National best practice and evidence based guidelines for wound ...
National best practice and evidence based guidelines for wound ...
National best practice and evidence based guidelines for wound ...
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NatioNal <strong>best</strong> <strong>practice</strong> aNd evideNce <strong>based</strong> guideliNes <strong>for</strong> wouNd maNagemeNt<br />
62<br />
Appendix 2: Examples of Wound Assessment Forms (continued)<br />
date of review<br />
patients blood pressure<br />
limb assessment<br />
stasis oedema<br />
eczema<br />
brown pigmentation<br />
atrophe blanche<br />
visible varicose veins<br />
induration/<br />
lipodermatosclerosis<br />
ankle flare<br />
ankle pulses<br />
palpable<br />
reduced<br />
absent<br />
measurements<br />
ankle circumference<br />
calf circumference<br />
ankle movements<br />
full/ limited/ fixed<br />
doppler assessment<br />
bracial systolic<br />
central bracial systolic<br />
dorsalis pedis pulse<br />
posterior tibialis<br />
Highest ankle systolic<br />
a.b.p.i.<br />
Right Left<br />
Right Left<br />
Wound Aetiology<br />
1. venous ulcer<br />
2. mixed venous/ arterial<br />
3. arterial<br />
4. pressure ulcer<br />
5. pretibial laceration<br />
6. surgical <strong>wound</strong><br />
7. burn<br />
8. diabetic neuropathic<br />
9. diabetic ischaemic<br />
10. Neuro-ischaemic<br />
11. trauma<br />
12. other_____________<br />
Location<br />
please state<br />
________________________<br />
Wound History<br />
recurrence<br />
length of time since previous<br />
ulcer<br />
Number of occurrences<br />
duration of <strong>wound</strong><br />
size at assessment<br />
current dressing regime<br />
frequency of dressing changes.
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