Professional Documents
Culture Documents
AN....... USIA.....
DI....................................
PENGKAJIAN
Tanggal : ...................................................................................................
Waktu : ...................................................................................................
Tempat : ...................................................................................................
IDENTITAS
a. Identitas Bayi
Nama : .......................................................................................
1. ALASAN DATANG
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2. KELUHAN UTAMA
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a. Sekarang :
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b. Dahulu :
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c. Keluarga :
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4. RIWAYAT KESEHATAN ANAK
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Penolong : ...................................................
6. RIWAYAT IMUNISASI
BCG
DPT
Polio
Campak
Hepatitis B
7. PERTUMBUHAN DAN PEKEMBANGAN
a. Motorik
b. Sosial kognitif
c. Bahasa
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a. Pola Nutrisi :
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b. Pola Eliminasi :
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c. Pola Istirahat :
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d. Pola Hygiene :
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1. PEMERIKSAAN FISIK
a. Pemeriksaan Umum
Kesadaran : ...............................................................
Vital sign :
Nadi : ...............................................................
Suhu : ...............................................................
RR : ...............................................................
b. Pengekuran Antropometri
BB : ...................................................................................................
PB : ...................................................................................................
LK : ...................................................................................................
LD : ...................................................................................................
LILA : ...................................................................................................
c. Keadaan Bayi
Menangis : .......................................................................................
Turgor : .......................................................................................
2. STATUS PRESENT
Kepala : .......................................................................................
Muka : .......................................................................................
Mata : .......................................................................................
Hitung : .......................................................................................
Mulut : .......................................................................................
Telinga : .......................................................................................
Leher : .......................................................................................
Dada : .......................................................................................
Ketiak : .......................................................................................
Pulmo/con : .......................................................................................
Abdomen : .......................................................................................
Genetalia : .......................................................................................
Punggung : .......................................................................................
Anus : .......................................................................................
Ekstremitas : .......................................................................................
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Kulit : .......................................................................................
3. PEMERIKSAAN PENUNJANG :
a. Laboratorium :
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c. DDST : .......................................................................................
III. ASSESMENT
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IV. PELAKSANAAN
Tanggal : .............................................................. Jam : .......................
1. ......................................................................................................................
Hasil : ...........................................................................................................
2. ......................................................................................................................
Hasil : ...........................................................................................................
3. ......................................................................................................................
Hasil : ...........................................................................................................
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Hasil : ...........................................................................................................
5. ......................................................................................................................
Hasil : ...........................................................................................................
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Mengetahui
Pembimbing Prodi
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