form askep anak

8/17/2019 Form Askep Anak

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I. IDENTITAS

A. Anak

1. Nama : …………………………………………………

2. Anak yang ke : …………………………………………………

3. Tanggal lahir/umur: ………………………………………………..

4. Jenis kelamin : …………………………………………………

5. Agama : …………………………………………………

. !rang "ua

1. Ayaha. Nama : …………………………………………#kan$ung/"iri%

&. 'mur : …………………………………………………

(. )eker*aan : …………………………………………………

$. )en$i$ikan : …………………………………………………

e. Agama : ………………………………………………..

+. Alama" : …………………………………………………

2. I&u

a. Nama : …………………………………………#kan$ung/"iri%

&. 'mur : …………………………………………………

(. )eker*aan : …………………………………………………

$. )en$i$ikan : …………………………………………………e. Agama : …………………………………………………

+. Alama" : …………………………………………………

II. ,EN!,-A # $i&ua" aa&ila a$a hu&ungan $engan kasus yang $i&ua" %


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III. A0ASAN DI-AATa% eluhan '"ama :

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&% -iaya" )enyaki" :

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I. -IAAT ANA #6 7 8 TA9'N%

A. )eraa"an $alam masa kan$ungan :

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. )eraa"an a$a ak"u kelahiran :

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lahir …………)0 ……………0/0D …………………

. E'T'9AN I!)SI!S!SIA0S)I-IT'A0 DA0A E9ID')AN

SE9A-I9A-I

A. erna+as

1. esuli"an &erna+as : a$a/"i$ak

2. esuli"an $irasakan : menarik/mengeluarkan na+as

3. eluhan yang $irasa :

4. Suara na+as :

. akan $an minum

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;. Eliminasi #A/A%


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D. Ak"i+i"as

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E. -ekreasi

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9. )enga"uran suhu "u&uh

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I. -asa

nyaman .....................................................................................................................

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J. -asa

aman .........................................................................................................................

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. ela*ar #anak $an =rang"ua%

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0. )res"asi

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. 9u&ungan s=sial anak


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N. elaksanakan i&a$ah

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I. )EN,AASAN ESE9ATAN

ila seha" $iaasi: "i$ak/ya $i uskemas> $=k"er> .............ila saki" min"a er"=l=ngan kea$a..............................................................................

un*ungan ke )=syan$u ……………….......................................................................

)engaasan anak $irumah…………………………………………………................

Imunisasi # 1 7 5 "ahun%

Imunisasi 'mur Tgl $i&erikan -eaksi Tema" Imunisasi

;,

)=li= 1

)=li= 2

)=li= 3

D)T I

D)T II

D)T III

9 I

9 II

9 III

;A)A

Tam&ahan / an*uran

II. )ENAIT AN, )E-NA9 DIDE-ITA

N

=

Jenis

)enyaki"

Aku"/r=nis/

enular/"i$ak

'mur saa"

saki"

0amanya )er"=l=ngan


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III. ESE9ATAN 0IN,'N,AN

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I?. )E-EAN,AN ANA #6 7 8 "ahun%

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?. )EE-ISAAN


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I. 9i$ung :

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J. Telinga

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. ulu":

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0. 0eher:

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. Th=raks:

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N. Jan"ung…………………………………………………...

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!. )ersara+an

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). A&$=men

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. Eks"remi"as


10/18

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-. Ala" kelamin

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S. Anus

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T. An"r==me"ri #ukuran er"um&uhan%

1. B kg

2. T B (m

3. 0ingkar keala B (m

4. 0ingkar $a$a B (m

5. 0ingkar lengan B (m

8.

'. ,e*ala kar$inal :

1. Suhu B

2. Na$i B

3. )erna+asan B

4. Tekanan $arah BC.

?I. )EE-ISAAN )EN'NJAN,

.

.

16.

11.

12.

13.

14.

15.

18.1C.


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1.

1.

?II. 9ASI0 !SE-ASI

1. In"eraksi anak $engan =rang "ua :

2. en"uk/arah k=munikasi :

3. Am&iFalensi/k=n"ra$iksi )rilaku :4. -asa aman anak :

26.

21. ANA0ISA DATA

22. 23. DATA


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28. 2C.

2.

2.

36.

31.

32.

33.

34.

35.

38.

3C.

3.

3.

46.

41.

42.

43.

44.

45.

48.

4C.

4.

4.

56.

51.

52.

53.

54.

55.

58.

5C.

5.

5.

86.

81.

4. 5.


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8.

C. ?I. DIA,N!SA E)E-AATAN E-DASA-AN

)-I!-ITAS

. 6. Diagn=sa eeraa"an 1.

3. 4. 5.

8.

C.

.

.

166.

161.

162.

163.

164. 165.

168. 16C. 16.

16.

116.

111.

112.

113.

114.

115.

118.

11C. 11.


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11. 126. 121.

122.

123.

124.

125.

128.

12C.

12.

12.

136. 131.

132.

133.

134.

135. ?. -EN;ANA E)E-AATAN

138. -EN;ANA TINDAAN

13C. 13. 13. Diagn=sa

eeraa"an

146.

Tu*

u

a

n

G

141.

ri"

e

r i

a

h

a

s

i

l

142.

In"e


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145. 148. 14C.

14.

14.

156.

151.

152.

153.

154.

155.

158.

15C.

15.

15.

186.

181.

182.

183.

184. 185.

18.

18. 1C6. 1C1. Diagn=sa

eeraa"an

1C2.

Tu*

u

a

n

G

1C3.

ri"

e

r

i

a

h

1C4.

In"e


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a

s

i

l

1CC. 1C. 1C.

16.

11.

12.

13.

14.

15.

18.

1C.

1.

1.

16.

11.

12.

13.

14.

15.

18.

1C.

1. 1.

262.

263. ;ATATAN )E-EAN,AN

264.

265. 268.

9

26C. 26. 26. Imle

men"asi

216.

212. 213. 214. 215. 218.

21C.

21.

21.

226.

222.


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221.

224. 225. 228. 22C. 22.

22.

236.

231.

232.

233.

234.

238. 23C. 23. 23. 246.

241.

242.

243.

244.

245.

24C.

24. 24.

9

256. 251. 252. Imle

men"asi

253.

255. 258. 25C. 25. 25.

286.

281.

282.

283.

284.

285.

28C. 28. 28. 2C6. 2C1.

2C2.

2C3.

2C4.

2C5.

2C8.

2CC.

2C. 26. 21. 22. 23.

24.

25.

28.

2C.

2.

2.


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21.

22.

23.

24.

25.28.

2C.

2.

2.

366.

361.

362.

363.

364.

365.

368.36C.

36.

36.

316.

311.

312.

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