FORMAT PENGKAJIAN ASUHAN KEPERAWATAN PRE NATAL KEPERAWATAN MATERNITAS

FORMAT PENGKAJIAN ASUHAN KEPERAWATAN PRE NATAL

KEPERAWATAN MATERNITAS

Nama Mahasiswa :

NIM :

Tempat Praktek :

Tanggal :

Pengkajian :

Praktik :

I. IDENTITAS PASIEN

Nama : ......................................................................................

Umur : ......................................................................................

Status Perkawinan : ......................................................................................

Agama : ......................................................................................

Suku : ......................................................................................

Pendidikan : ......................................................................................

Nama Suami : ......................................................................................

Umur Suami : ......................................................................................

Alamat : ......................................................................................

Pekerjaan : ......................................................................................

Diagnosa Medis : ......................................................................................

Tanggal Masuk RS : ......................................................................................

II. KELUHAN UTAMA

....................................................................................................................................

III. RIWAYAT PENYAKIT DAHULU

....................................................................................................................................

IV. RIWAYAT PENYAKIT KELUARGA

....................................................................................................................................

V. RIWAYAT GINEKOLOGI

....................................................................................................................................

VI. RIWAYAT OBSTETRI

§ Menarche usia : ......................................................................................

§ Siklus Menstruasi : teratur/ tidak,............hari.

§ Karakteristik mens : ......................................................................................

§ G.....P.....A.....

§ HPMT : ......................................................................................

§ HPL : ......................................................................................

§ Keluhan selama kehamilan ini

Trimester I : ..................................................................................................

Trimester II : ..................................................................................................

Trimester III : ..................................................................................................

VII. KEBIASAAN YANG MERUGIKAN

Merokok [ ] Obat-obat terlarang [ ]

Alkohol [ ] Obat-obat yang dijual bebas [ ]

VIII. KELUARGA BERENCANA

....................................................................................................................................

IX. KEBUTUHAN DASAR MANUSIA

§ NUTRISI

................................................................................................................................. ELIMINASI

.................................................................................................................................

§ ISTIRAHAT DAN TIDUR

.................................................................................................................................

§ SEKSUALITAS

.................................................................................................................................

§ PERSEPSI DAN KOGNITIF

................................................................................................................................. KONSEP DIRI

X. PEMERIKSAAN FISIK

Keadaan Umum

§ Kesadaran : ..................................................................................................

§ BB : .......kg (kenaikan BB selama hamil : ......kg), TB :........m

§ Tanda Vital : P :.........x/menit T : .........°C

R : ........x/menit BP : .........mmHg

§ Kulit

Linea nigrae [ ] Cloasma [ ]

Striae gravidarum [ ] Pucat [ ]

Angioma [ ] Eritema [ ]

§ Kuku dan kaki

Oedema [ ]

Lainnya : ..................................................................................................

§ Kepala

Sklera : ..................................................................................................

Konjungtiva : ..................................................................................................

Palpebra : ..................................................................................................

Pembesaran limphe nodi : ...........................................................................

Pembesaran kelenjar tiroid : ...........................................................................

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

THT : ..................................................................................................

§ Thoraks

Jantung : ..................................................................................................

Paru : ..................................................................................................

Payudara : ..................................................................................................

§ Abdomen

.................................................................................................................................

§ Perineum

.................................................................................................................................

§ Muskuloskeletal

.................................................................................................................................

§ Syaraf

.................................................................................................................................

XI. INFORMASI LAIN

....................................................................................................................................

XII. ANALISA DATA

DATA	PROBLEM	ETIOLOGY