SEKOLAH TINGGI ILMU KESEHATAN ( STIKes )

MITRA RIA HUSADA

Jl. Karya Bhakti No. 1 Cibubur, Jakarta Timur 13720
Telp/Fax : (021) 8730818, 87754573

FORMAT
ASUHAN KEBIDANAN PADA IBU NIFAS

Pengkaji hari / tanggal / jam :..........................................

Nama mahasiswa :..........................................
Nim mahasiswa :..........................................
Tempat pengkaji :..........................................
No Registrasi :..........................................

I . Data Subyektif ( S )
Nama Ibu : ................... Nama Ayah : .................
Umur : ................... Umur : .................
Suku / Bangsa : ................... Suku / Bangsa : .................
Agama : ................... Agama : .................
Pendidikan : ................... Pendidikan : .................
Pekerjaan : ................... Pekerjaan : .................
Alamat Rumah : ................... Alamat Rumah : .................
Alamat kantor : ................... Alamat kantor : .................
Telp/ Hp : ................... Telp/ Hp : .................

Keluhan Utama
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II. DATA OBJEKTIF (O)

Pemeriksaan fisik
Keadaan umum : …………………………………………………………
Kesadaran : …………………………………………………………
Keadaan emosional : …………………………………………………………
Tanda Vital
Denyut nadi : …………………………………………………………
Tekanan darah : …………………………………………………………
Suhu tubuh : …………………………………………………………
Respirasi : …………………………………………………………
Muka oedema : …………………………………………………………
Konjungtiva/Seklera : …………………………………………………………
TFU : …………………………………………………………
Kontraksi : …………………………………………………………
Kandung kemih : …………………………………………………………

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 Oedema :………………………………………………………….
Perineum :………………………………………………………….
Jahitan :………………………………………………………….
Lochea :………………………………………………………….
Vulva :………………………………………………………….

III. ASSESMENT (A)

Diagnosa :………………………………………………………………………………………...
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Masalah :…… …………………………………………………………………………………..
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Kebutuhan : ……………………………………………………………………………………….
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IV. PLANNING
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