1)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H732/S
Patient: Rivera-Mendez, Maria
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 07/09/1935 (83 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: Major depressive disorder, dementia, Alzheimers disease, spondylosis without
myelopathy or radiculopathy, osteoarthritis, asthma, functional dyspepsia, chronic rhinitis,
pressure ulcer, herpesviral vesicular dermatitis, vision loss, age-related cataract, and atopic
dermatitis.
Pertinent meds: alendronate, citalopram, and silver sulfadiazine.
Risk factors: decreased mobility, positional difficulty, decreased sensation, dementia,
Alzheimers disease, major depressive disorder, and h/o pressure ulcer.
Pain: no pain evident
Extremities: normal
General/Appearance: normal
Location: left gluteal cleft
Etiology(+/-stage): NPUAP stage 3
Size LxWxD (cm): 0.3 x 0.3 x 1 cm
Undermining/tunneling: none
Hist. involvement: SQ
Color: 100% Granulation
Moisture amount: moderate
Exudate: serous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: unstable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Change to Therahoney gel daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
2)WOUND PHYSICIAN: Joseph Yehounatan MD
( 516) 423-4526
Facility: TCC : 8/21/18 Room: H755S
Patient: Lourdes Calero Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 9/21/1958
(59)
Chief complaint: pressure ulcer on upper back Allergies: Mushrooms
PMH: Obesity, diabetes, hypothyroidism, depression, CAD, COPD, Dysphagia
RISK FACTORS: _Agitation _Anemia _Cancer X_COPD _Comatose _Confusion _CHF
_XContractures
_XCAD _Dec. sensation _Dementia _XDepression X_Diabetes _Diarrhea _Edema _XFragile skin
[X] H/o DU _Hospice _Hypoalbum _Hypoxia [X] Immobility _Immunosupp. _XIncont. Feces
_Incont. Urine _Liver failure [X] Malnutrition _Neuropathy _Non-compliant X_Obesity
_Osteomyelitis _Para/HP/quad _Parkinsons _PAD [] Renal failure [] Sepsis _Steroid use
_Tobacco _Underweight _Ven. stasis _Wt. loss _diminished pulses/PVD
Pain: _agitation _crying [X] no pain evident _restless _withdrawn
Extremities: _Clubbing _Contractures _Cyanosis _Dermatitis _Edema _Hair loss _Nail
dystrophy
General/Appearance: _Agitated _Cachectic _Calm & cooperative _Confused _Contracted
_Generalize edema _Immobile _Mild discomfort [X] No apparent distress _Well-groomed
_Well-nourished
Peripheral artery disease with wound to left great toe
PAD
1 x 1 x 0 cm
Histological involvement Dermis
 100 % scab
Moisture dry
exudate none
periwound normal
foul odor none
edema none
unstable
healing potential suboptimal
Calcium alginate daily and PRN
Peripheral artery disease with wound to Right great toe
PAD
0.3 x 0.2 x 0.1 cm
Histological involvement SQ
100 % Granulation
Moisture moderate
exudate serous
periwound normal
foul odor none
edema none
Improving
healing potential suboptimal
Calcium alginate daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time:
_XABI/Arterial Doppler to r/o PVD
[X] Offload wound
_XBed: group2/
_XCaution during transfers, bath (fragile skin)
_Chair: regular/gel cushion/ roho
_XConsult _____Follow up with surgery _________________________
_Elevate legs to level of heart to reduce edema
_Feet: regular/bunny; cradle/waffle/pillow; easy boot; multipodus boot
_Heel lifts, if available. Place pillow under calves for heel suspension
_Labs: CBC w diff/CMP/prealbumin/albumin
_Limit time spent in sitting position
_XNutritional Supplement
_NWB on affected LE unless o/w ordered by PMD
_XOptimize pain control/pain consult
_XOptimize glycemic control
_Patient is scheduled for discharge home
_Patient/family/companion has been educated
_Physical therapy
_Place knee spacer or pillow between knees
_Postop f/u operating surgeon _________________
_Protect LE from trauma
_PT to acquire appropriate positioning device
_Educated pt to shift weight q15min while sitting
_Radiograph to r/o osteomyelitis _______________
_Titrate diuretics prn edema control
Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: [X] weekly prn _monthly prn _bimonthly prn _reconsult prn
(Wound Care Consultant Tel #(516) 423 4526
Joseph Yehounatan MD CWS
3)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: H616S
Patient: William James
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 7/10/1949 (69)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Talwin
Past Medical History: Diabetes, diabetic foot ulcer status post left foot metatarsal amputation,
neuropathy
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Diabetic foot ulcer left dorsal foot
diabetic foot ulcer
wound measuring 2.0 x 3.0 x 0.2 cm
Histology involvement SQ
100 % Granulation
moderate drainage
serous exudate,
and no odor.
improving
Dressing: Calcium alginate BID and PRN
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Follow up
with surgery . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan MD (516)
423 4526
4)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H618/B
Patient: Mitchell, Anitha
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 12/20/1947 (70 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: HTN, bipolar disorder, hypercholesterolemia, GERD, PVD, osteoarthritis, chronic
bronchitis, glaucoma, athscl heart disease, chronic pulmonary embolism, arial fibrillation,
hyperlipidemia, delirium, schizophrenia, vit B deficiency, venous HTN, anemia, postmenopausal
bleeding, CKD, cardiac arrhythmia, heart failure, tinea corporis, seborrheic dermatitis,
candidiasis, allergic rhinitis, COPD, abnormal weight loss, DM, DU, nutritional deficiencies,
hypoosmolality, hyponatremia, major depressive disorder, and dysphagia.
Meds pertinent to wound: folic acid, furosemide, acetaminophen, mirtazapine, MVI,
olanazapine, sodium chloride, and warfarin.
RISK FACTORS: decreased mobility, positional difficulty, diminished pulses with PVD,
schizophrenia, anemia,
possible tissue hypoxia, renal failure, COPD, tobacco history, diabetes, decreased sensations,
h/o pressure ulcer,
depression, and poor wound healing.
Extremities: see below
General/Appearance: normal
Location: left lower leg
Etiology(+/-stage): vascular ulcer; venous stasis disease
Size LxWxD (cm): 18.0 x 8 x 0.1 cm
Undermining/tunneling: none
Hist. involvement: subcutaneous
Color: 100% pink epithelial
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: unstable
Healing potential: suboptimal
Surg. Procedure: not recommended.
Primary Dressing: Xeroform followed by coflex Q48 hours and PRN.
Treatment and Dressing Plan: Continue to pre-medicate prn pain with dressing changes. Clean
wound and periwound area with normal saline solution or wound cleanser prior to applying
primary dressing and cover secondarily with gauze and tape. Continue to treat periwound with
routine cleaning protocol. Offload wound. Adhere to facility's protocol on repositioning,
decubitus prevention, pain management, weight monitoring, and nutritionist involvement.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan MD (516)423-4526
5WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H652/A
Patient: Pou, Eric
DOB/Age: 4/13/56 (62 y)
Family Hx: [X] NC Soc Hx: [X] Tob _EtOH [X] NC
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: talwin
PMH: DM, hypokalemia, heart failure, hepatic failure, GERD, HTN, edema, insomnia, major
depressive disorder, opioid dependence, polyneuropathy, CKD, PVD, hypertrophy, dysuria,
shortness of breath, hypertensive heart disease, testicular hypofunction, benign prostatic
hyperplasia, and COPD.
Meds pertinent to wound: amitiza, ASA-low, eplerenone, gabapentin, klonopin, lasix,
methadone, omeprazole, senna, tamsulosin, trazodone, and xifaxan.
RISK FACTORS: decreased mobility, positional difficulty, diabetes, decreased sensations, renal
failure, depression, diminished pulses with PVD, COPD, and tobacco history.
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: right lower leg
Etiology(+/-stage): vascular
Size LxWxD (cm): Graft in place
Undermining/tunneling: none
Hist. involvement: subcutaneous
Color: 100% Granulation
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: cellulitis
Tissue edema: none
Infection/Abx: resolved
Objective: healing
Wound progress: unstable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: dressing in place as per surgeon not to be touched for 1 week
Location: Left dorsal foot
Etiology(+/-stage): dry scab
healed
PAD wound Right second and third toe (Right dorsal foot)
2 x 2.5 x 0.3 cm
80 % Granulation 20% slough
Histological involvement SQ
Moisture moderate exudate
exudate serous
periwound macerated
antibiotics indicated
100 % Granulation
Unstable
change to Clotrimazole/ Triamcinolone BID
Surgical donor site right upper thigh
5 x 4 x 0.1 cm
histological involvement SQ
100 % Granulation
moisture scant
exudate serous
initial evaluation
Xeroform daily ad PRN
PVD with wound to left anterior shin
Peripheral vascular disease
( 2 wounds measured as 1)
0.7 x 0.7 x 0.2 cm
100 % Granulation
moisture moderate
exudate serous
initial evaluation
Calcium Alginate daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: VASCULAR
SURGERY CONSULT Above recommendations discussed with nursing staff. Thank you for the
consult. Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan
MD (515) 423 4526
6WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H655/S
Patient: Smith, Lamont
Family Hx: [X] NC Soc Hx: [X]Tob _EtOH [X] NC DOB/Age: 08/12/1953 (65 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: bipolar disorder cardiac arrhythmias, DM, hyperlipidemia, hepC, thrombocytopenia,
hypo-osmolality, hyponatremia, thrombocytopenia, major depressive disorder, iron deficiency
anemia, ischemic heart disease, PVD, HTN, dermatitis, hemoptysis, chronic gingivitis, alcoholic
liver disease, postherpetic polyneuropathy, hepatic failure, opioid dependence, insomnia,
pityriasis versicolor, edema, hypertensive heart disease, pleural effusion, COPD, DU,
dyspepsia, xerosis cutis, UTI, osteomyelitis, bacteremia, and pruritus.
Meds pertinent to wound: ASA-low, cipro, coreg, diphenhydramine, gabapentin, lasix,
methadone, MVI, oxycodone, prilosec, spironolactone, and xifaxan.
RISK FACTORS: decreased mobility, positional difficulty, diabetes, decreased sensations,
depression, anemia, possible tissue hypoxia, diminished pulses with PVD, COPD, edema,
tobacco history, h/o pressure ulcer , poor wound healing. bleeding because he has
thrombocytopenia, hepatitis c and cirrhosis and is on aspirin.
