PEMERINTAH KABUPATEN ENDE

DINAS KESEHATAN
PUSKESMAS ROGA
Jln. Demulaka - Roga email: pkmroga17@gmail.com

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. Pemeriksaan Umum
Keadaan Umum : ...........................................................................
Kesadaran : ...........................................................................
Ekspresi wajah : ...........................................................................
Tanda vital Sign : ...........................................................................
Tekanan Darah : .............................. Nadi : ........................................
Pernafasan : .............................. Suhu : ........................................
BB : ...........................................................................
PB : ...........................................................................

2. Pemeriksaan Fisik
 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. Babinski :............................................................
e. Swallowing :............................................................

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