALINAN
PADA………………………….USIA KEHAMILAN …… MINGGU DI PMB
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O:
A:
P: