Escolar Documentos
Profissional Documentos
Cultura Documentos
II.
PENGKAJIAN
Tanggal Pengkajian
: ......................................
Oleh Mahasiswa
: ......................................
DATA SUBYEKTIF
1. Biodata
a. Nama anak
: .................................
Umur
: .................................
Jenis Kelamin
: .................................
b. Orang tua
Nama Ibu
.........................
Nama Ayah
.........................
Umur
.........................
Umur
.........................
Agama
........................
Agama
.........................
Suku/Bangsa :
........................
Suku/Bangsa
.........................
Pendidikan
........................
Pendidikan
.........................
Alamat
........................
Alamat
.........................
5. Riwayat natal :
Usia kehamilan
: .................................
Cara persalinan
: .................................
: .................................
: .................................
Berat badan
: .................................
6. Riwayat imunisasi
BCG
: .................................
HB I III
: .................................
DPT I III
: .................................
CAMPAK
: .................................
POLIO I IV
: .................................
: .......................................................................................
Frekuensi
: .......................................................................................
Jenis minuman
: .......................................................................................
Napsu makan
: .......................................................................................
b. Eliminasi
BAK
: .................................
Warna
: .................................
Bau
: .................................
BAB
: .................................
Warna
: .................................
Bau
: .................................
: .................................
Tidur malam
: .................................
d. Kebersihan
III.
Jenis makanan
: .......................................................................................
Frekuensi
: .......................................................................................
DATA OBJEKTIF
1. Pemeriksaan Umum
Keadaan umum
: .................................
Kesadaran
: .................................
Ekspresi wajah
: .................................
Suhu
.............celcius
Nadi
.............x/menit
BB sebelum sakit
: ....................kg
Pernapasan
..........x/menit
BB saat ini
: ...................kg
2. Pemeriksaan Fisik
1. Inspeksi dan Palpasi
Kepala
: .................................
Wajah
: .................................
Mata
: .................................
Telinga
: .................................
Hidung
: .................................
: .................................
Dada
: .................................
Perut
: .................................
Ekstremitas
: .................................