AKADEMI KEBIDANAN UMMI KHASANAH

Jl. Pemuda Gandekan Bantul Yogyakarta 55711

Telp. 0274-368055, 7418523. www.akbiduk.ac.id

ASUHAN KEBIDANAN PADA BAYI BARU LAHIR

No RM :………………………………..
Masuktgl/jam :………………………………..
Tempat :………………………………..
Pengkajian Tgl/jam : ..............................................

SUBYEKTIF
1. Identitas Bayi
Nama :........................................................................................................................
Umur :........................................................................................................................
Tanggal lahir :........................................................................................................................
2. Identitas Penanggungjawab
Nama :........................................................................................................................
Umur :........................................................................................................................
Agama :........................................................................................................................
Pendidikan :........................................................................................................................
Pekerjaan :........................................................................................................................
Suku/bangsa :........................................................................................................................
Alamat :........................................................................................................................
Telp :........................................................................................................................
3. Riwayat kelahiran
a. Lama kala I :........................................................................................................................
b. Lama Kala II :........................................................................................................................
c. Warna air ketuban :........................................................................................................................
d. Jumlah air ketuban :........................................................................................................................
e. Jenis persalinan :........................................................................................................................
f. Komplikasi Persalinan : .......................................................................................................................
g. Penolong :........................................................................................................................
h. Jam/tgl/lahir :........................................................................................................................
i. Jenis kelamin :........................................................................................................................

j. BB/PB :........................................................................................................................
k. Caput :........................................................................................................................
 AKADEMI KEBIDANAN UMMI KHASANAH
Jl. Pemuda Gandekan Bantul Yogyakarta 55711
Telp. 0274-368055, 7418523. www.akbiduk.ac.id

4. Eliminasi
BAK :..................................................................................................................................
BAB :..................................................................................................................................

OBYEKTIF
1. Pemeriksaan Umum
KU :.......................................................................................................................
Vital sign : N :.....................................S :................................R :.................................
Apgar score :
KRITERIA 0-1 MENIT 1-5 MENIT 5-10 MENIT
1. Denyut Jantung
2. Usaha Nafas
3. Tonus Otot
4. Reflek
5. Warna Kulit
TOTAL

2. Pemeriksaan Fisik
Kepala :................................................................................................
Muka :...............................................................................................
Ubun-Ubun :................................................................................................
Hidung :...............................................................................................
Bibir :...............................................................................................
Telinga :...............................................................................................
Leher :...............................................................................................
Ekstremitas Atas (Kanan & Kiri) : ..............................................................................................
Dada :...............................................................................................
Tali Pusat :...............................................................................................

Punggung :...............................................................................................
Genetalia :...............................................................................................
Anus :............................................ ..................................................
Ekstremitas bawah (kanan & kiri) :...............................................................................................
 AKADEMI KEBIDANAN UMMI KHASANAH
Jl. Pemuda Gandekan Bantul Yogyakarta 55711
Telp. 0274-368055, 7418523. www.akbiduk.ac.id

3. Reflek
Reflek moro :Ada/tidak. Jika .....................
Reflek rooting : Ada/tidak. Jika .....................
Reflek walking :Ada/tidak. Jika .....................
Reflek graps : Ada/tidak. Jika .....................
Reflek sucking : Ada/tidak. Jika .....................
Reflek tonik neck : Ada/tidak. Jika .....................
4. Antropometri
BB :………………………………………………………………………………………
PB :………………………………………………………………………………………
Lingkar kepala :.........................................................................................................................
Lingkar dada :.........................................................................................................................
Lingkar lengan :.........................................................................................................................

ASSESMENT

PENATALAKSANAAN

Tanggal ..................................... jam ...............................