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14791
Beschreibung
https://www.hope-clara.de/ The HOPE Hospice and Palliative Care Recording standard documentation is used for documentation of palliative care and as an instrument for quality assurance in pallatiave wards, hospices and oncological wards as well as in ambulatory services and palliative teams.
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- 28.04.16 28.04.16 -
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CC BY-NC 3.0
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28. April 2016
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Creative Commons BY-NC 3.0
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Palliative and Hospice Care Wound Treatment In Palliative Medicine
Palliative and Hospice Care Wound Treatment In Palliative Medicine
Ähnliche Modelle
Palliative and Hospice Care Wound Treatment In Palliative Medicine
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Baseline Form Number
Item
Baseline Form Number
integer
C0237753 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Item
Who completes this form?
integer
C0027361 (UMLS CUI [1,1])
C0700287 (UMLS CUI [1,2])
C0700287 (UMLS CUI [1,2])
CL Item
Doctor (1)
CL Item
Doctor's specialty (2)
CL Item
Nurse (3)
CL Item
Other staff (profession) (4)
Doctor's specialty
Item
Doctor's specialty
text
C0037778 (UMLS CUI [1])
Other staff (profession)
Item
Other staff (profession)
text
C0851286 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0028811 (UMLS CUI [1,3])
C0205394 (UMLS CUI [1,2])
C0028811 (UMLS CUI [1,3])
Wound exists since
Item
Wound exists since:
text
C0043250 (UMLS CUI [1,1])
C2987476 (UMLS CUI [1,2])
C2987476 (UMLS CUI [1,2])
previous therapy
Item
previous therapy
text
C1514463 (UMLS CUI [1])
CL Item
exulcerating tumor wound (1)
CL Item
decubitus ulcer, degree: (2)
CL Item
radiotherapy wound (3)
CL Item
other: (4)
degree of decubitus ulcer
Item
degree of decubitus ulcer
text
C0011127 (UMLS CUI [1,1])
C0449286 (UMLS CUI [1,2])
C0449286 (UMLS CUI [1,2])
other type of wound
Item
other type of wound
text
C1276783 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,2])
Item
wound- or therapy-related handicap
integer
C0231170 (UMLS CUI [1,1])
C0043250 (UMLS CUI [1,2])
C0039798 (UMLS CUI [1,3])
C0043250 (UMLS CUI [1,2])
C0039798 (UMLS CUI [1,3])
CL Item
odor (1)
CL Item
pain (2)
CL Item
pruritus (3)
CL Item
exudation (4)
CL Item
bleeding (5)
CL Item
issues eating, drinking, vision, hearing etc. (6)
CL Item
sleep disturbance (7)
CL Item
social isolation (8)
CL Item
body image (9)
other wound- or therapy-related handicap
Item
other wound- or therapy-related handicap
text
C0231170 (UMLS CUI [1,1])
C0043250 (UMLS CUI [1,2])
C0039798 (UMLS CUI [1,3])
C0205394 (UMLS CUI [1,4])
C0043250 (UMLS CUI [1,2])
C0039798 (UMLS CUI [1,3])
C0205394 (UMLS CUI [1,4])
Localization
Item
Localization
text
C0475264 (UMLS CUI [1])
Size, length
Item
Size, length, maximum of cm long:
integer
C0456389 (UMLS CUI [1,1])
C1444754 (UMLS CUI [1,2])
C1444754 (UMLS CUI [1,2])
Size, width
Item
Size, width, maximum of cm wide:
integer
C0456389 (UMLS CUI [1,1])
C0487742 (UMLS CUI [1,2])
C0487742 (UMLS CUI [1,2])
Size, depth
Item
Size, depth, maximum of cm deep:
integer
C0456389 (UMLS CUI [1,1])
C0205125 (UMLS CUI [1,2])
C0205125 (UMLS CUI [1,2])
CL Item
granulation tissue (1)
CL Item
fibrin film (2)
CL Item
epithelial layer (3)
CL Item
dry necrosis (4)
CL Item
wet necrosis (5)
CL Item
body structures such as muscles, fibers: (6)
Wound bottom body parts
Item
