Escolar Documentos
Profissional Documentos
Cultura Documentos
No MR :
Masuk tgl/jam :
2. Anamnesa
a. Keluhan Utama .........................................................................................................
b. Riwayat Perkawinan
Perkawinan ke : .............................................
Menikah sejak umur : .............................................
Lama perkawinan : .............................................
Status perkawinan : ............................................
c. Riwayat Haid
Menarche : ...............................................
Lama menstruasi : .............................................
Teratur /tidak : .............................................
Sakit /tidak : .............................................
Siklus : .............................................
HPHT : .............................................
HPL : .............................................
d. Riwayat Obstetrik
G ..........P........A........Ah.........
Jenis BB
No Thn UK Penolong Tempat H/M L/P Komplikasi
persalinan lahir
e. Riwayat KB
Pasang Lepas
No
Metode Tgl Petugas Tempat Tgl Petugas Tempat Alasan
f. Riwayat Kesehatan
a) Riwayat kesehatan yang lalu
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b) Riwayat kesehatan sekarang
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c) Riwayat kesehatan keluarga
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2) Eliminasi
Eliminasi BAK BAB
Frekuensi
Warna
Jumlah
Keluhan
3) Istirahat
Istirahat Siang Malam
Aktifitas
Personal hygiene
Pola seksual
Keluhan
II. OBYEKTIF
1. Pemeriksaan Umum
KU : .................................................................................................................
Kesadaran : .................................................................................................................
TB : .................................................................................................................
BB : Sebelum hamil : ................................. Setelah hamil ..............................
LILA : .................................................................................................................
Vital sign : T : ...................... N : ........................ S : .................... R : .....................
2. Pemeriksaan Obstetrik
Kepala : .................................................................................................................
Muka : .................................................................................................................
Mata : .................................................................................................................
Telinga : .................................................................................................................
Mulut : .................................................................................................................
Hidung : .................................................................................................................
Leher : .................................................................................................................
Aksila : .................................................................................................................
Payudara : .................................................................................................................
Abdomen :
Leopold I : .......................................................................................................
Leopold II : .......................................................................................................
Leopold III : ......................................................................................................
Leopold IV : ......................................................................................................
TBJ : ......................................................................................................
Djj : ......................................................................................................
Genetalia : ......................................................................................................
Ekstrimitas :
Tangan : ......................................................................................................
Kaki : ................................................................(reflek patela kanan/kiri)
3. Pemeriksaan Penunjang
Urine : tgl ................................ (Pptest, Protein, Glukosa, dll)
Darah : tgl ................................(Hb, Al, HMT, Golongan darah)
III.ANALISA
IV. PENATALAKSANAAN