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AKADEMI KEBIDANAN SUKAWATILAWANG – MALANG
Jalan Anjasmoro No. 19 A Lawang – MalangTelp./Fax 0341 – 421660
ASUHAN KEBIDANAN PADA NY “ “ G....P.............
USIA KEHAMILAN...................MINGGU
DI...............................................
I. DATA SUBYEKTIF
Anamnesa tanggal : Jam :
I.1 Identitas
Nama :
Umur :
Agama :
Suku bangsa :
Pendidikan :
Pekerjaan :
Penghasilan :
Kawin ke :
Lama kawin :
Alamat :
Nama :
Umur :
Agama :
Suku bangsa :
Pendidikan :
Pekerjaan :
Penghasilan :
Kawin ke :
Lama kawin :
Alamat :
I.2 Keluhan Utama
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I.3 Riwayat Kesehatan Sekarang
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I.4 Riwayat Kesehatan Lalu
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I.5 Riwayat Kesehatan Keluarga
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AKADEMI KEBIDANAN SUKAWATILAWANG – MALANG
Jalan Anjasmoro No. 19 A Lawang – MalangTelp./Fax 0341 – 421660
I.6 Riwayat Kebidanan
1) Riwayat Menstruasi
Menarche :.................................................................................................................
Siklus :.................................................................................................................
Lama :.................................................................................................................
Banyaknya :.................................................................................................................
.................................................................................................................
Warna :.................................................................................................................
Bau :.................................................................................................................
Konsistensi :.................................................................................................................
Keluhan :.................................................................................................................
Fluor Albus :.................................................................................................................
Kapan :.................................................................................................................
Warna :.................................................................................................................
Bau :.................................................................................................................
Gatal/tidak :.................................................................................................................
2) Riwayat Kehamilan, Persalinan, dan Nifas yang Lalu
Kawi
n
Ke
Kehamilan Persalinan Anak Nifas
Ke UK Peny. TempatJeni
sPenl. Peny. L/P BB PB Kelainan
Umu
rASI Peny.
3) Riwayat Kehamilan Sekarang
Hamil ke :.................................................................................................................
HPHT :.................................................................................................................
HPL :.................................................................................................................
UK :.................................................................................................................
ANC : TM I :.........................................................................................
AKADEMI KEBIDANAN SUKAWATILAWANG – MALANG
Jalan Anjasmoro No. 19 A Lawang – MalangTelp./Fax 0341 – 421660
TM II :.........................................................................................
TM III :.........................................................................................
Obat yang didapat selama hamil
TM I :.........................................................................................
TM II :.........................................................................................
TM III :.........................................................................................
Penyuluhan yang didapat selama hamil
TM I :.........................................................................................
TM II :.........................................................................................
TM III :.........................................................................................
Imunisasi TT :.........................................................................................
Quickening dirasakan :.........................................................................................
4) Riwayat KB
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5) Riwayat Ginekologi
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I.7 Riwayat Psikososial
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I.8 Keadaan Sosial Budaya
Menunjang :.................................................................................................................
..................................................................................................................
..................................................................................................................
Menghambat :.................................................................................................................
..................................................................................................................
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AKADEMI KEBIDANAN SUKAWATILAWANG – MALANG
Jalan Anjasmoro No. 19 A Lawang – MalangTelp./Fax 0341 – 421660
I.9 Pola Kebiasaan Sehari – hari
1) Pola Nutrisi
Sebelum hamil :.....................................................................................................
......................................................................................................
Selama hamil :.....................................................................................................
......................................................................................................
2) Pola Aktivitas
Sebelum hamil :.....................................................................................................
......................................................................................................
Selama hamil :.....................................................................................................
......................................................................................................
3) Pola Istirahat
Sebelum hamil :.....................................................................................................
......................................................................................................
Selama hamil :.....................................................................................................
......................................................................................................
4) Pola Eliminasi
Sebelum hamil :.....................................................................................................
