UNIVERSITAS NAHDLATUL ULAMA SURABAYA

FAKULTAS KEPERAWATAN DAN KEBIDANAN

PROGRAM STUDI S1 KEPERAWATAN
KAMPUS A JL. SMEA NO. 57 SURABAYA (031) 8291920, 8284508, FAX (031) 8298582
KAMPUS B RS. ISLAM JEMURSARI JL. JEMURSARI NO. 51-57 SURABAYA
Website : www.unusa.ac.id Email : info@unusa.ac.id

ASUHAN KEPERAWATAN ANAK

Nama Mahasiswa : RS :
NIM : Ruangan :
Tanggal Pengkajian : Jam :

A. IDENTITAS PASIEN
Nama : __________________________
Umur : __________________________
Tanggal Lahir : __________________________
Jenis Kelamin : __________________________
Berat Badan : __________________________
Panjang Badan : __________________________

B. IDENTITAS ORANG TUA

Nama Ibu : Nama Ayah :
Umur : Umur :
Agama : Agama :
Pendidikan : Pendidikan :
Pekerjaan : Pekerjaan :
Alamat :

C. KELUHAN UTAMA
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D. RIWAYAT PENYAKIT SEKARANG

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E. RIWAYAT KEHAMILAN DAN KELAHIRAN

1. Pranatal
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2. Natal
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3. Postnatal
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F. RIWAYAT PENYAKIT DAHULU

1. Penyakit masa kecil
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2. Riwayat MRS
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3. Riwayat pemakaian obat
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4. Tindakan operasi
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5. Alergi
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6. Kecelakaan
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7. Imunisasi
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G. RIWAYAT KESHATAN KELUARGA

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H. RIWAYAT SOSIAL
1. Pengasuh anak
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2. Hubungan dengan anggota keluarga

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3. Hubungan dengan teman sebaya
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4. Pembawaan umum
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I. PEMENUHAN KEBUTUHAN DASAR

1. Pola makan
Sebelum Sakit Saat Sakit
Frekuensi
Menu
Porsi
Yang disukai
Yang tidak disukai
Pantangan/Alergi
Gangguan

2. Pola minum
Sebelum Sakit Saat Sakit
Frekuensi
Jenis
Jumlah (cc/botol)
Yang disukai
Yang tidak disukai
Pantangan/Alergi
Gangguan

3. Istirahat tidur
Sebelum sakit Saat sakit
Tidur siang
Tidur malam
Gangguan

4. Eliminasi
Sebelum sakit Saat sakit
 BAK

BAB

Gangguan
5. Personal hygiene
Sebelum sakit Saat sakit
Mandi
Sikat gigi
Ganti pakaian
Memotong kuku
Lain-lain

J. KESEHATAN SAAT INI

1. Diagnosa medis
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2. Tindakan operasi
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3. Status nutrisi
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4. Status hidrasi
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5. Aktivitas saat MRS
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K. PEMERIKSAAN FISIK
1. Keadaan umum
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2. Tanda vital
Nadi : ____________ kali/menit
RR : ____________ kali/menit
Suhu : ____________ °C
3. Antopometri
BB : ____________ kg TB : _____________ cm
4. Kepala dan leher
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5. Integumen
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6. Thoraks (Pulmo & Cor)
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7. Abdomen
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8. Genitalia
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9. Neuro – Muskuloskeletal
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L. PEMERIKSAAN TUMBUH KEMBANG

1. Adaptasi sosial
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2. Bahasa
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3. Motorik kasar
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4. Motorik halus
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M. PEMERIKSAAN PENUNJANG
1. Laboratorium
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2. Rontgen
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3. USG
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N. TERAPI MEDIS
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