PERAWATAN LUKA (WOUND CARE) PERKEMBANGAN dan DOKUMENTASI (PROGRESS and

DOCUMENTATION)
Petunjuk Cara Penggunaan !r" (Guidelines for Use of Form)
LUKA (WOUND) Jika lebih dari satu luka, beri nomor untuk tiap luka dan gunakan di dalam kotak ini. Pastikan nomor pengkajian
(if more than 1 wound, give each wound a number and use numeral in this box. Ensure same number as in
assessment
STADIUM LUKA (WOUND STAGE) !arus memperlihatkan stadium paling bawah sampai luka membaik. "unakan stadium untuk
mengindikasikan form pengkajian luka (#hould demonstrate lower stages as wound progresses towards healing.
$se stages as indicated on wound assessment form
DASAR LUKA (WOUND BED) Estimasi persentase tiep luka jaringan, misal 1%& eschar '%& slough( ')& granulasi )& epitel
baru. Juga harus di dokumentasikan disini apabila dilakukan debridemang dengan menggunakan alat tajam
(Estimate & wound tissue t(pe eg 1%& eschar eschar '%& slough( ')& granulating )& newl( epithialted. #hould
also document here when conservative sharp wound dbridement performed (*#+,
CAIRAN LUKA (EXUDATE) -indikasikan tipe, kepekatan dan perkiraan volume, Penambahan jumlah cairan dan bau (ang tidak
sedap dapat berarti adan(a infeksi (-ndicate t(pe, odour, viscosit( and approximate volume, increased exudate
volume and odour ma( indicate infection
KULIT SEKITAR LUKA (SURROUNDING SKIN) .dan(a indikasi jaringan bereaksi terhadap perekat serta status umum (-ndicate
tissue reactions to adhesives as well as general status
RASA SAKIT (PAIN) ,okumentasi perubahan tingkat rasa sakit, penghilang rasa sakit (ang dibutuhkan untuk tindakan dll.
/eningkatn(a rasa sakit dapat diakibatkan oleh infeksi (,ocument alterarions in pain levels, pain relief re0uired
for procedure etc. increased pain levels m( indicate infection
UKURAN LUKA (WOUND MEASUREMENT) !arus di dokumentasikan minimal 1 minggu sekali. 2ampirkan jika ada pengambilan
foto atau jiplakan (to be documented at least fornightl(. -ndicate if photograph or tracing taken
PERORMA BALUTAN (DRESSING PERFORMANCE) -ndikasikan kepatutan dari metode (ang digunakan dan pergantian
produk balutan (indicates appropriateness of current regime and changes to dressing products
CATATAN PERKEMBANGAN (RECORD of PROGRESS)
3gl
(Date)
2uka
(Wound)
#tadium 2uka
(Wound
Stage)
,asar 2uka
(Wound
Bed)
*airan 2uka
(Exudate)
4ulit #ekitar
(Surrounding
Skin)
5asa #akit
(Pain)
$kuran
(Measure
)
*ara /embalut (ang telah dilakukan
dan produk (ang digunakan (previous
dressing performane and urrent produt
used)
33,
(#ign
CATATAN PERKEMBANGAN (RECORD of PROGRESS)
3gl
(Date)
2uka
(Wound)
#tadium 2uka
(Wound
Stage)
,asar 2uka
(Wound
Bed)
*airan 2uka
(Exudate)
4ulit #ekitar
(Surrounding
Skin)
5asa #akit
(Pain)
$kuran
(Measure
)
*ara /embalut (ang telah dilakukan
dan produk (ang digunakan (previous
dressing performane and urrent produt
used)
33,
(Sign
)