Extremities: see below
General/Appearance: normal
Location: right ischium
Etiology(+/-stage): NPUAP Stage 3
Size LxWxD (cm): 3 x 5.7 x 0.4 cm
Undermining/tunneling: none
Hist. involvement: subcutaneous
Color: 90% Granulation and 10% slough
Moisture amount: scant
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Therahoney daily and PRN
Left and right legs,Stable multiple vascular wounds with no measurements. 100% red with
large moisture, serosanguinous exudate, and no odor. Histology involvement is dermis.
Dressing: Zinc Oxide daily and PRN wound is stable this week.
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with Normal saline prior to applying primary
dressing and cover secondarily with gauze and tape. Periwound should be treated with routine
cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus prevention
protocol. Pain was addressed where appropriate. Nutritionist involvement and weight
monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan MD (516) 423 4526
7)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H682/S
Patient: Washington, Annabelle
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 02/17/1937 (81 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: HTN, dry eye syndrome, GERD, folate deficiency anemia, DM, osteoarthritis,
polyneuropathy, heartburn, DU, osteoporosis, sicca syndrome, impacted cerumen,
hypercholesterolemia, dyspepsia
Meds pertinent to wound: baclofen, gabapentin, hydrochlorothiazide, labetalol, lipitor, losartan,
acetaminophen, MVI, nifedipine, omeprazole, and oxycodone.
RISK FACTORS: decreased mobility, positional difficulty, diabetes, decreased sensations,
anemia, possible tissue hypoxia, and h/o pressure ulcer.
Extremities: contracted
General/Appearance: normal
Location: sacrum
Etiology(+/-stage): NPUAP Stage 4
Size LxWxD (cm): 1.3 x 1 x 1.5 cm
Undermining/tunneling: 12:00 = 1 cm
Hist. involvement: muscle
Color: 90% granulation 10 % slough
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: Unstable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Pack with Iodoform Packing BID and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan MD (516) 423 4526
8)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H510/S
Patient: Glazer, Howard Chester
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 11/11/1932 (85 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Detrol LA, fesoterodine, oxybutynin, SEAFOOD, and SOIFENACIN
PMH: HTN, heartburn, BPH, puritis, obstructive uropathy, and vit deficiency.
Pertinent medications: enalapril, finasteride, heparin, metoprolol, multivitamin, omeptrazole,
ranitidine, and senna.
Additional RF: decreased mobility, positional difficulty, and hypoalbuminemia.
Pain: no pain evident
Extremities: see below
General/Appearance: frail
Location: left upper back
Etiology(+/-stage): NPUAP 3
Size LxWxD (cm): 1 x 0.4 x 0.1 cm
Undermining/tunneling: none
Hist. involvement: SQ
Color: 100% granulation
Moisture amount: scant
Exudate: serosanguinous
Odor: none
Periwound: blanching erythema
no odor
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: xeroform daily and PRN
Location: Sacrum
Etiology(+/-stage): NPUAP stage 4
Size LxWxD (cm): 4.0 x 3.5 x 0.4 cm
Undermining: deepest at 12:00 = 1.0 cm
Hist. involvement: muscle
Color: 30% yellow and 70% granulation
Moisture amount: scant
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: suboptimal
Surg. Procedure: not recommended
Primary Dressing: Santyl daily and PRN
Location: left gluteal cleft
Etiology(+/-stage): NPUAP Stage 4
Size LxWxD (cm): 0.3 x 0.4 x 0.4 cm
Undermining/tunneling: deepest at 12:00 = 1.0 cm
Hist. involvement: muscle
Color: 20% yellow and 80% pink
Moisture amount: moderate
Exudate: serosanguinous
Odor: malodorous
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Pack with Iodoform packing BID and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with Dakins and normal saline solution prior to
applying primary dressing and cover secondarily with gauze and tape. Periwound should be
treated with routine cleaning protocol. Offload wound. Adhere to facility repositioning and
decubitus prevention protocol. Pain was addressed where appropriate. Nutritionist involvement
and weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
9WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: H513/S
Patient: Suckins, Monroe
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 03/24/1951 (67 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: depression, anorexia, hypercholesterolemia, PVD, muscle weakness, HLD, GERD, CHF,
atrial fibrillation, atrial flutter, osteoporosis, HTN, dementia, seizures, impetigo, and
hypothyroidism.
Pertinent meds: Atorvastatin, gabapentin, mirtazapine, and warfarin.
Risk Factors: decreased sensation, decreased mobility, positional difficulty, depression,
anorexia, muscle weakness, CHF, dementia, seizures, PVD, and possible tissue hypoxia.
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Left lateral ankle
Etiology (+/-stage): Vascular
Size LxWxD (cm): 7 x 5 x 0.3 cm
Undermining/tunneling: none
Hist. involvement: subcutaneous
Color: 90% granulation and 10% yellow
Moisture amount: moderate
Exudate: serosanguinous
Odor: mild
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: unstable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: cleanse site with 1/4 strength Dakin's solution apply Silvadene and cover
with dry protective dressing BID and PRN
TED stockings for compression therapy
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Recommend
physical therapy. Above recommendations discussed with nursing staff. Thank you for the
consult. Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan
(516) 423 4526
10)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: H516/S
Patient: Beverly Idels
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 12/2/1957 (60)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Risk factors to wound healing: PVD, COPD, Diabetes, Anemia, CHF, hypothyroidism
PAD with wound to left 2nd toe
Peripheral artery disease
histological involvement unable to determine
1.0 x 1.3 x 0 cm
100 % eschar
moisture dry
exudate none
periwound thinned
antibiotics not indicated
stable
healing potential unavoidable due to above risk factors
Betadine cover with dry protective dressing BID and PRN
Vascular surgery consult
PAD with wound to left 5th toe
Peripheral artery disease
histological involvement full thickness
2 x 1.5 x 0.0 cm
100 % Dry gangrene
moisture moderate
exudate serous
periwound thinned
antibiotics not indicated
stable
healing potential unavoidable due to above risk factors
Betadine cover with dry protective dressing daily and PRN
Vascular surgery consult
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with sterile water solution prior to applying primary
dressing and cover secondarily with gauze and tape. Periwound should be treated with routine
cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus prevention
protocol. Pain was addressed where appropriate. Nutritionist involvement and weight
monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Recommend
physical therapy. Above recommendations discussed with nursing staff. Thank you for the
consult. Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan
(516) 423 4526
11)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: H523/A
Patient: Hee Shik Han
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 5/17/1931 (87)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Past medical history: History of pressure ulcers, CAD, PAD, anemia, immobility, decreased
sensation, anemia, abnormal weight loss, Stroke history, Alzheimer dementia, Parkinson's
disease
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Pressure ulcer right foot bunion
Etiology (+/-stage): NPUAP stage 3
Size LxWxD (cm): 0.8 x 0.7 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: SQ
Color: 80 % Granulation 20 % slough
Moisture amount: moderate
Exudate: serous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: Improving
Healing potential: suboptimal due to above risk factors
Primary Dressing: Therahoney gel daily and PRN
Location: Pressure ulcer left foot bunion
Etiology (+/-stage): NPUAP stage SDTI
healed
Asked by nursing staff to evaluate left and right sacrum for wounds: No wounds noted. Healed
scars noted on exam.
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Recommend
physical therapy. Above recommendations discussed with nursing staff. Thank you for the
consult. Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan
(516) 423 4526
12)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: H530 S
Patient: Donald Rhodes
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 2/5/1953 (65)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Past medical history: CKD, anemia, Diabetes, CHF, immobility, decreased sensation
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Open wound Coccyx
Etiology (+/-stage): excoriation
Size LxWxD (cm): 4 x 2 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: dermis
Color: 100 % Granulation
Moisture amount: moderate
Exudate: serous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: Initial evaluation
Healing potential: suboptimal due to above risk factors
Primary Dressing: Honey foam daily and PRN

Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Recommend
physical therapy. Above recommendations discussed with nursing staff. Thank you for the
consult. Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan
(516) 423 4526
13)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: H533 S
Patient: Blunnie, Elizabeth
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 80 (03/01/1938)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: codeine, radiocontrast and shellfish.
PMH: hypocalcemia, a-fib, hypothyroidism, HTN, ESRD, nutritional deficiency and diabetes.
Meds pertinent to wound: allopurinol, aspirin, atorvastatin, calcium acetate, guaifenesin,
ipratropium-albuterol, levothyroxine, metoprolol tartrate, polyethylene glycol, repaglinide, and
warfarin.
Pertinent labs (04/09/2018 CBC, CMP): H/H 8.5/26.2, INR 1.75, BUN/Cr 58/6.01, AST/ALT
27/33, Glu 149.
RISK FACTORS: decreased mobility, positional difficulty, diabetes and ESRD.
Vascular: diminished peripheral pulses; Cap. Refill equivocal
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Patient continues to sleep every night with her legs dangling in bed, even when warned
countless times by me and staff that her wound is secondary to venous hypertension and by
doing so she leads to worsening wound. She admits to this and says she will attempt to
change her behavior.
Location: right posterior leg
Etiology(+/-stage):PVD
Size LxWxD (cm): 5 x 3.5 x 0 cm
Undermining/tunneling: none
Hist. involvement: unable to determine
Color: 70% yellow 30 % Granulation
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: thinned
Tissue edema: none
Infection/Abx: indicated
Objective: healing
Wound progress: Unstable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Honey foam daily and PRN
Location: right medial leg (extending too right posterior leg)
Etiology(+/-stage): PVD
Size LxWxD (cm): 13 x 6.5 x 0 cm
Undermining/tunneling: none
Hist. involvement: full thickness
Color: 20% yellow 60 % tendon 20 % Granulation
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: unstable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Honey Foam daily and PRN
Vascular consult
PAD with wound to left 2nd toe
peripheral artery disease
0.5 x 0.5 x 0 cm
80 % slough 20 % granulation
moisture moderate
exudate serous
periwound fragile
unstable
healing potential suboptimal
change to Honey Foam dressing daily and PRN
PAD with wound to left dorsal foot
peripheral artery disease
0.3 x 0.3 x 0.1 cm
100 % Granulation
moisture moderate
exudate serous
periwound fragile
stable
healing potential suboptimal
Honey Foam dressing daily and PRN
PAD with wound to right upper shin ( now combined with right posterior leg)
PAD with wound to left medial leg
peripheral artery disease
3.7 x 2.5 x 0.2 cm
100 % Granulation
moisture moderate
exudate serous
periwound fragile
improving
healing potential suboptimal
Honey foam dressing daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with 1/4 strength Dakin's solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: VASCULAR
SURGERY CONSULT . Above recommendations discussed with nursing staff. Thank you for
the consult. Follow up: weekly prn. PLEASE CONTACT DR. Yehounatan (516) 423 4526
14)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: H536/S
Patient: Cordova, Maria
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 01/10/1963 (55 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: ibuprofen
PMH: hypothyroidism, depression, hypokalemia, CHF, diabetes, GERD, COPD, osteoarthritis,
anemia, polyneuropathy, asthma, bipolar disorder, PVD, hep C, HTN, edema, dysuria, opioid
dependence, polyneuropathy, schizophrenia, alcohol abuse, Q fever, DVT, and morbid obesity.
Pertinent meds: citralopram, gabapentin, levofloxacin, metformin, methadone, Percocet,
quetiapine, senna, tizanidine, and zolpidem.
RISK FACTORS: decreased mobility, positional difficulty, decreased sensation, CHF, diabetes,
and hep C.
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Right foot dorsum
Etiology(+/-stage): Vascular
Size LxWxD (cm): 4 x 8 x 0.3 cm
Undermining/tunneling: none
Hist. involvement: SQ
Color: 90 % Granulation 10 % slough
Moisture amount: large
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Metrogel cover with xeroform daily and PRN
Vascular surgery consult
PVD with wound to right posterior calf
PVD
3 x 2 x 0.2 cm
histological involvement SQ
90 % Granulation 10 % slough
drainage moderate
exudate serous
unstable
change to Honey Foam dressing daily and PRN
PVD with wound to right posterior distal leg
PVD
1 x 4 x 0.2 cm
histological involvement SQ
90 % Granulation 10 % slough
drainage moderate
exudate serous
initial evaluation
Honey Foam dressing daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Vascular
surgery consult Above recommendations discussed with nursing staff. Thank you for the
consult. Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan
(516) 423 4526
15)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: H555/B
Patient: Smith, James
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 6/22/1949 (69 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: GERD, cerebral disease, Type II DM, angina pectoris, hyperlipidemia, HTN, iron
deficiency anemia, dysphagia, fever, heart disease, sepsis, vit. deficiency, and osteomyelitis.
Meds pertinent to wound: acetaminophen, amlodipine, amoxicillin, and asa.
RISK FACTORS: possible tissue hypoxia, anemia, and heart disease.
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Right heel
Etiology (+/-stage): Surgical
Size LxWxD (cm): 2.3 x 2.0 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: muscle
Color: 100% granulation
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Therahoney gel daily and PRN
Venous stasis with wound to right shin
Peripheral vascular disease
1 x 1.5 x 0.2 cm
histological involvement dermis
moisture scant
exudate serous
initial evaluation
xeroform daily and PRN
Treatment and Dressing Plan: Continue to pre-medicate prn pain with dressing changes. Clean
wound and periwound area with normal saline solution or wound cleanser prior to applying
primary dressing and cover secondarily with gauze and tape. Continue to treat periwound with
routine cleaning protocol. Offload wound. Adhere to facility's protocol on repositioning,
decubitus prevention, pain management, weight monitoring, and nutritionist involvement.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan MD (516) 423 4526
16)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: H559 S
Patient: Stokes , Frank
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 4/24/1958 (60)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: penicillins
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Right Hip abscess
Etiology (+/-stage): abscess
healed
protect with dry protective dressing daily and PRN
Treatment and Dressing Plan: Continue to pre-medicate prn pain with dressing changes. Clean
wound and periwound area with normal saline solution or wound cleanser prior to applying
primary dressing and cover secondarily with gauze and tape. Continue to treat periwound with
routine cleaning protocol. Offload wound. Adhere to facility's protocol on repositioning,
decubitus prevention, pain management, weight monitoring, and nutritionist involvement.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up:Re
consult prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan MD (516) 423 4526
17)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H527/S
Patient: Kerr, Claudia
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 12/16/1951 (66 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: penicillamine and NSAIDS.
PMH: osteoporosis, vit deficiency, multiple myeloma, and dermatitis.
Meds pertinent to wound: alendronate, cepacol, enulose, oxycodone-acetaminophen, and zinc
oxide.
RISK FACTORS: decreased mobility, positional difficulty, and decreased sensation.
Asked by nursing staff to evaluate patient for wound to Sacrum; No wound noted at this time.
Please protect with Optifoam Q 48 hours and PRN. Reconsult PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Recommend
physical therapy. Above recommendations discussed with nursing staff. Thank you for the
consult. Follow up: Reconsult PRN prn. FOR ANY QUESTIONS, PLEASE CONTACT DR.
Yehounatan (516) 423 4526
18WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: C411/A
Patient: Covington, Marcia
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 07/29/1962 (56 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: Athscl. Heart disease, DM II, HTN, major depressive disorder, GERD, intracardiac
thrombosis, and acquired coagulation factor deficiency.
Pertinent meds: acetaminophen, aspirin, atorvastatin, cefpodoxime, gabapentin, metformin ER,
metoprolol succinate ER, metronidazole, mirtazapine, morphine, nortriptyline, ondasetron HCl,
oxycodone, and pantoprazole.
Risk factors: decreased mobility, positional difficulty, decreased sensation, DM II, HTN, major
depressive disorder, GERD, and acquired coagulation factor deficiency.
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Patient status post amputation wound descriptions below
Location: surgical site left TMA
Etiology(+/-stage): Surgical site
Size LxWxD (cm): 3.0 x 6 x 0.3 cm
Undermining/tunneling: none
Hist. involvement: muscle
Color: 100% Granulation
Moisture amount: scant
Exudate: serous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: unavoidable
Surg. Procedure: not recommended
Primary Dressing: cover with dry protective dressing daily and PRN
Pressure ulcer Left heel
NPUAP stage 4
1.7 x 2.6 x 0.5 cm
histological involvement muscle
90 % granulation 10 % slough
Moisture moderate
exudate serous
improving
healing potential unavoidable
cleanse with 1/4 strength Dakin's solution cover with calcium alginate BID
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Note: No
palpable pulses. Needs follow up appointments with vascular doctor and surgeon. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
19)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: C408 /A
Patient: Joseph Policastro
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 12/8/1954 (63)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Talwin
PMH: Athscl. Heart disease, DM II, HTN, CAD, PAD, diabetic neuropathy, hyperlipidemia
Risk factors: decreased mobility, positional difficulty, decreased sensation, DM, CAD, Diabetic
foot ulcer status post left TMA , Osteomyelitis to wound
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: surgical site left TMA
Etiology(+/-stage): Surgical site
Size LxWxD (cm): 2 x 13 x 0 cm
Undermining/tunneling: none
Hist. involvement: muscle
Color: 80 % eschar 20 % Granulation
Moisture amount: dry
Exudate: none
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: indicated for Osteomyelitis
Objective: healing
Wound progress: unstable
Healing potential: unavoidable
Surg. Procedure: not recommended
Primary Dressing: change to Xeroform daily and PRN
Diabetic foot ulcer right plantar foot
Diabetic foot ulcer
3 x 7 x 0.0 cm
histological involvement full thickness
100 % scab
Moisture dry
exudate none
antibiotics indicated for Osteomyelitis
unstable
healing potential unavoidable
change to Betadine cover with dry protective dressing daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: follow up with
surgery Needs follow up appointments with vascular doctor and surgeon. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
20)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C412B
Patient: Nato Kereselidze
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 10/2/1949 (68)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA.
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Surgical site Left Knee
Etiology(+/-stage): surgical site
healed
Location: Surgical site Left medial Knee
Etiology(+/-stage): surgical site
healed
Location: Surgical site Left lateral Knee
Etiology(+/-stage): surgical site
healed
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: follow up with
surgery . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. PLEASE CONTACT DR. Yehounatan (516) 423 4526
21)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C412A
Patient: Charlotte Bangoura
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 9/7/1957 (60)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA.
PMH: Diabetes, Right TMA, PAD, CAD, Hyperlipidemia, polyneuropathy
Risk factors: decreased mobility, positional difficulty, and decreased sensation, Diabetes, Right
TMA, PAD, CAD, Hyperlipidemia, polyneuropathy
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Surgical site right TMA
Etiology(+/-stage): surgical site
Size LxWxD (cm): 3.7 x 6.6 x 1 cm
Undermining/tunneling: none
Hist. involvement: subcutaneous
Color: 90% granulation 10 % slough
Moisture amount: moderate
Exudate: serous
Odor: none
Periwound: blistered
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: dressing placed by patient's surgeon not to be touched until seen by
surgeon again
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: follow up with
surgery . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. PLEASE CONTACT DR. Yehounatan (516) 423 4526
22)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C409B
Patient: Frank Walsh Jr
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 6/29/1943 (75)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Moxifloxicin
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Open wound right great toe
Etiology(+/-stage): excoriation
Size LxWxD (cm): 0.4 x 0.4 x 0.1 cm
Undermining/tunneling: none
Hist. involvement: dermis
Color: 100% granulation
Moisture amount: scant
Exudate: serous
Odor: none
Periwound: blistered
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: initial evaluation
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Bacitracin daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: follow up with
surgery . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. PLEASE CONTACT DR. Yehounatan (516) 423 4526
23)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C415 B
Patient: Grace Pica Burgos
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 9/4/1957 (60)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Fish
Risk factors: decreased mobility, positional difficulty, and decreased sensation, Diabetes, Right
TMA, PAD,Osteomyelitis, Nicotine usage
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Surgical site right TMA (2nd-5th toes)
Etiology(+/-stage): surgical site
Size LxWxD (cm): 7.5 x 6.0 x 1 cm
Undermining/tunneling: none
Hist. involvement: subcutaneous
Color: 90% granulation 10 % slough
Moisture amount: moderate
Exudate: serous
Odor: none
Periwound: thinned
Tissue edema: none
Infection/Abx: indicated for Osteomyelitis
Objective: healing
Wound progress: improving
Healing potential: suboptimal
Primary Dressing: Pack with continuous moist dressing with normal saline BID and PRN
Awaiting surgical follow up
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: follow up with
surgery . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. PLEASE CONTACT DR. Yehounatan (516) 423 4526
24)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 821/18
Room: C417 B
Patient: Guillermo Vinas
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 4/7/1936 (82)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA.
PMH: ESRD, Diabetes, diabetic neuropathy, hyperlipidemia , CAD, COPD, anemia
Risk factors: decreased mobility, positional difficulty, and decreased sensation, Diabetes,
ESRD, COPD, polyneuropathy
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: IV Infiltrate site right anterior forearm
Etiology(+/-stage): IV site
Size LxWxD (cm): 1.0 x 1.0 x 0 cm
Undermining/tunneling: none
Hist. involvement: unable to determine
Color: 100 % slough
Moisture amount: moderate
Exudate: serous
Odor: none
Periwound: blistered
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: suboptimal
Surg. Procedure: not recommended
Primary Dressing: Xeroform daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: follow up with
surgery . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. PLEASE CONTACT DR. Yehounatan (516) 423 4526
25)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C417A
Patient: Derek Upson
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 10/6/1959 (58)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies NKA
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Surgical site Right Medial leg
Surgical site
0.7 x 0.4 x 0.2 cm
Histological involvement dermis
moisture dry
exudate none
antibiotics not indicated
periwound thinned
improving
healing potential suboptimal
xeroform daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Follow up
with surgery . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. PLEASE CONTACT DR. Yehounatan (516) 423 4526
26)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C419A
Patient: Annette Taylor
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 5/31/1962 (56)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies NKA
Past medical history: Diabetes, CHF, PAF, CAD, neuropathy
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Surgical site left lower extremity
Surgical site
healed
Location: Surgical site left upper thigh dehiscence site
Surgical site
healed
Location: Surgical site left medial lower extremity
Surgical site
48 sutures removed without complication
Histological involvement dermis
moisture dry
exudate none
antibiotics not indicated
periwound thinned
improving
healing potential suboptimal
skin prep daily and PRN
Surgical site left great toe
surgical amputation site left great toe
histological involvement muscle
3.0 x 6 x 1.0 cm
10 % slough 90 % Granulation
moisture scant
exudate serous
improving
healing potential suboptimal
Santyl cover with xeroform daily and PRN
follow up vascular surgery
patient warned very high possible need for graft placement for eventual healing
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Follow up
with surgery . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. PLEASE CONTACT DR. Yehounatan (516) 423 4526
27)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/14/2018
Room: C426A
Patient: Carlos Oyola
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 6/5/1955 (63)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Risk factors to healing: osteomyelitis, Diabetes, Neuropathy , diabetic foot ulcers, chronic viral
hepatitis, Chronic kidney disease
Vascular: diminished peripheral pulses; Cap Refill: Equivocal
Pain: no pain evident
Extremities: normal
General/Appearance: normal
Diabetic foot ulcer left lateral distal foot
Diabetic foot ulcer
healed
Diabetic foot ulcer left lateral distal plantar foot
Diabetic foot ulcer
1.0 x 1.0 x 0.2 cm
histological involvement SQ
30 % Granulation 70 % slough
moisture scant
exudate serous
periwound thinned
antibiotics indicated for Osteomyelitis
improving
healing potential unavoidable
change to Betadine cover with dry protective dressing daily and PRN
Follow up with Vascular surgery
PAD with wound to right second toe
PAD
0.4 x 0.3 x 0.2 cm
histological involvement SQ
20 % slough 80 % granulation
moisture scant
exudate serous
periwound thinned
antibiotics indicated for Osteomyelitis
improving
healing potential unavoidable
Therahoney gel daily and PRN
Follow up with Vascular surgery
Patient warned of high likelihood of eventual amputation. He understands and thanks us for
services.
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: follow up with
surgery . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423
4526
28)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C443 B
Patient: Deloris Weaver
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: ( 5/9/1937 (81)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Pollen
PMH: Asthma, anemia, pressure ulcer, immobility, decreased sensation, urinary and fecal
incontinence , CHF
Pain: no pain evident
Extremities: normal
General/Appearance: normal
Pressure ulcer Sacrum
NPUAP stage 3
Wound measures 0.5 x 0.4 x 0.2 cm
100 % Granulation
Histological involvement SQ
Moisture moderate
exudate serous
antibiotics: Not indicated
improving
Therahoney gel daily and PRN
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: None . Above
recommendations discussed with nursing staff. Thank you for the consult. PLEASE CONTACT
DR. Yehounatan MD (516) 423 4526
29)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H416 S
Patient: Charles Tressan
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 12/17/1961 (56)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: COPD, CAD, right foot abscess status post I and D, bladder Cancer status post partial
resection, Chronic kidney disease
RISK FACTORS: decreased mobility, positional difficulty, decreased sensation, COPD, CAD,
right foot abscess status post I and D, bladder Cancer status post partial resection, Chronic
kidney disease
Vascular: diminished peripheral pulses; Cap Refill: Equivocal
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Surgical I & D site right plantar foot
Surgical site
2.3 x 3 x 1.0 cm
histological involvement full thickness
80 % granulation 20 % slough
moisture scant
exudate serous
antibiotics indicated for abscess
healing potential suboptimal
improving
change to Silvasorb gel daily and PRN
Open wound Scalp
secondary to chronic fungal scalp
2 x 2 x 0.2 cm
90 % Granulation 10 % slough
improving
Bactroban BID and PRN
PAD with wound to right second toe
PAD
healed
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: follow up with
surgery . . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan MD (516)
423 4526
30)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H417 S
Patient: Dowling, David
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 10/10/1970 (47)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Vascular: diminished peripheral pulses; Cap Refill: Equivocal
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Surgical site Right Knee
surgical wound
healed
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Follow up
with surgery Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan MD (516)
423 4526
31)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C427 S
Patient: Concepcion Jamie Pacheco
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 3/13/1962 (56)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Pain: no pain evident
Extremities: normal
General/Appearance: normal
Location: Surgical site back
Etiology(+/-stage): surgical site
healed
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: follow up with
surgery . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. PLEASE CONTACT DR. Yehounatan (516) 423 4526
32)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: H430 S
Patient: Matthew Kerwick
Family Hx: [X] NC Soc Hx: _Tob _XEtOH [] NC DOB/Age: 4/2/1971 (47)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
surgical site Right hip
surgical site
healed
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound
and periwound area with normal saline solution prior to applying primary dressing and cover
secondarily with gauze
and tape. Periwound should be treated with routine cleaning protocol. Offload wound. Adhere
to facility repositioning
and decubitus prevention protocol. Pain was addressed where appropriate. Nutritionist
involvement and weight
monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Surgical
consult . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: Reconsult PRN . FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516)
423 4526
33)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C434S
Patient: Robert Carrol Jr
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 3/25/1968 (50)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA.
Pain: no pain evident
Extremities: normal
General/Appearance: normal
Location: Surgical site right BKA
Etiology(+/-stage): surgical site
Size LxWxD (cm): 2 x 5.5 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: unable to determine
Color: 20 % slough 80 % Granulation
Moisture amount: scant
Exudate: serous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to continuous moist dressing with normal saline BID and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Follow up
with surgery . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. PLEASE CONTACT DR. Yehounatan (516) 423 4526
34)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: H 436 B
Patient: Gogarty Ritzi
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 2/20/1951 (67)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Pain: no pain evident
Extremities: normal
General/Appearance: normal
Surgical site left hip
Surgical site
healed
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: follow up with
surgery . Above recommendations discussed with nursing staff. Thank you for the consult.
PLEASE CONTACT DR. Yehounatan MD (516) 423 4526
35)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C436 A
Patient: Phyllis Snead
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 10/28/1934 (83)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Pain: no pain evident
Extremities: normal
General/Appearance: normal
Risk factors to wound healing: Diabetes, Vitamin deficiency, CAD, CHFm neuropathy , stroke
with hemiplegia
Open wound left dorsal foot
trauma from fall at home
Wound measures 10 x 7 x 0 cm
80 % Hematoma 20 % Granulation
Histological involvement SQ
undermining none
Moisture scant
exudate serous
antibiotics: Not indicated
initial evaluation
healing potential unavoidable due to above risk factors
skin prep to closed hematoma , xeroform to open site daily and PRN
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: None . Above
recommendations discussed with nursing staff. Thank you for the consult. PLEASE CONTACT
DR. Yehounatan MD (516) 423 4526
36)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: H442 S
Patient: Liang Chu
Family Hx: [X] NC Soc Hx: _Tob _XEtOH [] NC DOB/Age: 1/5/1963 (55)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Surgical site occipital head
surgical site
16 x 0 x 0 cm
histological involvement dermis
sutures removed without complication
moisture dry
exudate none
periwound thinned
edema none
improving
healing potential suboptimal
betadine daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound
and periwound area with normal saline solution prior to applying primary dressing and cover
secondarily with gauze
and tape. Periwound should be treated with routine cleaning protocol. Offload wound. Adhere
to facility repositioning
and decubitus prevention protocol. Pain was addressed where appropriate. Nutritionist
involvement and weight
monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Surgical
consult . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423
4526
37)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C447 B
Patient: Cristobal Diaz
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 11/16/1948 (69)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Cephalosporins, Levaquin
Pain: no pain evident
Extremities: normal
General/Appearance: normal
Risk factors to wound healing: Diabetes, Vitamin deficiency, pressure ulcers, CAD,
Hyperlipidemia, immobility, decreased sensation, urinary and fecal incontinence
Pressure ulcer left gluteal fold
NPUAP stage 4
Wound measures 0.5 x 0.3 x 2 cm
100 % Granulation
Histological involvement Muscle
undermining greatest at 12 o clock 4 cm
Moisture moderate
exudate serous
antibiotics: Not indicated
improving
healing potential unavoidable due to above risk factors
Pack with Iodoform packing BID and PRN
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: None . Above
recommendations discussed with nursing staff. Thank you for the consult. PLEASE CONTACT
DR. Yehounatan MD (516) 423 4526
38)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Patient: Tannen, Edith
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 02/16/1910 (108y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: mood disorder, MDD, hypokalemia, dysphagia, cellulitis, cough, constipation, blister,
tinea corporis, PU,
nausea, vomiting, abrasion, influenza, fever, UTI, rash, pain and dementia.
Meds pertinent to wound: bacitracin, levothyroxine, mapap, metoprolol tartrate, MVI, mupirocin
and senna.
RISK FACTORS: decreased mobility, positional difficulty, decreased sensation and dementia.
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Open wound to left lower leg
skin tear
1 x 1 x 0.2 cm
Histological involvement SQ
moisture scant
exudate serous
80 % Pink epithelial 20 % slough
periwound fragile
antibiotics not indicated
mild pitting edema to lower extremity
unstable
change to Zinc Oxide daily and PRN
Open wound right forearm
skin tear
1 x 1 x 0.1 cm
histological involvement dermis
100 % Granulation
moisture scant
exudate serous
improving
xeroform daily and PRN
Pressure ulcer left buttock
NPUAP stage 2
histological involvement dermis
100 % Granulation
0.3 x 0.3 x 0.1 cm
moisture scant
exudate serous
stable
Unavoidable due to Hospice status
Zinc Oxide Q shift and PRN
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations
discussed with nursing staff. Thank you for the consult. Follow up: weekly prn. PLEASE
CONTACT DR. Yehounatan MD at (516) 423 4526
39)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Patient: Louise McDowell
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 6/21/1943 (75)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: environmental , seasonal
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Surgical wound lower back
surgical wound
3 x 1 x 1 cm
Histological involvement SQ
80 % Granulation 20 Slough
moisture dry
exudate none
sutures in place
periwound fragile
antibiotics not indicated
stable
Betadine cover with dry protective dressing daily and PRN
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations
discussed with nursing staff. Thank you for the consult. Follow up: weekly prn. PLEASE
CONTACT DR. Yehounatan MD at (516) 423 4526
40)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H459 A
Patient: Moverline Russel
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 1/19/1962 (56)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: shellfish
Extremities: see below
General/Appearance: contracted
Risk factors to wound healing: ESRD, Immobility, pressure ulcer on admission , diabetes
Location: Pressure ulcer left heel
Etiology (+/-stage): NPUAP stage 3
healed
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none . Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
41)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Patient: Quran Walker
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 2/20/1988 (30)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Penicillins
PMH: 30 y/o, male, H/O RLE fasciotomy, provoked DVT(on Xaralto on 05-2018), anemia,
ulcerative colitis S/P ileostomy, H/O multiple GSW to abd (S/P colostomy 2012). GSW to RLE
with R SFA covered with stent placement (05-27-18). He was admitted CP with RLE swelling
and discharges, fcomplicated by RLE necrotizing myosisits with E faecalis, pseudomaonas and
proteusin wound cultures, complicated with ulcerative colitis S/P prctoscopy, penile ulcer
(HSV), on tx with valtrex
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Surgical site right lateral leg
surgical wound
22 x 6 x ? cm
Histological involvement full thickness
50 % slough 50 % Granulation ( status post removal of necrotic tissue without complication)
moisture scant
exudate serous
periwound fragile
antibiotics not indicated
healing potential unavoidable
improving
cleanse with 1/4 strength Dakin's solution then apply Silvadene BID and PRN
Surgical site right medial leg
surgical wound
11 x 3.5 x 0.3 cm
Histological involvement SQ
100 % Granulation
moisture scant
exudate serous
100 % Pink epithelial
periwound fragile
antibiotics not indicated
healing potential unavoidable
improving
cleanse with 1/4 strength Dakin's solution then apply Silvadene BID and PRN
PAD with wound to right plantar foot worsened by pressure
100 % eschar
1 x 2 x 0 cm
improving
healing potential unavoidable
Xeroform daily and PRN
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: follow up with
surgery
. Above recommendations
discussed with nursing staff. Thank you for the consult. Follow up: weekly prn. PLEASE
CONTACT DR. Yehounatan MD at (516) 423 4526
42)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Patient: John Williams
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 1/16/1924 (94)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Venous stasis with wound to left lower leg
Venous stasis
2 x 2 x 0.1 cm
Histological involvement dermis
100 % Granulation
moisture scant
exudate serous
periwound fragile
antibiotics not indicated
healing potential suboptimal
initial evaluation
zinc oxide cover with Kling daily and PRN
Venous stasis right Lower leg : zinc oxide cover with Kling daily and PRN
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none
. Above recommendations
discussed with nursing staff. Thank you for the consult. Follow up: weekly prn. PLEASE
CONTACT DR. Yehounatan MD at (516) 423 4526
43)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: H485 A
Patient: Leon Taylor
Family Hx: [X] NC Soc Hx: _Tob _XEtOH [] NC DOB/Age: 12/20/1943 (74)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Risk factors to wound healing: diabetes, PAD, status post bilateral lower extremity
amputations, urinary and fecal incontinence, anemia
Pressure ulcer right gluteal fold
NPUAP stage 3
healed
left gluteal fold healed
Pressure right perirectum
NPUAP stage 3
healed
Pressure ulcer scrotum
NPUAP stage 3
8 x 4 x 0.2 cm
histological involvement SQ
100 % granulation
moisture scant
exudate serous
periwound thinned
edema none
improving
healing potential unavoidable due to above risk factors
change to Zinc Oxide BID and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound
and periwound area with normal saline solution prior to applying primary dressing and cover
secondarily with gauze
and tape. Periwound should be treated with routine cleaning protocol. Offload wound. Adhere
to facility repositioning
and decubitus prevention protocol. Pain was addressed where appropriate. Nutritionist
involvement and weight
monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
44)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: H306 S
Patient: Theodosia, Brown
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 2/3/1938 (80)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Coconuts, nuts, green peas
PMH: Diabetes, diabetic nephropathy, immobility, urinary and Fecal incontinence , CAD,
Alzheimer dementia
RISK FACTORS: diabetic nephropathy, immobility, urinary and Fecal incontinence, CAD,
Alzheimer dementia
Vascular: diminished peripheral pulses; Cap. Refill equivocal
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Pressure ulcer sacrum
Etiology(+/-stage): NPUAP stage 2
Size LxWxD (cm): 2 x 0.5 x 0.1 cm
Undermining/tunneling: none
Hist. involvement: dermis
Color: 100 % pink epithelial
Moisture amount: scant
Exudate:serous
Odor: none
Periwound: thinned
Tissue edema: none
Infection/Abx: indicated
Objective: healing
Wound progress: improving
Healing potential: suboptimal
Surg. Procedure: not recommended
Primary Dressing: Silvadene BID and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: None . Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. PLEASE CONTACT DR. Yehounatan (516) 423 4526
45)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H335/S
Patient: Marabyan, Meri
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 06/28/1996 (22 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: naproxen
PMH: Quadriplegia, anterior spinal artery compression syndrome, respiratory tuberculosis,
muscle spasm, depression, ascorbic acid def., polyneuropathy, hypotension, GERD,
hypokalemia, insomnia, Vit D def., chronic pain, delusional disorder, hematuria, bladder
disorder, SOB, hypovolemia, abnormal EKG, bladder disorder, bronchiectasis, and xerosis
cutis.
Pertinent meds: acetaminophen, baclofen, Enemeez, gabapentin, lactulose, lidocaine,
midodrine, MVI, omeprazole, ondansetron HCL, and oxybutynin chloride.
Risk Factors: decreased mobility, decreased sensation, positional difficulty, depression,
hypokalemia, abnormal EKG and impaired wound healing.
Extremities: see below
General/Appearance: contracted
Location: Right hip
Etiology (+/-stage): NPUAP Stage 4
Size L x W x D (cm): 1.0 x 1 x 2.0 cm
Undermining/tunneling: 4:00 to 8:00, deepest at 6:00 = 4.0 cm
Histologic involvement: muscle
Color: 10% yellow and 90% pink
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: stable
Healing potential: reasonable
Surg. Procedure: none
Primary Dressing: Pack with cIodoform packing daily and PRN
zinc oxide to periwound
Location: left ischium
Etiology (+/-stage): NPUAP Stage 3
Size L x W x D (cm): 1 x 1.5 x 3.5 cm
Undermining/tunneling: none
Histologic involvement: subcutaneous
Color: 10% pink 90 % slough
Moisture amount: moderate
Exudate: serosanguinous
Odor: malodorous
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: unstable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Santyl pack with Iodoform daily and PRN
zinc oxide to periwound
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
46)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H337/A
Patient: Rix, Gloria
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 05/16/1941 (77 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: Parkinson's disease, Schizoaffective disorder, dementia, pain, PU and nutritional
deficiency.
Meds pertinent to wound: acetaminophen, aripirazole, buprorion, carbidopa, donepezil,
lamotrigine, and mirtazapine.
RISK FACTORS: decreased mobility, positional difficulty, Parkinson's, Schizophrenia, dementia,
and possible tissue hypoxia.
Vascular: peripheral pulses are grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: sacrum
Etiology(+/-stage): NPUAP stage 4
Size LxWxD (cm): 7.0 x 7.0 x 0.5 cm
Undermining/tunneling: 7 to 5 oclock, deepest @12:00 = 1.0 cm
Hist. involvement: muscle
Color: 90 % Granulation 10 % slough
Moisture amount: large
Exudate: serosanguinous
Odor: malodorous
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Opticel silver BID and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound
and periwound area with Dakins solution prior to applying primary dressing and cover
secondarily with gauze
and tape. Periwound should be treated with routine cleaning protocol. Offload wound. Adhere
to facility repositioning
and decubitus prevention protocol. Pain was addressed where appropriate. Nutritionist
involvement and weight
monitoring, as per protocol.
RECOMMENDATIONS: Above recommendations discussed with nursing staff. Thank you for
the consult. Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR.Yehounatan
(516) 423 4526 .
47)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Patient: Pernia King
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 1/14/1964 (54)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Penicillin
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Open wound right inner thigh
excoriation
histological involvement dermis
0.4 x 0.4 x 0.2 cm
100 % pink epithelial
moisture dry
exudate none
initial evaluation
Bacitracin daily and PRN
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none . Above
recommendations
discussed with nursing staff. Thank you for the consult. Follow up: weekly prn. PLEASE
CONTACT DR. Yehounatan MD at (516) 423 4526
48)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H360 S
Patient: Carmen Rios
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 3/20/1930
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: evista, fosomax, Miacalcin, Penicillins, Premarin, Sertraline, Zithromax
Vascular: peripheral pulses are grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Pressure ulcer sacrum
Etiology(+/-stage): NPUAP stage 2
Healed
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound
and periwound area with Dakins solution prior to applying primary dressing and cover
secondarily with gauze
and tape. Periwound should be treated with routine cleaning protocol. Offload wound. Adhere
to facility repositioning
and decubitus prevention protocol. Pain was addressed where appropriate. Nutritionist
involvement and weight
monitoring, as per protocol.
RECOMMENDATIONS: Above recommendations discussed with nursing staff. Thank you for
the consult. Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR.Yehounatan
(516) 423 4526 .
49)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H 216B
Patient: John Rios
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 12/21/1954 (63)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Vascular: diminished peripheral pulses; Cap. Refill equivocal
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Open wound right shin
skin tear
measuring 0.7 x 0.4 x 0.2 cm
100 % Granulation
with moderate drainage
serous exudate
no odor
Histology involvement is dermis
stable
Dressing: Zinc Oxide daily and PRN
Venous stasis with wound to right Posterior leg
PVD
0.3 x 0.3 x 0.1 cm
100 % Granulation
moisture scant
exudate serous
improving
zinc Oxide daily and PRN
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Arterial and
venous doppler is abnormal. Awaiting vascular consult. Above recommendations discussed
with nursing staff. Thank you for the consult. Follow up: weekly prn. FOR ANY QUESTIONS,
PLEASE CONTACT DR. Yehounatan (516) 423 4526
50)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H 2220
Patient: Brian Wall
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 3/25/1951 (67)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: penicillin, procain, sulfa
Vascular: diminished peripheral pulses; Cap. Refill equivocal
Pain: no pain evident
Extremities: see below
General/Appearance: normal
surgical site abdomen
surgical site
measuring 0.5 x 0.5 x 0.1 cm
100 % Granulation
with moderate drainage
serous exudate
no odor
Histology involvement is dermis
improving
Dressing: Calcium alginate daily and PRN
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Arterial and
venous doppler is abnormal. Awaiting vascular consult. Above recommendations discussed
with nursing staff. Thank you for the consult. Follow up: weekly prn. FOR ANY QUESTIONS,
PLEASE CONTACT DR. Yehounatan (516) 423 4526
51)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H 222 A
Patient: Manuel Cardona
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 8/14/1962 (56)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Vascular: diminished peripheral pulses; Cap. Refill equivocal
Pain: no pain evident
Extremities: see below
General/Appearance: normal
PAD with wound to left great toe
vascular wound
measuring 0.2 x 0.2 x 0.2 cm
100 % Granulation
with moderate drainage
serous exudate
no odor
Histology involvement is dermis
improving
Dressing: Opticel silver daily and PRN
Lotrimin cream to toes for fungal rash
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Arterial and
venous doppler is abnormal. Awaiting vascular consult. Above recommendations discussed
with nursing staff. Thank you for the consult. Follow up: weekly prn. FOR ANY QUESTIONS,
PLEASE CONTACT DR. Yehounatan (516) 423 4526
52)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H235 S
Patient: Melvin Williams
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 3/16/1967 (51)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: Noncompliance, immobility, anemia, decreased sensation, urinary and fecal
incontincence
RISK FACTORS: decreased mobility, positional difficulty, decreased sensation, anemia
Vascular: diminished peripheral pulses; Cap. Refill equivocal
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Pressure ulcer Upper sacrum
NPUAP stage 4
measuring 4.8 x 2 x 1.7 cm
Undermining greatest at 12 o clock 1 cm
90 % Granulation 10 % slough
with no moisture
no exudate
no odor
Histology involvement muscle
improving
healing potential suboptimal
Dressing: pack with Opticel silver daily and PRN
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: None Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
53)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: H236 B
Patient: Vasquez, Juan
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 56 (06/18/1962)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA.
PMH: OM, opioid dependence, DM2, vit deficiency and HTN.
Pertinent meds: acetaminophen, atorvastatin, cholecalciferol, linezolid, methadone, nifedipine,
oxycodone-acetaminophen, pantoprazole, tamsulosin, Trulicity and zosyn.
Pertinent lab (04.28.2018 CBC, CMP): Plt 503, H/H 11.8/36.4, HgA1c 13.4, Na 132, Cl 91,
BUN/Cr 23/1.73, Glu 175.
Risk factors: decreased mobility, positional difficulty, decreased sensation, and DM2.
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: left great toe amputation site (autoamputation site )
Etiology(+/-stage): diabetic foot ulcer
Size LxWxD (cm): 2 x 1.4 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: SQ
Color: 100 % yellow scab
Moisture amount: moderate
Exudate: serous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: unstable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing:change to betadine cover with dry protective dressing daily and PRN
Vascular surgery consult
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Needs
vascular consult. Needs follow-up with surgeon. Needs arterial doppler. . Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. PLEASE CONTACT DR. Yehounatan (516) 423 4526
54)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H254/B
Patient: Morgan, Natalie
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 03/06/1958 (60 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Bacitracin, Bactrim, Morphine
PMH: Type II DM, anxiety disorder, opioid dependence, postherpetic polyneuropathy, cellulitis,
bacterial infection, ulcer of esophagus, hypercholesterolemia, asthma, GERD, heartburn, and
COPD.
Meds pertinent: clonidine, fenofibrate nanocrystallized, furosemide, gabapentin,
hydromorphone, ipratropium-albuterol, Januvia, lorazepam, Maalox Advanced, metformin,
methadone, montelukast, nortriptyline, and omeprazole.
RISK FACTORS: decreased mobility, positional difficulty, decreased sensation, nutrition/
dehydration risk, COPD, GERD, and Type 2 diabetes mellitus.
Vascular: diminished peripheral pulses; Cap. Refill equivocal
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: right lower extremity
Etiology(+/-stage): vascular
Size LxWxD (cm): 10.0 x 21.0 x 0.3 cm
Undermining/tunneling: none
Hist. involvement: muscle
Color:100% granulation
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Honey foam dressing daily and PRN
Location: right medial malleolus
Etiology(+/-stage): vascular
Size LxWxD (cm): 5 x 4.5 x 0.1 cm
Undermining/tunneling: none
Hist. involvement: muscle
Color: 100% pink
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to honey foam dressing daily and PRN
Open wound left great toe
skin tear
0.8 x 0.8 x 0.2 cm
histological involvement dermis
moisture scant
exudate serous
unstable
change to Zinc Oxide daily and PRN
Fluid filled blister Left Medial Bunion
Fluid filled blister
Histological involvement dermis
moisture dry
exudate none
0.2 x 0.2 x 0 cm
improving
change to zinc oxide and PRN
Open wound left shin
venous stasis
1 x 1 x 0.3 cm
histological involvement SQ
moisture scant
exudate serous
initial evaluation
Zinc Oxide daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Vascular
Surgery Consult . Above recommendations discussed with nursing staff. Thank you for the
consult. Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan
(516) 423 4526
55)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: H256/S
Patient: Dewitt, Maurice
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 5/07/43 (75 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: HTN, type II DM, edema, HF, GERD, CKD, COPD, fever, polyneuropathy, constipation,
PU, anemia, hyperkalemia, migraine, Vit. D deficiency, SOB, diarrhea, hypothyroidism, and
rash.
Meds pertinent to wound: ASA, atorvastatin, clopidogrel, levothyroxine, Lisinopril,
Pantoprazole, senna, and tylenol.
RISK FACTORS: possible tissue hypoxia, pulse not palpable, decreased sensation, edema,
DM2, anemia, and kidney failure.
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: left heel
Etiology(+/-stage): NPUAP Stage 4
Size LxWxD (cm): 1.0 x 1.0 x 0.1 cm
Undermining/tunneling: none
Hist. involvement: muscle
Color: 100% pink epithelial
Moisture amount: small
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: stable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Opticel silver and PRN
Location: right heel
Etiology(+/-stage): NPUAP Stage 4 (Wound is resolving)
Size LxWxD (cm): 0.5 x 0.5 x 0.1 cm
Undermining/tunneling: none
Hist. involvement: muscle
Color: 100% pink
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Betadine cover with dry protective dressing QD and PRN
Open wound right dorsal foot
Open Blister
healed
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516 ) 423 4526
56)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: H264 B
Patient: Livingston, Paul
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 4/19/1972 (46)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: shrimp
PMH: Obesity, TIA, CVA, Diabetes, ESRD, anemia, PAD, Quadraplegia
RISK FACTORS: Obesity, TIA, CVA, Diabetes, ESRD, anemia, PAD, Quadraplegia
Pain: no pain evident
Extremities: see below
General/Appearance: normal
PAD with Right TMA
PAD
0.3 x 0.3 x 0.3 cm
histological involvement muscle
100 % Granulation
moisture moderate
exudate serous
improving
healing potential suboptimal
change to Honey Foam dressing daily and PRN
Vascular surgery consult
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516 ) 423 4526
57)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: H 278 S
Patient: Jean Jallot
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 1/18/1936 (82)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: COPD, Diabetes, CHF, immobility, PAD
RISK FACTORS: COPD, Diabetes, CHF, immobility, PAD
Pain: no pain evident
Extremities: see below
General/Appearance: normal
PAD with wound to left second toe
PAD
0.3 x 0.3 x 0.1 cm
histological involvement SQ
100 % Pink epithelial
moisture moderate
exudate serous
improving
healing potential suboptimal
Silvadene BID and PRN
Vascular surgery consult
PAD with wound to right second toe
PAD
0.4 x 0.4 x 0.1 cm
histological involvement SQ
100 % Pink epithelial
moisture moderate
exudate serous
stable
healing potential suboptimal
Silvadene BID and PRN
Vascular surgery consult
PAD with wound to right dorsal foot
2 x 2 x 0.1 cm
histological involvement dermis
moisture scant
exudate serous
initial evaluation
xeroform daily and PRN
Open wound left shin
4 wounds measured as 1
0.3 x 0.3 x 0.2 cm
Histological involvement dermis
100 % Granulation
improving
Calcium alginate daily and PRN
Fluid filled blister left medial shin
4 x 1 x 0.1 cm
100 % ruptured blister
moisture scant
exudate serous
improving
 Xeroform daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516 ) 423 4526
58)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 821/2018
Room: H281/S
Patient: Johnson, Ronald
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 10/25/1956 (61 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: COPD, HPN, anemia in kidney disease, candidal endocarditis, type 2 diabetes, PVD,
hyperkalemia, chronic kidney disease, ESRD, atrial fibrillation, streptococcus pneumoniae, and
altered mental status.
Meds pertinent to wound: acetaminophen, albuterol sulfate, enalapril maleate, nifedipine,
oxycodone-acetaminophen, voriconazole
RISK FACTORS: decreased mobility, positional difficulty, decreased sensation, diabetes,
COPD, anemia, possible tissue hypoxia, ESRD, diminished pulses with PVD, and altered
mental status.
Vascular: Peripheral pulses not palpable
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Right medial ankle, vascular wound measuring 0.4 x 0.4 x 0.1 cm. 100% pink epithelial with no
moisture, no exudate, and no odor. Histology involvement is SQ. Dressing: Xeroform. daily and
PRN
Location: right posterior knee
Etiology(+/-stage): vascular
Size LxWxD (cm): 1.4 x2 x 0.2 cm (two wounds are being measured as one)
Undermining/tunneling: none
Hist. involvement: subcutaneous
Color: 10% yellow and 90% pink
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: unstable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Honey foam dressing daily and PRN.
PVD with wound to right lateral upper leg
healed
Note: Awaiting vascular consult with Dr. Reid.; arterial Doppler is abnormal.
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with Dakins and saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Recommend
to place colostomy bag on left abdomen surgical wound. Awaiting vascular consult with Dr.
Reid. Above recommendations discussed with nursing staff. Thank you for the consult. Follow
up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
59)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: H 283 B
Patient: Ulysses Floyd
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 12/17/1949 (68)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Pain: no pain evident
Extremities: normal
General/Appearance: normal
Callous Left Plantar foot
Callous
healed
Callous Right Plantar foot
Callous
healed
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: Weekly
PLEASE CONTACT DR. Yehounatan (516) 423 4526
60)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H284/A
Patient: Marrero, Tomas
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 10/05/1957 (60 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Fish Containing Products
PMH: Atherosclerosis of native arteries of extremities with rest pain, bilateral legs, opioid
dependence, chronic pain, HTN, sepsis, muscle weakness, postherpetic polyneuropathy, acute
hepatitis C, hypertensive heart disease, insomnia, pain in right hip, repeated halls, pressure
ulcer, rash and other nonspecific skin eruption, iron deficiency anemia, edema, cirrhosis of liver,
cellulitis, unspecified mental disorder, altered mental status, and allergic urticaria.
Pertinent meds: acetaminophen, amlodipine, furosemide, gabapentin, hydromorphone,
methadone, spironolactone, and Xifaxan.
Risk factors: decreased mobility, positional difficulty, decreased sensation, HTN, edema,
anemia, possible tissue hypoxia, h/o pressure ulcer, cellulitis, unspecified mental disorder, and
altered mental status.
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Left anterior lower leg
Etiology(+/-stage): vascular
Size LxWxD (cm): 7.0 x 1.0 x 0.3 cm (two wounds are being measured as one)
Undermining/tunneling: none
Hist. involvement: subcutaneous
Color: 10% yellow and 90% pink
Moisture amount: scant
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Honey foam dressing daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
61)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: H284/B
Patient: Young, Perry H.
Family Hx: [X] NC
Soc Hx: _Tob _EtOH [X] NC
DOB/Age: 02/12/1952 (66 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: athscl heart disease, HPN, psychosis, cerebral infarction due to embolism, bipolar
disorder, PVD, aphasia, hyperglyceridemia, schizophrenia, vitamin D deficiency, insomnia,
subacute dyskinesia, hyperlipidemia, Long QT syndrome, cellulitis, and atherosclerosis of
native arteries of right leg.
Pertinent Meds: Abilify, aspirin, Depakote Sprinkles, Ingrezza, Santyl, trazodone, and Tylenol.
RISK FACTORS: decreased mobility, positional difficulty, diminished pulses with PVD,
schizophrenia, hypoalbuminenia, and poor wound healing.
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Right Lower anterior ankle
Etiology(+/-stage): vascular
Size LxWxD (cm): 4 x 4.3 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: muscle
Color: 10% yellow and 90% pink
Moisture amount: moderate
Exudate: serosanguinous
Odor: malodorous
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Honey foam dressing daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with Dakins solution prior to applying primary
dressing and cover secondarily with gauze and tape. Periwound should be treated with routine
cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus prevention
protocol. Pain was addressed where appropriate. Nutritionist involvement and weight
monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
62)WOUND PHYSICIAN: Yehounatan, Joseph M.D
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C222 B
Patient: Usra Saeed
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 4/13/1999 (19)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: latex, Vanilla
RISK FACTORS: Pressure ulcer history, immobility decreased sensation, urinary and fecal
incontinence .
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Presssure ulcer Sacrum
NPUAP stage 3
0.3 x 0.3 x 1 cm
100 % Pink epithelial.
histological involvement SQ
moisture scant
exudate serous
antibiotics not indicated
improving
change to Silvadene BID and PRN
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations
discussed with nursing staff. Thank you for the consult. Follow up: weekly prn. PLEASE
CONTACT DR. Yehounatan ( 516) 423 4526
63)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C226/S
Patient: Gomez, Chalies
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 22 (2/29/96)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: HTN, flatulence, ascorbic acid deficiency, iron deficiency, insomnia, epilepsy, DU,
dysphagia, dermatitis,
asthma, blister abdominal wall, candidiasis, chronic bronchitis, pseudomonas, acute follicular
conjunctivitis, infections
of skin, and h/o DU stage 4.
Meds pertinent to wound: acetaminophen, ferrous sulfate, ibuprofen, lamictal, simethicone,
and vit C.
Pertinent labs (06/05/2017 CBC): H/H 10/30.
RISK FACTORS: decreased mobility, positional difficulty, and h/o pressure ulcer.
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Right ischium
Etiology: NPUAP stage 4
Size LxWxD (cm): 0.3 x 0.3 x 0.2 cm
Undermining/tunneling: undermining from 6 to 12 o'clock, deepest at 9:00 @ 3.0 cm
Hist. involvement: muscle
Color: 20% yellow and 80% pink
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Zinc Oxide TID and PRN
Pressure ulcer left gluteal fold
NPUAP stage 3
reopened site
0.7 x 0.7 x 0.1 cm
histological involvement SQ
moisture scant
exudate serous
Zinc Oxide TID and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: None. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn.
Dr Yehounatan
516 423 4526
64)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: HN137/S
Patient: Wallerstein, Susan
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 46 (4/15/72)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: PCN
PMH: Huntington's disease, bipolar disorder, major depressive disorder, candidiasis, rash,
hyperlipidemia, cellulitis,
DU and hypertrophic nails.
Meds pertinent to wound: citalopram, clonazepam, haloperidol, acetaminophen, MVI,
simvastatin and trazodone.
RISK FACTORS: decreased mobility, positional difficulty, depression, and h/o pressure ulcer.
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
General/Appearance: normal
Location sacrum
Etiology(+/-stage): NPUAP stage 3
Size LxWxD (cm): 0.4 x 0.3 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: subcutaneous
Color: 100% granulation
Moisture amount: scant
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Zinc Oxide daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound
and periwound area with normal saline solution prior to applying primary dressing and cover
secondarily with gauze
and tape. Periwound should be treated with routine cleaning protocol. Offload wound. Adhere
to facility repositioning
and decubitus prevention protocol. Pain was addressed where appropriate. Nutritionist
involvement and weight
monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations
discussed with nursing staff. Thank you for the consult. Follow up: weekly prn. FOR ANY
QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526

65)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: HS152 A
Patient: Neforis Martinez
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 8/10/1959 ( 59)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
General/Appearance: normal
Location Open wound left ankle
Etiology(+/-stage): excoriation
healed
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound
and periwound area with normal saline solution prior to applying primary dressing and cover
secondarily with gauze
and tape. Periwound should be treated with routine cleaning protocol. Offload wound. Adhere
to facility repositioning
and decubitus prevention protocol. Pain was addressed where appropriate. Nutritionist
involvement and weight
monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations
discussed with nursing staff. Thank you for the consult. Follow up: weekly prn. FOR ANY
QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
66)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C 108 A
Patient: Thomas Williams
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 7/31/1960 (58)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
General/Appearance: normal
Pressure ulcer left lateral heel
NPUAP stage 3
0.3 x 0.5 x 0.2 cm
100 % granulation
histological involvement SQ
moisture dry
exudate none
periwound bruised
edema none
antibiotics not indicated
healing potential suboptimal
improving
change to Xeroform daily and PRN
Pressure ulcer right medial bunion
NPUAP stage unstageable
1 x 1 x 0 cm
100 % Hemorrhagic blister
histological involvement unable to determine
moisture dry
exudate none
periwound bruised
edema none
antibiotics not indicated
healing potential suboptimal
stable
betadine cover with dry protective dressing daily and PRN
Open wound Left Upper thigh
histological involvement dermis
2 x 2 x 0.1 cm
histological involvement dermis
moisture scant
exudate serous
100 % Granulation
initial evaluation
Xeroform daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound
and periwound area with normal saline solution prior to applying primary dressing and cover
secondarily with gauze
and tape. Periwound should be treated with routine cleaning protocol. Offload wound. Adhere
to facility repositioning
and decubitus prevention protocol. Pain was addressed where appropriate. Nutritionist
involvement and weight
monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations
discussed with nursing staff. Thank you for the consult. Follow up: weekly prn. FOR ANY
QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
67)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: C114/A
Patient: Rivera, Julia
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 07/22/1933 (85 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: benztropine; Diltiazem HCl; Haldol; valproic acid
PMH: HTN, DM2, obesity, heart failure, hypothyroidism, hypercholesterolemia, osteoporosis,
aplastic anemia, osteoarthritis, hyperlipidemia, tinea corporis, anxiety disorder, cellulitis,
seborrhea capitis, schizophrenia, vitamin deficiency, GERD, major depressive disorder,
hypocalcemia, hypokalemia, Alzheimers disease, altered mental status, dysuria, UTI,
hypoxemia, atrial fibrillation, hyperlipidemia, sleep apnea, PVD, bipolar disorder, gangrene,
acute kidney failure, and cellulitis.
Pertinent meds: Abilify, acetaminophen, amlodipine, Aspir-low, atorvastatin, carvedilol,
furosemide, gabapentin, isosorbide mononitrate, Januvia, Lantus, levothyroxine, linsinopril,
metformin, omeprazole, tramadol, and trazodone.
Risk factors: decreased mobility, positional difficulty, decreased sensation, diminished pulses
with PVD, possible tissue hypoxia, HTN, DM2, Alzheimers disease, altered mental status, and
major depressive disorder.
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Right first toe,
surgical wound
measuring 0.5 x 0.5 x 0.0 cm.
100 %^ scab
moisture dry
exudate none
improving
Histology involvement is subcutaneous.
healing potential suboptimal
Dressing: Betadine cover with dry protective dressing daily and PRN
right 4th toe discoloration :
1.5 x 1 x 0 cm
100 % Dry Gangrene
betadine cover with dry protective dressing daily and PRN
improving
Vascular surgery consult
PAD with wound to right second toe
1 x 1 x 0 cm
70 % slough 30 % Granulation
periwound cellulitis
antibiotics indicated Doxycycline 100 mg BID x 3 days remaining
improving
cleanse site with 1/4 strength Dakin's solution cover with Silvadene BID and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan MD (516) 423 4526
68)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: C114B
Patient: Ona Carey
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 4/8/1923 (95)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Open wound left upper extremity
excoriation
measuring 0.5 x 0.5 x 0.1 cm
100 % granulation
moisture dry
exudate none
improving
Histology involvement is subcutaneous.
healing potential suboptimal
Dressing: xeroform daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan MD (516) 423 4526
69)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Dr Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: C117/B
Patient: Chow, Yu Ming
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 10/30/1963 (54 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: Rash and other nonspecific skin eruption, thyrotxcosis, asthma, dysphasia, HTN,
pressure ulcer, atopic dermatitis, brain stem stroke syndrome, UTI, and tinea corporis.
