Professional Documents
Culture Documents
HSN: ____________________________________
WOUND CARE RECORD
Page 1 of 2 D.O.B.: __________________________________
Consults Goal
OT Healing
PT Palliative/Maintenance
Dietician
Wound Resource Team
Swab taken (After cleansing) N/A Yes, Type __________ N/A Yes, Type ____________
extends under the intact skin along the wound
edge
Tunneling (sinus tract) - destruction of
tissue that occurs in any direction starting
from the wound bed. _____cm _____cm _____cm _____cm
Wound Base Appearance _____ % Red/Pink Granulation _____% Red/Pink Granulation
(Estimate % of each tissue type. _____ % Yellow slough _____ % Yellow slough
Must total 100%.)
_____ % Black/Grey Eschar _____ % Black/Grey Eschar
_____ % Epithelial _____ % Epithelial
_____ % Not Visible _____ % Not Visible
_____ % Other ___________________ _____ % Other ___________________
Wound Edge Appearance
Tick all that apply Attached Attached
Attached – even with wound bed
Not-Attached – wound base deeper than Not Attached Calloused Not Attached Calloused
edge
Demarcated – easy to define wound outline Punched Out Punched Out
Diffuse – undefined wound outline
Calloused – thickened Demarcated Rolled Demarcated Rolled
Punched Out – Distinctive shape with sharp
edged border Diffuse Diffuse
Rolled – edges rolled under
Dressing/Packing Application
Irrigation/Cleansing Dual top Dual top
Solution Amount Solution Amount
Syringe Syringe
________ ________ ________ ________
Cath Cath
Skin Prep Cavilon Other Skin Prep Cavilon Other
Periwound Skin Care