Wound bottom body parts
text
C1511276 (UMLS CUI [1,1])
C0043250 (UMLS CUI [1,2])
C0229962 (UMLS CUI [1,3])
C0043250 (UMLS CUI [1,2])
C0229962 (UMLS CUI [1,3])
CL Item
intact (1)
CL Item
diffuse (2)
CL Item
ragged (3)
CL Item
undermined (4)
CL Item
dry (5)
CL Item
macerated (6)
CL Item
edematous (7)
CL Item
reddened (8)
CL Item
intact (1)
CL Item
hardened (2)
CL Item
scaly (3)
CL Item
swollen (4)
CL Item
dry (5)
CL Item
macerated (6)
CL Item
none (1)
CL Item
faint (2)
CL Item
medium (3)
CL Item
strong (4)
CL Item
none (1)
CL Item
viscous (2)
CL Item
liquid (3)
CL Item
bloody (4)
CL Item
none (1)
CL Item
small (2)
CL Item
medium (3)
CL Item
large (4)
Item
Wound surface film
integer
C0043250 (UMLS CUI [1,1])
C0205148 (UMLS CUI [1,2])
C1561572 (UMLS CUI [1,3])
C0205148 (UMLS CUI [1,2])
C1561572 (UMLS CUI [1,3])
CL Item
yellow solid (1)
CL Item
yellow soft (2)
CL Item
greenish (3)
CL Item
gray/black (4)
CL Item
reddening (1)
CL Item
tumor (2)
CL Item
hyperthermia (3)
CL Item
functional disability (4)
CL Item
none (1)
CL Item
continuous (2)
CL Item
only during change of bandages (3)
CL Item
on contact (1)
CL Item
spontaneous (2)
CL Item
none (1)
CL Item
mild (2)
CL Item
moderate (3)
CL Item
severe (4)
Comment
Item
Comment
text
C0947611 (UMLS CUI [1])
wound smear test
Item
wound smear test
boolean
C0444086 (UMLS CUI [1])
excision sample
Item
excision sample
boolean
C0728940 (UMLS CUI [1,1])
C0870078 (UMLS CUI [1,2])
C0870078 (UMLS CUI [1,2])
other
Item
other
text
C0205394 (UMLS CUI [1])
Item
Photography documentation (with flash)
integer
C0031749 (UMLS CUI [1])
C0920316 (UMLS CUI [2])
C0920316 (UMLS CUI [2])
CL Item
patient agreed to photo documentation (1)
CL Item
palliative (1)
CL Item
curative (2)
CL Item
protection of surrounding skin (1)
CL Item
reduction of odor (2)
CL Item
size reduction of the wound (3)
CL Item
atraumatic change of bandage (4)
CL Item
reduction/absorption of secretion (5)
CL Item
containment of bleeding (6)
CL Item
pain reduction (7)
CL Item
cosmetically acceptable bandage (8)
CL Item
assistance with the experience and the challenges (9)
Comment
Item
Comment
text
C0947611 (UMLS CUI [1])
Item
Therapeutic procedures for wound management
integer
C0087111 (UMLS CUI [1,1])
C1272654 (UMLS CUI [1,2])
C1272654 (UMLS CUI [1,2])
CL Item
wound cleaning (1)
CL Item
wound purging solvent (2)
CL Item
wound therapeutics (3)
CL Item
wound overlay (4)
CL Item
wound margin protection (5)
CL Item
therapy for exudate (6)
CL Item
procedures against bleedings (7)
CL Item
procedures against odor (8)
CL Item
pharmaceutic procedures (9)
CL Item
additional procedures (10)
CL Item
other (11)
Other therapeutic procedures for wound management
Item
Other therapeutic procedures for wound management
text
C0087111 (UMLS CUI [1,1])
C1272654 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C1272654 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
gentle removal of the bandage
Item
gentle removal of the bandage, wetting of the bandage with:
text
C0004726 (UMLS CUI [1,1])
C0015252 (UMLS CUI [1,2])
C0015252 (UMLS CUI [1,2])
CL Item
no cleaning (1)
CL Item
surgical cleaning (2)
CL Item
autolysis (3)
CL Item
enzymatic cleaning (4)
CL Item
biosurgical (maggots) (5)
CL Item
ultrasound (6)
CL Item
other: (7)
other wound cleaning
Item
other wound cleaning
text
C0455099 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,2])
CL Item
clary tea (1)
CL Item
aseptic water (2)
CL Item
ringer solution (3)
CL Item
NaCl 0,9% (4)
CL Item
local antibiotic (5)
CL Item
antiseptic (6)
CL Item
other (7)
other wound rinses