......................................................................................................
Selama hamil :.....................................................................................................
......................................................................................................
5) Pola Personal Hygiene
Sebelum hamil :.....................................................................................................
......................................................................................................
Selama hamil :.....................................................................................................
......................................................................................................
6) Pola Seksualitas
Sebelum hamil :.....................................................................................................
......................................................................................................
Selama hamil :
TM I :.................................................................................................................
AKADEMI KEBIDANAN SUKAWATILAWANG – MALANG
Jalan Anjasmoro No. 19 A Lawang – MalangTelp./Fax 0341 – 421660
TM II :.................................................................................................................
TM III :.................................................................................................................
II. DATA OBYEKTIF
1.1 Pemeriksaan Umum
Keadaan Umum:.................................................................................................................
Kesadaran :.................................................................................................................
Postur tubuh :.................................................................................................................
Cara berjalan :.................................................................................................................
TB :.................................................................................................................
BB sebelum hamil :.....................................................................................................
BB saat hamil :.....................................................................................................
Kenaikan BB :.....................................................................................................
LILA :.....................................................................................................
TTV : Tekanan darah :.........................................................................................
Nadi :.........................................................................................
Suhu :.........................................................................................
Respirasi :.........................................................................................
1.2 Pemeriksaan Fisik
1) Inspeksi
Kepala :.....................................................................................................
......................................................................................................
Muka :.....................................................................................................
......................................................................................................
Mata :.....................................................................................................
......................................................................................................
Hidung :.....................................................................................................
......................................................................................................
Mulut dan gigi :.....................................................................................................
......................................................................................................
Telinga :.....................................................................................................
AKADEMI KEBIDANAN SUKAWATILAWANG – MALANG
Jalan Anjasmoro No. 19 A Lawang – MalangTelp./Fax 0341 – 421660
......................................................................................................
Leher :.....................................................................................................
......................................................................................................
Axilla :.....................................................................................................
......................................................................................................
Mammae :.....................................................................................................
......................................................................................................
Abdomen :.....................................................................................................
......................................................................................................
Punggung :.....................................................................................................
......................................................................................................
Ekstremitas atas :.....................................................................................................
......................................................................................................
Ekstremitas bawah :.....................................................................................................
......................................................................................................
Genetalia :.....................................................................................................
......................................................................................................
Anus :.....................................................................................................
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2) Palpasi
Kepala :.....................................................................................................
......................................................................................................
Leher :.....................................................................................................
......................................................................................................
Axilla :.....................................................................................................
......................................................................................................
Mammae :.....................................................................................................
......................................................................................................
Abdomen :
Leopold I :.....................................................................................................
......................................................................................................
AKADEMI KEBIDANAN SUKAWATILAWANG – MALANG
Jalan Anjasmoro No. 19 A Lawang – MalangTelp./Fax 0341 – 421660
......................................................................................................Leopold II :.....................................................................................................
......................................................................................................
......................................................................................................Leopold III :.....................................................................................................
......................................................................................................
......................................................................................................Leopold IV :.....................................................................................................
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......................................................................................................TBJ :.....................................................................................................
3) Auskultasi
Dada :.....................................................................................................
Abdomen :.....................................................................................................
4) Perkusi
Reflex Patella :.....................................................................................................
1.3 Pemeriksaan Panggul Luar
1) Distansia Spinarum :.....................................................................................................
2) Distansia Cristarum :.....................................................................................................
3) Conjugata Externa :.....................................................................................................
4) Lingkar Panggul :.....................................................................................................
1.4 Pemeriksaan Penunjang
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AKADEMI KEBIDANAN SUKAWATILAWANG – MALANG
Jalan Anjasmoro No. 19 A Lawang – MalangTelp./Fax 0341 – 421660
Kesimpulan
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Planning
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Mengetahui,
Pembimbing Akademik Pembimbing Praktek
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Mahasiswa
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NIM :......................................