When assessing wounds in your patient, use the mnemonic, 'WOUND PICTURE" for a fast and accurate assessment: W-ound or ulcer location. O-dor Assess before and during all dressing changes. U-lcer category, stage (for pressure ulcer) or classifi cation (for diabetic ulcer), and depth (partial-thickness or full-thickness). N-ecrotic tissue. D-imension of wound (shape, length, width, depth); drainage color, consistency, and amount (scant, moderate, large). P-ain (When it occurs, what relieves it, patient’s description, patient’s rating on scale of 0 to 10). I-nduration (Surrounding tissue hard or soft). C-olor of wound bed (Red-yellow-black or combination). T-unneling (Record length and direction —toward patient’s right, left, head, feet). U-ndermining (Record length and direction, using clock references to describe). R-edness or other discoloration in surrounding skin. E-dge of skin loose or tightly adhered? Edges fl at or rolled under.
Posted on: Tue, 03 Sep 2013 19:55:48 +0000
Trending Topics
Recently Viewed Topics
© 2015