Wound Care Orders by 67qd0Aqf

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									                                                                                                   PLACE LABEL HERE
WOUND CARE
ORDERS
     The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
          Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

LOCATION OF  WOUND or  RASH: ______________________ TYPE: ______________________
STAGE OF PRESSURE ULCER: ___________________ POA: Yes or No
           Partial Thickness             Full Thickness
1.     Consult dietician if not already done
2.     Float heels       Heel protectors      Pillow or waffle cushion when sitting
3.    Positioning: turn q 2 hrs          Left  Right        Back
4.    Clean wound with:  Normal Saline  Wound Cleanser
5.    Dry surrounding skin/peri-wound area

MEDICATIONS:
6.    With every dressing change, apply to peri-wound or rash area:
          None                               Anti-fungal ________________________________________
          Skin prep                          Mycolog (nystatin/triamcinolone) Cream
          Moisture Barrier                Other: ____________________________________________

7.  With every dressing change, apply to wound bed:
       Gauze moistened with:  NS  Gel  Dakin’s ¼ Strength (sodium hypochlorite)
                               Other: _____________________________________________________
       NuGauze ____ inch: moistened with:  NS  Gel  Dakin’s ¼ Strength (sodium hypochlorite)
                                                Other: __________________________________________
       Debriding Agents:  Santyl (collagenase)
       Antibiotic ointment:  Bactroban  Triple Antibiotic (neomycin/bacitracin/polymixin)
                              Silvadene (silver sulfadiazine)
8.  Silver Nitrate to closed wound edges by Certified Wound Care Nurse
9.  Sharp excisional debridement with scissors/scalpel by Certified Wound Care Nurse
10. Cover wound with:
               Dry gauze  Absorbent Foam  Hydrocolloid  Silicon dressing
               Elastogel  Adaptic/Non-adherent gauze  Alginate  Other: ___________________
11. Secure dressing with ___________________________________________________________________
12. Change dressing q: __________ day(s)  BID  Other: ____________________________________
13. DC previously ordered topical: ____________________________________________________________
    

ADDITIONAL INSTRUCTIONS:
________________________________________________________________________________________

________________________________________________________________________________________
______________           ___________________             _________________________________                 __________
Date                     Time                            Physician Signature                               PID Number


*1-21265*                          FORM 1-21265 REV. 05/2012     WHITE: Medical Record   CANARY: Nursing       Page 1 of 1

								
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