• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Course Login

WoundEducators.com | Online Wound Care Certification Courses

Your online source for wound care certification.

  • Courses
  • About Us
    • Meet The Team
    • Risk-Free Guarantee
    • Accredited Wound Care Course Info
    • Student Testimonials
    • Our Mission to Help
  • Why Certify?
    • What’s Included
    • How Hard is Wound Care Certification?
    • Wound Care Certification Cost
    • Wound Care Certification for Nurses
    • Getting Started: Wound Care Certification
  • Resources
    • Sign up for Our Newsletter
    • Search Wound Care Jobs
    • Post a Wound Care Job
    • Submit Your Resume
    • I Completed My Wound Care Course – Now What?
    • Wound Care CE Hours Online
    • Wound Care Recertification Process
  • Certifications
    • Compare Wound Care Certification Options
    • ABWM® Wound Care Certifications
      • The CWCA® Certification
      • The CWS® Certification
      • The CWSP® Wound Care Certification
    • The WCC® Certification
    • The AWCC® Wound Care Certification
    • The CWCN® Certification
  • Blog
  • FAQ’s
  • Contact

Wound Assessment- Wound Location and Size

September 30, 2014 Leave a Comment

64
SHARES
ShareTweetGoogle +Linkedin
PinterestRedditTumblrStumbleuponDiggDelicious

wound sizePrior to assessing a wound, it may be necessary to irrigate and/or debride the wound so that the actual size of the wound can be determined, as well as the wound characteristics. Ideally, the same person should assess the wound each time, with the patient positioned in the same manner, to maximize the reliability of the wound assessment.

Location of the Wound

It is important to describe the location of the wound as accurately as possible, using the correct anatomical terminology. Why is wound location important? Wound location can provide information regarding the etiology of the wound. For example, a wound on a patient’s coccyx is likely due to pressure, while a wound on the lower leg may be due to venous insufficiency. The location of the wound will also guide dressing selection and other interventions, such as use of pressure-relieving devices.

You should document as specifically as possible the area of the body (i.e. lower leg), the side of the body (right or left) and the surface on which the wound is located (i.e. anterior, medial, posterior). If there are multiple wounds present, you can label the wounds alphabetically (i.e. wound A and wound B) and describe their location relative to specific anatomical landmarks (i.e. wound A is located 2 cm distal to the tibial tuberosity, wound B is located 3 cm above the medial malleolus).

Size of the Wound

There are several methods that can be used to measure wound size. More important than the method you use is that you use the same method consistently, as changes in wound size can be used to determine whether a wound is improving or getting worse over time.

Direct measurement– Direct measurement involves measuring the wound at its longest length and its widest width. Width should be measured perpendicular to the length. By multiplying the length times the width (l x w), you will obtain the surface area of the wound. To measure wound depth, you will need a probe. Insert the probe gently into the deepest part of the wound and note the measurement at the point where the probe is level with the skin surrounding the wound. For wounds with an irregular depth at different points, use the clock method to measure wound depth, with the top of the wound (12:00) being the part of the wound that faces the patient’s head. Direct measurement is easy to learn, simple to perform and is also cost effective.

Wound tracing– Wound tracings are another popular method to determine wound size. This method uses wound tracing sheets comprised of two layers: a layer that contacts the wound, and a layer that is adhesive that can be affixed to the patient’s record or chart. To perform a wound tracing, you must first clean the transparent contact layer to prevent contaminating the wound. Then place the transparency against the wound, ensuring it makes contact with the entire wound, and trace the wound in its entirety. The contact layer is discarded, and the outer (permanent) layer is placed in the patient’s record/chart. Surface area is calculated by multiplying length times width, as in direct measurement. You should make sure to label the recording with the patient’s name, the date and time, the wound location and the measured size. You must measure wound depth directly and this too should be recorded, as well as other characteristics. Note that some commercial transparencies will have premeasured marks in a grid pattern, which makes calculation of wound size a simple matter of counting the number of squares contained within the wound outline. Wound tracing may be more reliable than direct measurement because they present a more accurate depiction of wound size, particularly when wounds are round or irregularly shaped. Of course, wound tracing is only as accurate as the clinician performing the tracing.

There are other wound measurement methods that are sometimes used, such as photographic measurement and volumetric measurement, but these are less common.

If you enjoy learning about wound care management, or your job requires you to manage clients with wounds, you might consider becoming a certified wound care professional. The online wound care certification education offered by Wound Educators allows you to study in the comfort of your own home, at your own pace.

Sources

Meyers, B (2008). Wound Management: Principles and Practice. 2nd edition. Pearson Prentice Hall. Upper Saddle River, New Jersey. pg. 48-50.

Morgan, N. Measuring wounds. Wound Care Advisor, July 11, 2012 http://woundcareadvisor.com/measuring-wounds/

 

 

Categories: Wound Assessment and Documentation

About the Author

Laurie Swezey's avatar

Laurie Swezey, founder and president of WoundEducators.com, has been a Registered Nurse for more than a quarter century, with most of those years dedicated to wound treatment. Ms. Swezey is a Certified Wound Care Nurse and a Certified Wound Specialist.

Reader Interactions

Leave a Comment Cancel

This site uses Akismet to reduce spam. Learn how your comment data is processed.

sidebar

Blog Sidebar

Free Preview!

Sign up for our newsletter and enjoy a Free Preview of our Wound Care Certification Course!

Support Our “Where There’s a Wound, There’s a Way!™” Foundation

fundraiser logo

Join our “Where There’s a Wound, There’s a Way!™” fundraising campaign  Learn more

Payment Information

All major credit cards & PayPal accepted. All transactions are performed via a SSL secure server to ensure your privacy.

payments accepted visa mastercard amex discover paypal

Copyright © 2009-2021 WoundEducators.com
Wound Care Certification Courses | Risk Free Guarantee | Terms and Policies

We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking “Accept”, you consent to the use of ALL the cookies.
Cookie settingsACCEPT
Manage consent

Privacy Overview

This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may affect your browsing experience.
Necessary
Always Enabled
Necessary cookies are absolutely essential for the website to function properly. These cookies ensure basic functionalities and security features of the website, anonymously.
CookieDurationDescription
cookielawinfo-checbox-analytics11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checbox-functional11 monthsThe cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checbox-others11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-necessary11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-performance11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy11 monthsThe cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.
Functional
Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features.
Performance
Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors.
Analytics
Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc.
Advertisement
Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. These cookies track visitors across websites and collect information to provide customized ads.
Others
Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet.
SAVE & ACCEPT