PENGKAJIAN PADA ANTE NATAL

Nama Mahasiswa :

Tempat Praktik :

Sumber Data :

Metode Pengkajian :

Tanggal Pengkajian :

1. Pengkajian

Nama Ibu :

Usia :

Pendidikan :

Alamat :

Jam/ tgl masuk :

Nama Suami :

Umur :

Agama :

Pendidikan :

Pekerjaan :

2. Pengkajian Awal

a. Masalah Kehamilan :

b. HPHT :

c. Taksiran Kelahiran :

d. Pemeriksaan Kehamilan :

e. Dari pemeriksaan

ANC diketahui :

- BB janin :

- Usia Kehamilan :

- Jenis Kelamin Janin :

f. Pemeriksaan Fisik Ibu

Berat Badan : TD :

RR : Tinggi Badan :

HR : S :

3. Pengkajian Chepalo Caudal (Head to toe)

a. Kulit, rambut dan kuku

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b. Kepala dan Leher

Mata : ............................................................................................................................

Leher : ............................................................................................................................

Telinga : ............................................................................................................................

c. Mulut, tenggorokan dan hidung

I. mulut : ............................................................................................................................

I. tenggorokan : ............................................................................................................................

I. hidung : ............................................................................................................................

d. Dada

- Jantung

Inspeksi : ............................................................................................................................

Palpasi : ............................................................................................................................

Perkusi : ............................................................................................................................

Auskultasi : ............................................................................................................................

- Paru-paru

Inspeksi : ............................................................................................................................

Palpasi : ............................................................................................................................

Perkusi : ............................................................................................................................

Auskultasi : ............................................................................................................................

e. Payudara

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f. Abdomen

Inspeksi : ............................................................................................................................

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Palpasi : ............................................................................................................................

Leopod I :.............................................................................................................................

Leopod II :.............................................................................................................................

Leopod III :.............................................................................................................................

Leopod IV :.............................................................................................................................

g. Genitalia

Edema :.............................................................................................................................

Varises :.............................................................................................................................

Keputihan :.............................................................................................................................

Kebersihan :.............................................................................................................................

Skresi :.............................................................................................................................

h. Anus/rectum

Inspeksi :.............................................................................................................................

i. Ekstremitas

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4. Pola Kebiasaan

a. Aspektif-biologis

1) Nutrisi

Pola makan, frekuensi, dan jumlah

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Perubahan pola makan selama hamil

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Alergi makanan

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Minum, jumlah dan jenis

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Keluhan yang berhubungan dengan nutrisi

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Eliminasi

a) BAK

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b) BAB

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2) Istirahat dan tidur

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3) Seksualitas

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4) Kebersihan diri

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5) Riwayat KB

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6) Riwayat kehamilan Ibu yang lalu

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b. Riwayat psikologis selama hamil

1. Apakah kehamilan ini diharapkan

Ya...........................................................................................................................................................

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2. Apakah selama kahamilan ibu mengalami masalah/ stres yang mengganggu?

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3. Apakah suami memberikan support saat hamil?

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4. Apakah keluarga memberikan support saat hamil?

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5. Riwayat ANC

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6. Riwayat pemberian ASI

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B. Pemeriksaan penunjang

1) Pemeriksaan Laboratorium:

Jenis Nilai Normal Satuan Hasil