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

■ = Historical Item

Problems / Conditions

~~- [ ] Anemia~~
~~- [ ] Depression~~
~~- [ ] Neuropathy~~
~~- [ ] Friction~~
~~- [ ] Shear~~

Other: Mycotic toenails

~~(130 – RA) NURSING – Skin Impairment – Potential/Actual (Admission)~~

Potential for alteration in skin integrity
Actual skin impairment

AS EVIDENCED BY:

~~- [ ] Abscess~~
~~- [ ] Abrasions/bruises~~
~~- [ ] Blister(s)~~
~~- [ ] Skin tear~~
~~- [ ] Stasis ulcer(s)~~
~~- [ ] Arterial ulcer(s)~~
~~- [ ] Diabetic foot ulcer(s)~~
~~- [ ] Gangrene~~
~~- [ ] Pressure ulcer~~
~~- [ ] Stage I~~
~~- [ ] Stage II~~
~~- [ ] 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~~

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