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  • Wound Care Patient Assessment Chart

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    Brian Harris
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    WOUND CARE: PATIENT assessment CHART. MANAGED HEALTHCARE PATIENT DETAILS: length of time wound present: ____________ days / weeks / months / years (delete where not applicable) Factors that may delay healing Authorisation number Date Diabetes Clinic nurse Anaemia Immobility Dermatologist Medication Surgeon Allergies Dietician Poor nutrition Others Cardiac Other Section 3 nature of wound Healthy Granulation Necrotic Odour (of

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    WOUND CARE: PATIENT assessment CHART. MANAGED HEALTHCARE PATIENT DETAILS: length of time wound present: ____________ days / weeks / months / years (delete where not applicable) Factors that may delay healing Authorisation number Date Diabetes Clinic nurse Anaemia Immobility Dermatologist Medication Surgeon Allergies Dietician Poor nutrition Others Cardiac Other Section 3 nature of wound Healthy Granulation Necrotic Odour (of

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    191 views2 pages

    Wound Care Patient Assessment Chart

    Uploaded by

    Brian Harris
    WOUND CARE: PATIENT assessment CHART. MANAGED HEALTHCARE PATIENT DETAILS: length of time wound present: ____________ days / weeks / months / years (delete where not applicable) Factors that may delay healing Authorisation number Date Diabetes Clinic nurse Anaemia Immobility Dermatologist Medication Surgeon Allergies Dietician Poor nutrition Others Cardiac Other Section 3 nature of wound Healthy Granulation Necrotic Odour (of

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 2

    WOUND CARE: PATIENT ASSESSMENT CHART

    Section 1

    MANAGED HEALTHCARE

    PATIENT DETAILS

    Patient name/s: _____________________________________________________ Date of birth: D D / M M / Y Y Y Y


    Membership number:
    Doctor:______________________________________________________________________________________________

    Section 2

    PATIENT history

    Length of time wound present: ____________ days/weeks/months/years (delete where not applicable)
    Factors that may delay healing

    Authorisation number

    Date

    Diabetes

    Clinic nurse

    DD/MM/YYYY

    Anaemia

    GP

    DD/MM/YYYY

    Immobility

    Dermatologist

    DD/MM/YYYY

    Medication

    Surgeon

    DD/MM/YYYY

    Allergies

    Dietician

    DD/MM/YYYY

    Poor nutrition

    Others

    DD/MM/YYYY

    Cardiac

    DD/MM/YYYY

    Non-compliance

    DD/MM/YYYY

    Other

    DD/MM/YYYY

    Previous treatment history:_ _____________________________________________________________________________


    ___________________________________________________________________________________________________
    ___________________________________________________________________________________________________
    ___________________________________________________________________________________________________
    ___________________________________________________________________________________________________
    ___________________________________________________________________________________________________

    Section 3

    nature of wound

    Type of wound:_______________________________________________________________________________________
    ___________________________________________________________________________________________________
    ___________________________________________________________________________________________________
    Location:_ ___________________________________________________________________________________________
    ___________________________________________________________________________________________________
    ___________________________________________________________________________________________________
    Dimensions: Length________________ cm/mm Width _ _____________ cm/mm Depth_ _____________ cm/mm
    Nature of wound bed:

    Healthy

    Granulation

    Epitheliazation

    Sloughy

    Necrotic

    Exudate (high)

    Exudate (moderate)

    Exudate (low)

    Odour (offensive)

    Odour (some)

    Odour (none)

    Other

    Sizwe Medical Fund is administered by Sechaba Medical Solutions (Pty) Ltd.

    Section 4

    risk assessment

    Pressure sore risk assessment scale used:___________________________________________________________________


    Dopler reading:_________________________________________ Index:________________________________________
    Condition of skin:

    Intact

    Fair

    Poor

    Date dressing changed: D D / M M / Y Y Y Y


    Dimensions: Length________________ cm/mm Width _ _____________ cm/mm Depth_ _____________ cm/mm
    Are the dimensions:

    Increasing?

    Decreasing?

    Wound bed (approximate percentage of cover):

    Exudate levels:

    High

    Surrounding skin:

    Macerated

    Static?

    Necrotic (black)

    Sloughy (yellow)

    Granulating (red)

    Epithelialising (pink)

    Moderate

    Low

    Oedematous

    Increasing

    Erythema

    Fragile

    Decreasing
    Dry/scaling

    Pain:

    Continuous

    Specific times

    Changing

    Odour:

    Offensive

    Some

    None

    Action taken:

    Swab sent

    Results

    Treatment objectives:

    Debridement

    Absorption

    Hydration

    Protection

    Type of dressing used:

    Allevyn

    Ingtrasite Gel

    Optisite Flexigrid

    Bactrazine

    Jelonet/Bactigras

    Hydrocolloid

    Alginate

    Other

    Healthy

    None

    Sizwe Medical Fund is administered by Sechaba Medical Solutions (Pty) Ltd.

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