Item
other wound rinses
text
C0043250 (UMLS CUI [1,1])
C1882955 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C1882955 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
CL Item
silverhydrate wound overlay (1)
CL Item
alginate (2)
CL Item
morphine gel (3)
CL Item
antiseptic gel (4)
CL Item
hydrofibres (5)
CL Item
hydrogel (6)
CL Item
sterile honey (7)
CL Item
wound distance grid (1)
CL Item
coal containing wound overlay (2)
CL Item
foam bandage (3)
CL Item
suction compression (4)
CL Item
super absorber (5)
CL Item
sterile compression (6)
CL Item
fixation mat (7)
CL Item
silicon coated fixation bandage (8)
CL Item
other (9)
Other wound overlay
Item
Other wound overlay
text
C0043250 (UMLS CUI [1,1])
C1706359 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C1706359 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Item
Specific procedures for wound margin protection
integer
C1545981 (UMLS CUI [1,1])
C1545588 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,3])
C0205369 (UMLS CUI [1,4])
C1545588 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,3])
C0205369 (UMLS CUI [1,4])
Code List
Specific procedures for wound margin protection
CL Item
zinc lotion (1)
CL Item
silicone oil (2)
CL Item
urea cream (3)
CL Item
dexpanthenol lotion (4)
Item
specific therapeutic procedures for exudation
integer
C0311437 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
C0205369 (UMLS CUI [1,3])
C0087111 (UMLS CUI [1,2])
C0205369 (UMLS CUI [1,3])
Code List
specific therapeutic procedures for exudation
CL Item
drainage, stoma material (1)
Item
Specific therapeutic procedure for exudation, vacuum therapy
integer
C0311437 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
C0205369 (UMLS CUI [1,3])
C1322784 (UMLS CUI [1,4])
C0087111 (UMLS CUI [1,2])
C0205369 (UMLS CUI [1,3])
C1322784 (UMLS CUI [1,4])
Code List
Specific therapeutic procedure for exudation, vacuum therapy
CL Item
black sponge (1)
CL Item
white sponge (2)
Item
Specific therapeutic procedures for bleeding wounds
integer
C0087111 (UMLS CUI [1,1])
C0205369 (UMLS CUI [1,2])
C0241742 (UMLS CUI [1,3])
C0205369 (UMLS CUI [1,2])
C0241742 (UMLS CUI [1,3])
Code List
Specific therapeutic procedures for bleeding wounds
CL Item
compression of the wound (1)
CL Item
sympathomimetic agent (e.g. suprarenin) (2)
CL Item
NaCl 0,9% ice cubes on capillary bleedings (3)
CL Item
application of sucralfat suspension (4)
CL Item
local absorbable hemostyptic agent (5)
CL Item
local non-absorbable hemostyptic agent (6)
Item
Specific therapeutic procedures for malodorous wounds
integer
C0087111 (UMLS CUI [1,1])
C0205369 (UMLS CUI [1,2])
C2168496 (UMLS CUI [1,3])
C0205369 (UMLS CUI [1,2])
C2168496 (UMLS CUI [1,3])
Code List
Specific therapeutic procedures for malodorous wounds
CL Item
compressions soaked with antiseptic agent (1)
CL Item
compressions soaked with antibiotic agent (2)
CL Item
compressions soaked with chlorophyll 0,25% (3)
CL Item
painkillers (1)
CL Item
antibiotics (2)
CL Item
sedatives (for wounds close to blood vessels) (3)
CL Item
other (4)
other pharmaceuticals
Item
other pharmaceuticals
text
C0013227 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,2])
CL Item
lymphatic drainage (1)
CL Item
physiotherapy (2)
CL Item
counseling on stoma therapy (3)
CL Item
compression bandage (4)
CL Item
fragrance lamp (5)
CL Item
odor binding synthetic (6)
description of localization
Item
Please describe the localization of the wound and plot it in the drawing
text
C0475264 (UMLS CUI [1,1])
C0678257 (UMLS CUI [1,2])
C0678257 (UMLS CUI [1,2])