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Care Plan Activity Report

Kings Harbor Multicare Center

Resident: Barksdale, Clydia
Unit-Room-Bed: M1 - 114 - A
DOB: 6/15/1928 (96 y)
System/Facility ID: 19302 / 041353

Selection:
Scheduled Date: 3/11/2025; With Corrections: From 3/5/2025

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• Stage III
• Stage IV
• Unstageable secondary to nonremovable dressing/device
• Unstageable secondary to slough and/or eschar
• Unstageable secondary to deep tissue injury
• Excoriation
• Cellulitis to __________________________
• Wound
• Rash
• Surgical wound
• Burn(s)
• Open lesion(s) other than ulcers, rashes, cuts (e.g. cancer lesion)
• Vascular Ulcer
• Moisture Associated Skin Damage (MASD)
• Other ________________________________

RELATED TO:

• Terminal illness
• PVD
• Diabetes
• MS
• Hemiparesis/Hemiplegia
• Impaired sensory perception
• Hx stasis/pressure ulcers
• Use of restraint
• Dementia/Alzheimer’s Disease
• Incontinence
• Bed mobility problems
• Splint/Cast/Device to (Specify) __________________
• Use of antidepressants, antianxiety, hypnotics, & antipsychotics
• Contractures
• S/P Fracture Specify: __________________________
• Edema
• Impaired mobility
• S/P Surgery
• Weight loss
• Malnutrition/low body weight/obesity
• Trauma
• Advanced age
• Bed rest
• Prolonged hospitalization
• Eczema/Psoriasis/Rash/Dermatitis
• Fragile skin
• Cancer
• History of previous breakdown
• Hypoalbuminemia
• LBM
• ESRD

⬜ = Historical Item

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generated by Anash, Nikol on 4/17/2025 at 9:36 am
v4 SigmaCare by MatrixCare
Page 110 of 464