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Curativo
This document contains a list of dates and signatures for the dispensation of home medical supplies. It also includes a form for registering patient information for wound care, collecting details on their medical history, wound characteristics, medications, and allergies. The form is signed by the responsible nurse.
Curativo
- 1. Dispensação de materialpara curativo domiciliar __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ __________________________ __/___/_____ _________________________ __/___/_____ _________________________ __/___/_____ _________________________ _______________________________________________ Assinatura da enfermeira responsável
- 2. Cadastro de pacienteem curativo Nome:______________________________________________________________________________________ Endereço: ____________________________________________________________________________________ Data de nascimento:______/______/_________ idade:_________ Telefone:___________________________ Doenças/ Hábitos Hipertenso: ( ) sim ( )Não Cardíaco: ( ) sim ( )Não outros: ______________________ Diabético: ( ) sim ( )Não Vascular: ( ) sim ( )Não Fuma: ( ) sim ( )Não Historia da ferida:______________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ __________________________________________________________________________ Característica da ferida Medicações em uso/pomadas Alergias medicamentosa/pomadas ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ Localização Extensão Tecido Exsudato Odor Epitelização Sim Fétido Granulação Pouco Característico Macerada Médio Sem odor Esfacelo Muito Necrose Debridamento Fibrina Não Cirúrgico UBS Regional Sul