Patient Name D.O.B.. Type of Wound. Pressure Ulcer; Diabetic Ulcer; Traumatic wound; Skin tear / laceration; Burn / scald; Surgical wound; Fungating ... |
Wound Assessment form. Date: Patient Name: Patient ID: Assessor Name: Patient. Age: years. Weight: kgs. Gender: Male. Female. Nutrition status: Well nourished. |
Ensure any sensitivities to dressings are documented on front page of chart. Consider if the patient can self – manage wound care with support from health. |
Wound Assessment - Evidence of wound improvement or deterioration includes measurable changes in the following: □ ↓ ↑Drainage □ ↓↑Inflammation □↓↑Swelling/Edema ... |
Wound Assessment form. Date: Patient Name: Patient ID: Patient. Age: years. Weight: kgs. Gender: Male. Female. Nutrition status: Well nourished. Malnourished. |
Reference: Wound Assessment Guideline Decision Support Tool (DST). Adapted from VCHA Wound Care Assessment Tool (2009). (Please fill out ONE form per wound). |
Fill out the attached rating sheet to assess a wound's status after reading the definitions and methods of assessment described below. |
Length. Width. Depth. Sinus Tract #1 Depth. Location (o'clock). Sinus Tract #2 Depth. Location (o'clock). Undermining #1 Depth. Location (o'clock). |
Condition of surrounding skin: H = Healthy D = Dry Ec = Eczema E = Erythema. M = Macerated. If any of the above are present, please state maximum distance from ... |
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