Waterlow Pressure Sore Assessment Chart > 의학

Question/Area to explore

Score Value

Date:

Date:

Gender

x

x

x

Female

2

Male

1

Age

x

x

x

14-49

1

50-64

2

65-74

3

75-80

4

81+

5

Height-Weight: BMI

x

x

x

Average 20 – 24.9

0

Above average 25 – 29.9

1

Obese above 30

2

Below Average below 20

3

Skin Type-Visual Risks Area

x

x

x

Healthy

0

Tissue paper

1

Dry

1

Oedematous

1

Discoloured: Stage 1

2

Broken spots: Stage 2 - 4

3

Mobility

x

x

x

Fully mobile

0

Restless/fidgety

1

Lethargic

2

Restricted

3

Inert/Traction

4

Chair bound

5

Continence

x

x

x

Complete/catheterised

0

Occasion incontinence

1

Cath/incontinent of faeces

2

Doubly incontinent (urine & faeces)

3

M.U.S.T.

x

x

x

What is patient’s MUST Score?

?

Special Risks-Tissue Malnutrition

x

x

x

Cardiac Failure

5

Peripheral Vascular disease

5

Anaemia

2

Smoking

1

Question/Area to explore

Score Value

Date:

Date:

Special Risks-Neurological Deficits 

x

x

x

CVA: Stroke

4-6

Diabetes