PENGKAJIAN PRENATALNama Mahasiswa: ................................................NIM: ................................................TGL Pengkajian: ................................................Ruangan: ................................................DATA UMUM1. Inisial Klien: ................................................2. Usia: ................................................3. Status Perkawinan: ................................................4. Pekerjaan: ................................................5. Pendidikan Terakhir: ................................................Riwayat Kehamilan dan Persalinan yang LaluNoTahunJenis PersalinanPenolongJK bayiKeadaan Bayi Waktu LahirMasalah Kehamilan

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Pengalaman Menyusui : ya / tidakBerapa lama :

Riwayat Ginekologi1. Masalah Ginekologi..........................................................................................................................................................................................................................................2. Riwayat KB..........................................................................................................................................................................................................................................Riwayat Kehamilan Saat IniHPHT:...............................................Taksiran partus :.........................................BB sebelum hamil :........................Kg TD sebelum hamil :............/...........mmHgTDBB/TDTFULetak/presentasi janinDJJUsia GestasiKeluhanData lain

DATA UMUM KESEHATAN SAAT INIStatus obstetrik : G..... P..... A..... H..... MingguKeadaan umum :..................... Kesadaran :.......................... BB/TB :.............Kg ...............cmTanda VitalTekanan Darah:..............mmHgNadi:............ x/mntSuhu:...............0 CPernapasan:.............x/mnt

Kepala & LeherKepala: ........................................................................................................................................................................................Mata: .......................................................................................................................................................................................Hidung: .......................................................................................................................................................................................Mulut: ........................................................................................................................................................................................Telinga: ........................................................................................................................................................................................Leher: ........................................................................................................................................................................................Masalah Keperawatan :.............................................................................DadaJantung: ........................................................................................................................................................................................Paru: ........................................................................................................................................................................................Payudara: ........................................................................................................................................................................................Puting susu: ........................................................................................................................................................................................Pengeluaran ASI : ..........................................................................................Masalah Khusus : ............................................................................................AbdomenUterus:TFU :....................cm kontraksi : ya/tidakLeopold I: kepala/bokong/kosongLeopold II: Kanan: Punggung/Bagian Kecil/Bokong/KepalaKiri: Punggung/Bagian Kecil/Bokong/KepalaLeopold III : Kepala/Bokong/KosongLeopold IV : Bagian Masuk PAPPigmentasi :Linea nigra:..................................................................................Striae: ..................................................................................Fungsi pencernaan:...................................................................................Masalah Keperawatan:..................................................................................Perineum dan GenitalVagina : varises; ya/tidakKebersihan :.Keputihan :Jenis/warna :.......................Konsistensi : ....................... Bau : .......................Hemorrhoid :Derajat :...................... lokasi : ....................Berapa lama : ........ Nyeri : ya/tidakMasalah Keperawatan :........................................................................................EkstremitasEkstremitas AtasEdema : ya/tidakVarises : ya/tidakEkstremitas BawahEdema : ya/tidakVarises : ya/tidakRefleks patela : +/- jika ada : +1/+2/+3Masalah Keperawatan : ....EliminasiUrin : Kebiasaan BAK....................Fekal : Kebiasaan BAB..............................................................................Masalah Keperawatan :.....................................................................................Istirahat dan KenyamananPola Tidur : Kebiasan tidur....................................... lama...........................Frekuensi............. Pola tidur saat ini.......................................Keluhan ketidaknyamanan: ya/tidak, lokasi..................................................Sifat................................ Intensitas.......................................Masalah Keperawatan:...............................................................................Mobilisasi dan LatihanTingkat mobilisasi:.........................................................................Latihan/senam: ........................................................................Masalah Keperawatan: ..................................................................................Nutrisi dan CairanAsupan Nutrisi:.................................Nafsu Makan:baik/kurang/tidak adaAsupan Cairan:................................................................Cukup/kurangMasalah Keperawatan : .......................................................................................Keadaan MentalAdaptasi psikologis : ......................................................................................Penerimaan terhadap kehamilan :..................................................................Masalah Keperawatan : ........................................................................................

Pola Hidup yang Meningkatkan Risiko Kehamilan...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Masalah Keperawatan.................................................................................Persiapan Persalinan Senam hamil Rencana tempat melahirkan Perlengkapan kebutuhan bayi dan ibu Kesiapan mental ibu dan keluarga Pengetahuan tentang tanda-tanda melahirkan, caramenangani nyeri, proses persalinan Perawatan payudaraObat-obatan yang Dikonsumsi Saat Ini...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Hasil Pemeriksaan Penunjang...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... ...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................RANGKUMAN HASIL PENGKAJIANMasalah........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... ...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................8