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    KKM Wound Borang Kemajuan Luka

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    rebecca
    This document contains guidelines for wound care services in primary health care facilities. It includes forms for wound assessment, wound progress evaluation, and wound care plans. The forms collect patient information, wound characteristics, examination results, diagnosis, treatment plan including dressing types and frequency of follow-up, education provided, and referrals made.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    KKM Wound Borang Kemajuan Luka

    Uploaded by

    rebecca
    293 views4 pages
    This document contains guidelines for wound care services in primary health care facilities. It includes forms for wound assessment, wound progress evaluation, and wound care plans. The forms collect patient information, wound characteristics, examination results, diagnosis, treatment plan including dressing types and frequency of follow-up, education provided, and referrals made.

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    © © All Rights Reserved

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    This document contains guidelines for wound care services in primary health care facilities. It includes forms for wound assessment, wound progress evaluation, and wound care plans. The forms collect patient information, wound characteristics, examination results, diagnosis, treatment plan including dressing types and frequency of follow-up, education provided, and referrals made.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    293 views4 pages

    KKM Wound Borang Kemajuan Luka

    Uploaded by

    rebecca
    This document contains guidelines for wound care services in primary health care facilities. It includes forms for wound assessment, wound progress evaluation, and wound care plans. The forms collect patient information, wound characteristics, examination results, diagnosis, treatment plan including dressing types and frequency of follow-up, education provided, and referrals made.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    GARIS PANDUAN PERKHIDMATAN PENJAGAAN LUKA DI FASILITI KESIHATAN PRIMER

    Lampiran 3

    BORANG PENILAIAN LUKA


    KLINIK KESIHATAN :

    NOMBOR PENDAFTARAN : TARIKH :

    MAKLUMAT PERIBADI

    NAMA :

    NO. KP/ PASSPORT :

    UMUR :

    JANTINA :

    BANGSA :

    ALAMAT :

    PEKERJAAN :

    NO. TELEFON :

    MASALAH SEMASA (CHIEF COMPLAINT)

    SEJARAH PESAKIT/ FAKTO RISIKO

    DIABETES AUTOIMMUNE DISEASE

    HYPERTENSION CANCER/ MALIGNANCY

    PERIPHERAL VASCULAR DIASEASE/ VENOUS INSUFFICIENCY SMOKER

    DIABETES BMI OTHERS eg: CKD, IHD, CVA, COPD

    SEJARAH UBAT / CURRENT DRESSING

    SEJARAH SOSIAL

    m/s 1

    22
    GARIS PANDUAN PERKHIDMATAN PENJAGAAN LUKA DI FASILITI KESIHATAN PRIMER

    TANDA VITAL

    BP : HR : SPO2 : TEMP : RBS : PAIN SCORE :

    LOKASI LUKA

    SILA LAKARKAN
    LOKASI LUKA

    BIL. LUKA 1 2 3 4 5 6

    PANJANG (CM)

    LEBAR (CM)

    DALAM (CM)

    PENILAIAN LUKA

    PENYIASATAN MAKMAL/ RADIOLOGI

    UJIAN JENIS / TARIKH / KEPUTUSAN

    BLOOD

    XRAY

    CULTURE

    DIAGNOSIS

    JENIS LUKA

    CANCER WOUND SURGICAL WOUND

    PRESSURE INJURY TRAUMATIC WOUNDS

    DIABETIC ULCER BURNS

    VENOUS ULCER OTHERS

    m/s 2

    23
    GARIS PANDUAN PERKHIDMATAN PENJAGAAN LUKA DI FASILITI KESIHATAN PRIMER

    PELAN PERAWATAN LUKA


    1. Cleansing Solution
    Superoxidise Solution Water For Irrigation
    PHMB (polyhexamethylene biguanide) Diluted Povidone - Iodine Solution
    Octenidine Dihydrochloride Others :

    2. Primary Dressing
    Hydrogel : Collagen :
    Polymeric Membrane Dressing :
    Anti-microbial gel :
    Foam :
    Alginate gel : Others :

    3. Secondary dressing
    Tulle dressing : Polymeric membrane dressing :
    Film Dressing : Foam :
    Alginate : Gauze / gamgee :
    Others :

    4. Skin Protection / Barrier


    Aqueous cream : Barrier Spray / Cream :
    Zinc Oxide : Others :
    Collagen lotion :

    5. Compression Bandage
    Stockinette Type : _______________________

    6. Patient’s Education
    Personal Hygiene Wound site Advise
    Turning and Positioning Nutritional
    Sign of wound infection Others :

    7. Rujukan
    Pegawai Dietetik Pegawai Farmasi
    Pegawai Sains Pemakanan Hospital
    Pegawai Kerja Sosial Perubatan

    8. Temujanji :

    Tandatangan : Nama / cop :

    m/s 3

    24
    GARIS PANDUAN PERKHIDMATAN PENJAGAAN LUKA DI FASILITI KESIHATAN PRIMER

    Lampiran 4
    KKM/BPKK/WC 301-2018

    BORANG KEMAJUAN LUKA

    NAME : I/C :

    WOUND :

    DATE OF DRESSING
    SIZE OF WOUND
    LENGTH (CM)
    WIDTH (CM)
    DEPTH (CM)
    TISSUE VIABILITY
    <25 >25 <25 >25 <25 >25 <25 >25 <25 >25
    % OF SLOUGH / NECROTIC
    % RED (GRANULATION TISSUE)
    % PINK (EPITHELIAL TISSUE)
    INFECTION
    PRESENT (systemic / local)
    NO
    MOISTURE (EXUDATE)
    DRY
    MINIMAL
    WET MODERATE
    HEAVY
    WOUND EDGES (Healthy, Maceration, Dehydration, Rolled Edges, Undermining)

    PERIWOUND SKIN (Healthy, Maceration, Excoriation, Dry, Hyperkerotosis, Callus, Eczema)

    DRESSING SOLUTION

    DRESSING MATERIAL

    RANDOM BLOOD GLUCOSE


    PAIN SCORE
    DEBRIDEMENT METHOD
    CULTURE TAKEN (DATE)
    TYPES OF ANTIBIOTIC
    TCA / FOLLOW UP
    DRESSING DONE BY
    DOCUMENTED BY
    COMMENTS

    m/s 1

    25

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