Appendix 5: Weekly Measurement Tool

Introduction

Patient Name:________________________________________________________Date:________________________________

Location:________________________________  Tunnel:  _____________ o'clock _____________ cm

Size (length × width):______________________cm      _____________ o'clock _____________ cm

Depth:_________________________________ cm      _____________ o'clock _____________ cm

Wound base: ________ % red      ________ % yellow      ________ % black

Odor: ________ present ________ absent

Exudate: ________ color ________ amount

Dressing Type: ___________________________________________________________________

Frequency Change: _____________________________________________________________________

Pertinent Labs: _______________________________________________________________________

Nutritional Supplements: ______________________________________________________________

Pressure-Relieving Program/Devices: ___________________________________________________

Clinician Signature/Title:_____________________________________________________