Physical Assessment Form Page 6
ADVERTISEMENT
1
2
3
4
5
6
7
8E: UPPER EXTREMITIES
Comments:
IDENTIFYING LEVEL OF RISK OF PRESSURE
HIGH RISK FACTORS
◊
1. Does the Service User have a history of skin trauma?
Yes
No
Location:
___________________________________________________________________________________________
◊
2. Does the Service User presently have a skin trauma?
Yes
No
Location:
___________________________________________________________________________________________
Stage / Grade:
1
Redness
2
Skin breakdown
3
Underlying tissue involvement
4
Sinus / bone infection
(For more detailed stage description please refer to references below 2 & 3)
◊
3. Can the Service User do an independent weight shift?
Yes
No
◊
If yes: Is it effective?
Yes
No
◊
If yes: Is it consistent?
Yes
No
If any of the diamonds above are ticked the Service User is a High Pressure-Risk user
MODERATE RISK FACTORS
◊
1. Is the Service User very bony in the sitting position and is active?
Yes
No
◊
2. Does the Service User have atrophied muscle in the sitting surface and is active?
Yes
No
◊
3. Does the Service User have impaired/absent sensation on sitting/lying surface and is active? Yes
No
If any of the diamonds above are ticked the Service User is a Moderate Pressure-Risk user (unless already a
High Pressure Risk user)
LOW RISK
If no diamonds in any of the above sections above are ticked the Service User is a Low Pressure-Risk user
FINAL RISK:
High
Moderate
Low
1. National Pressure Ulcer Advisory Panel (NPUAP). (Last updated 11/2003). NPUAP Staging Report. ,
referenced 10/06/2005.
2.Cook, A. M., & Hussey, S. M. (2002). Assistive Technology: Principles and Practice. (Second Edition). Mosby, Inc: St. Louis. Ch6, Pg189
Don’t forget your
!
Page 6 of 8
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical