YAYASAN HAJI SOEHEILY QARI

SEKOLAH TINGGI ILMU KESEHATAN (STIKES)

MERANGIN
PRODI D III KEBIDANAN
Jln.BangkoKerinci Km.6 Kungkai, Kecamatan Bangko Kabupaten Merangin
email.stikes.merangin@yahoo.com
MANAJEMEN ASUHAN KEBIDANAN PADA IBU AKSEPTOR PADA IBU KB IUD

Tempat praktek

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Nama Mahasiswa

:............................

Nomor MR

:.............................

No.Absen

:.............................

Keterampilan ke

:.............................

Masuk RS.H/Tgl/Jam :.............................

1. Pengkajian data
1. Identitas
Nama
Umur
Agama
Suku/Bangsa
Pendidikan
Pekerjaan

ISTRI
:.................................................
:..................................................
:..................................................
:..................................................
:..................................................
:..................................................

SUAMI
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...................................................
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...................................................
...................................................
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Alamat
:...................................................... .......................................................
2. Anamnesia (Data Subjektif)
a. Keluhan Utama
:...........................................................................................
b.Riwayat Perkawinan
Kawin....kali,Kawin Pertama Kali Umur.....Tahun, Dengan suami sekarang
sudah .........tahun.
c. Riwayat Haid
Menarche Umur

....tahun,

Cyclus.....

kali

:,

Teratur/Tidak,

Sakit/Tidak,

Lamanya ...... hari, Sifat Darah : Encer/Beku, Bau..........Flour Albus...............

d.Riwayat Obstetri :
N
O

Usia
Kehamilan

Proses
Persalinan
/Penolong

BBL

JK

BAYI
Hidup/
Mati

Nifas
pendarahan

Ket

e. Riwayat KB
n
o

Alat/ cara
Tgl

Mulai pakai
Bln Th Oleh

Di

Berhenti/Ganti Cara
Tgl Bln Th Oleh Di

Alasan

f. Riwayat Kesehatan
Penyakit yang pernah diderita
Penyakit yang diderita sekarang
Pengobatan yang diberikan

:.....................................................
:......................................................
:...................................................

g. Pola pemenuhan Kebutuhan Sehari-hari

1) Nutrisi
-Pola makan perhari
-Jenis makanan yang dikonsumsi

:......................................................
:.....................................................
:......................................................

2) Eliminasi
a. BAK
Frekuensi
Warna
Keluhan
b. BAB
Frekuensi
Sifat
Warna
Keluhan

:............................................................................
:............................................................................
:............................................................................
:...........................................................................

3) Istirahat
Tidur Siang

:...........................................................................

:...........................................................................
:...........................................................................
:...........................................................................

4) Aktifitas
Di dalam rumah :...........................................................................................
Di luar rumah
:..........................................................................................
5) Personal Hygiene
Kebiasaan membersihkan alat kelamin :................................................
Kebiasaan mengganti pakaian dalam
:................................................
Jenis bahan pakaian yang dipakai
:.................................................
6) Seksual
:.................................................
Frekuensi :............................................................................................................
Keluhan :............................................................................................................
.........................................................................................................................
h. Kebiasaan yang berhubungan dengan kesehatan
Obat obatan /Jamu :.......................................................................................
Merokok
:.......................................................................................
Dll
:.......................................................................................

i. Data Psikososial, Spiritual

Tanggapan ibu terhadap penggunaan alat kontrasepsi :.......................................
j. Pengetahuan ibu tentang Alat Kontrasepsi
:.......................................
3.Data Obyektif
a. Pemeriksaan Umum
Keadaan Umum
: ........................................................................................
TTV: TD
: ........................................................................................
.........................................................................................................................
S
: ........................................................................................
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Nadi
: ........................................................................................
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Pernafasan : .......................................................................................
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BB
:.........................................................................................
TB
: ........................................................................................
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b. Pemeriksaan Khusus (Obstetri)

1. Insfeksi
Kepala
: ................................................................................
.........................................................................................................................
Muka
: .................................................................................
.........................................................................................................................
Leher
: .................................................................................
.........................................................................................................................
Dada
: ..................................................................................
.........................................................................................................................
Jantung
: .................................................................................
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Paru
:..................................................................................
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Payudara
:...................................................................................
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Perut
: ..................................................................................
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Punggung dan pinggang : ..................................................................................
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Vulva/genitalia
:..................................................................................
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Anus
: .................................................................................
Kaki
: ..................................................................................
Periksa Dalam (Pada Akseptor IUD )

Gerakan Serviks bebas/ tidak

Tanda-tanda kehamilan
Tanda-tanda tumor/infeksi
Posisi Uterus
In Spekulo ( kalau perlu )