*

BY
GROUP 6
*1. Assessment Date :
*2. HPHT :
*3. Medical Diagnosis :

*A. Assessment Patient Identity :

*- Patient Name :
*- Age :
*-Adsress :
*-Religion :
*-Job :
*- Ethnicity :
 Assessment of Husband
identification

- Name :
- Age :
- Address :
- Religion :
- Job :
- Ethnicity :
*B. Menstrual History
1. Is your period regular ?
2. What cycle ?
3. Is there a problem with menstruation
4. HPHT/HPMT ?

C. Marriage history
1. How long is the patients marriage ?
*D. Past pregnancy history

Pregnant to Problems in pregnancy

*E. past birth history

Parturition to The Length The Childbirth Labor

labor of labor place helper problems
procces of labor
F. Gynecological history

Whether the patient has a history of

tumors, cysts or uterine myomas
*G. Past puerperal history

Postpartum problems Baby problems ever State of the child

experienced experienced
* 1. type of contraception ever used ?
*2. problem in this way
*3. type of contraception used after child birth.
*4. number of children planned
 *
* 1. what is the reason for the mother come to the clinic ?
* 2. changes that occur during pregnancy ?
* 3. expectation about her pregnancy ?
* 4. people who live with her ?
* 5. the most important person ?
* 6. the impact that occurs on the family with a visit to the clinic ?
* 7. whether the husband wants to accompany to the clinic ?
* 8. plan fot birth ?
* 9. plan for breastfeeding ?
* 10. do you keep cats ?
 *
* 1. movement
* 2. vision
* 3. hearing
* 4. fluid
* 5. nutrition
* 6. elimination
* 7. oxygenation
* 8. sexual
 *
* 1. general examination :
* - general condition :
* weight :
* Fetal movement :
* - deformity :
* - awareness :
* - vital sign
* Blood : temperature : breathing :

* Pressure : pulse :
SPECIAL EXAMINATION :
A. INSPECTION :
head :
eyes :
breast :
neck :
chest :
Lungs
abdomen :
extremities :
genitalia :
* B. PALPATION
 LEOPALD 1 : OBJECITIVE : TO DETERMINE THE GESATTIONAL AGE
AND WHAT PARTS OF THE BODY ARE CONTAINED IN THE UTERINE
FUNDUS
 LEOPALD 2 : OBJECTIVE : TO DETERMINE WHERE THE CHILDS BACK
IS AND WHERE THE SMALL PARTS ARE LOCATED
 LEOPALD 3 : OBJECTIVE : TO FIND OUT WHAT IS AT THE BOTTOM
AND IF THE BOTTOM IS ALREADY HELD BY A LARGE (PAP) DOOR
TOP PELVIS
 LEOPALD 4 : OBJECTIVE : TO DETERMINE THE LOWER PART OF THE
UTERUS AND HOW THE LOWER PART ENTERS THE PAP.
 *
* 1. urine : protein urine
* 2. blood glucose :
* 3. HB :
* 4. HT :
* 5. blood type stool :
* 6. USG :
* 7. ultrasound :
* 8. simear pap :
* 9. cervical latex culture:
* 10. therapy :
*