Pertinent meds: Acetaminophen, atenolol, baclofen, levothyroxine, and vitamin D.
Risk factors: decreased mobility, positional difficulty, decreased sensation, h/o pressure ulcer,
and HTN.
Pain: no pain evident
Extremities: normal
General/Appearance: normal
Pressure ulcer left buttock
NPUAP stage 2
100 % pink epithelial
measuring 1 x 1 x 0.2 cm.
Histology involvement is dermis
moisture scant
exudate serous .
stable
Dressing: change to Silvadene BID and PRN.
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan MD (516) 423 4526
70)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: C117/A
Patient: Turney, Tracey
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 10/29/1961 (56 y)
Allergies: Bactrim, sulfa
PMH: GERD, HTN, central pain syndrome, asthma, ascorbic acid deficiency, fever, UTI,
hyperosmolality and hypernatremia, urine retention, vitamin D deficiency, volume depletion,
MDD, dysphagia, dermatophytosis, gingivitis, hyperlipidemia, tinea corporis, slow transit
constipation, pneumonia, and gastrostomy complication.
Pertinent medications: acetaminophen, baclofen, chlorhexidine, fentanyl, fleet enema, heparin,
ipratropium-albuterol, miralax, Pepcid, simvastatin, timolol maleate, Vitamin D3, and Xalatan.
Additional risk factors: decreased mobility, positional difficulty, and hypoalbuminemia.
Vascular: normal peripheral pulses; Cap. Refill <3 secs
Extremities: normal
General/Appearance: normal
Location: Sacrum
Etiology(+/-stage): NPUAP stage 4
Size LxWxD (cm): 0.5 x 0.4 x 0.2 cm
undermining/tunneling: none
Hist. involvement: muscle
Color: 90% pink epithelial 10 % slough
Moisture amount: moderate
Exudate: serous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: stable
Healing potential: suboptimal
Surg. Procedure: not recommended
Primary Dressing: Calcium alginate BID and PRN
Treatment and Dressing Plan: Continue to pre-medicate prn pain with dressing changes. Clean
wound and periwound area with normal saline solution or wound cleanser prior to applying
primary dressing and cover secondarily with gauze and tape. Continue to treat periwound with
routine cleaning protocol. Offload wound. Adhere to facilities protocol on repositioning,
decubitus prevention, pain management, weight monitoring, and nutritionist involvement.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
71)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: C118 B
Patient: Rincon, Justa
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 8/20/1942 (76)
Allergies NKA
Additional risk factors: decreased mobility, positional difficulty
Vascular: normal peripheral pulses; Cap. Refill <3 secs
Extremities: normal
General/Appearance: normal
Location: Open wound Sacrum
Etiology(+/-stage): excoriation ( 3 wounds measured as 1)
Size LxWxD (cm): 2 x 3 x 0.2 cm
undermining/tunneling: none
Hist. involvement:dermis
Color: 100% pink epithelial
Moisture amount: moderate
Exudate: serous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: initial evaluation
Healing potential: suboptimal
Surg. Procedure: not recommended
Primary Dressing: Honey foam dressing daily and PRN
Treatment and Dressing Plan: Continue to pre-medicate prn pain with dressing changes. Clean
wound and periwound area with normal saline solution or wound cleanser prior to applying
primary dressing and cover secondarily with gauze and tape. Continue to treat periwound with
routine cleaning protocol. Offload wound. Adhere to facilities protocol on repositioning,
decubitus prevention, pain management, weight monitoring, and nutritionist involvement.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
72)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: C119/B
Patient: Lyons, Georgina
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 6/24/1954 (64 Y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: Aphasia following unspc. cerebrovascular disease, contracture, HPN, gastro-esoph. rflx.
disease, anoxic brain damage, PU stage 4 of unsp. elbow, gastrostomy malfunction,
osteoarthritis, edema, chronic obstructive pulmonary disease, dysphagia, PU stage3 of sacral
region, hypokalemia, PU unsp. stage of unsp. buttock, PU unsp. stage sacral region, PU
stage2 of right buttock, PU stage4 of sacral region, seizures, epilepsy, PU stage2 of sacral
region, liver disease, excoriation disorder
Meds pertinent to wound: acetaminophen, docusate sodium, ipratropium-albuterol, metoprolol,
omeprazole, phenobarbital, polyethylene glycol, senna, spironolactone, valproic acid, zinc
oxide
RISK FACTORS: decreased mobility, positional difficulty, decreased sensation, HPN, PU stage
4 of unsp. elbow, PU stage3 of sacral region, PU unsp. stage of unsp. buttock, PU unsp. stage
sacral region, PU stage2 of right buttock, PU stage4 of sacral region, seizures, epilepsy, PU
stage2 of sacral region
Pain: no pain evident
Extremities: contracted
General/Appearance: normal
Location: sacrum
Etiology(+/-stage): NPUAP stage 2
Size LxWxD (cm): 0.2 x 0.2 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: dermis
Color: reopened; 100 % Granulation
Moisture amount: scant
Exudate: serous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: stable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Zinc Oxide QD and PRN. Continue off-loading.
Ruptured blister abdomen
0.5 x 0.5 x 0.1 cm
100 % Granulation
moisture scant
exudate serous
improving
change to Xeroform daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
73)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: C120/S
Patient: Gonzalez, Ruben
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 10/13/1990 (27 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: Cerebral palsy, enterocolitis, HTN, conjunctival xerosis, pressure ulcer, GERD,
dysphagia, UTI, bacterial pneumonia, tachycardia, hypothalamic dysfunction, chronic gastritis,
iron deficiency anemia, conjunctivitis and acute kidney failure.
Pertinent meds: acetaminophen, labetalol, morphine, omeprazole, oxycodone-acetaminophen,
and sulfamethoxazole.
Additional Risk Factors: decreased mobility, decreased sensation, positional difficulty, cerebral
palsy, nutritional deficiency, decreased wound healing, hypoalbuminemia, and h/o PU.
Vascular: normal peripheral pulses; Cap. Refill < 3 seconds
Extremities: contracted with multiple wounds
General/Appearance: emaciated
Location: Right Hip
Etiology (+/-stage): NPUAP stage 4
Size L x W x D (cm): 6.0 x 7 x 0.3 cm
Undermining/tunneling: resolved
Histologic involvement: Muscle
Color: 90% granulation 10 % slough
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Honey foam dressing daily and PRN
Location: Right Ischium
Etiology (+/-stage): NPUAP stage 4
Size L x W x D (cm): 5 x 2.4 x 0.3 cm
Undermining/tunneling: none
Histologic involvement: Muscle
Color: 90% pink and 10% yellow
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: Not recommended
Primary Dressing: change to Honey foam dressing daily and PRN
Location: Sacrum
Etiology (+/-stage): NPUAP stage 4
Size L x W x D (cm): 3.0 x 6.0 x 0.3 cm
Undermining/tunneling: none
Histologic involvement: Muscle
Color: 100% pink
Moisture amount: large
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: unstable
Healing potential: reasonable
Surg. Procedure: see below
Primary Dressing: change to Honey foam dressing daily and PRN
Location: Left Hip
Etiology (+/-stage): NPUAP stage 4
Size L x W x D (cm): 4.0 x 10.5 x 0.3 cm
Undermining/tunneling: 12:00 2:00, deepest at 2:00 = 1.0 cm
Histologic involvement: Muscle
Color: 90% pink and 10% yellow
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: see below
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Honey foam dressing daily and PRN
Left lateral lower leg, healed
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
74)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: C120/S
Patient: Alice Guzman
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 2/17/1963 (55)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Bactrim, Iodine, Sulfa
PMH: HIV, Diabetes, Obesity, PAD, CAD, Opioid dependence
Additional Risk Factors: decreased mobility, decreased sensation, positional difficulty, CAD,
PAD, HIV
Vascular: normal peripheral pulses; Cap. Refill < 3 seconds
Extremities: contracted with multiple wounds
General/Appearance: emaciated
Location: Surgical site left medial knee
Etiology (+/-stage): surgical site
Size L x W x D (cm): 8 x 0 x 0 cm
Undermining/tunneling: none
Histologic involvement: dermis
Color: steristrips in place
Moisture amount: dry
Exudate: none
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: suboptimal
Surg. Procedure: not recommended
Primary Dressing: cover with dry protective dressing daily and PRN
Location: Surgical site left medial leg
Etiology (+/-stage): surgical site
Size L x W x D (cm): 11 x 3.3 x 0.5 cm
Undermining/tunneling: none
Histologic involvement: Muscle
Color: 90% pink and 10% yellow
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: Not recommended
Primary Dressing: change to Hydrogel silver BID and PRN
Location: Surgical site left Lateral leg
Etiology (+/-stage): surgical site
Size L x W x D (cm): 9 x 3.0 x 1 cm
Undermining/tunneling: none
Histologic involvement: Muscle
Color: 90% pink and 10% yellow
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: Not recommended
Primary Dressing: change to Hydrogel silver BID and PRN
PAD with dry gangrene left great toe
( present on admission but was not shown to me by patient until today)
100 % Dry Gangrene
moisture dry
exudate none
periwound thinned
initial evaluation
betadine cover with dry protective dressing daily and PRN
spoke to patient regarding unavoidable amputation to left great toe given the gangrene and
death to this toe
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Follow up
with Surgery . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423
4526
75)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/2018
Room: C120/S
Patient: Merle Winston
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 7/12/1946 (72)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Talwin
Additional Risk Factors: decreased mobility, decreased sensation, positional difficulty,
Immobility
Vascular: normal peripheral pulses; Cap. Refill < 3 seconds
Extremities: contracted with multiple wounds
General/Appearance: emaciated
Location: Pressure ulcer Sacrum
Etiology (+/-stage): NPUAP stage 4
Size L x W x D (cm): 0.5 x 0.3 x 1.0 cm
Undermining/tunneling: throughout. greatest at 12 o clock 1 cm
Histologic involvement: muscle
Color: 100 % Granulation
Moisture amount: moderate
Exudate: serous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: suboptimal
Surg. Procedure: not recommended
Primary Dressing: change to Silvasorb gel pack with dry protective dressing daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: None . Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
76)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: C618 A
Patient: Barbara Mitchell
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 8/30/1961
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: and risk factors to wound healing: Immobility, multiple pressure wounds , urinary and
fecal incontinence, HIV, anemia
Pain: no pain evident
Extremities: contracted
General/Appearance: normal
Location: right ischium
Etiology(+/-stage): NPUAP stage 4
Size LxWxD (cm): 1 x 2 x 1.5 cm
Undermining/tunneling: greatest at 12 o clock 4.0 cm
Hist. involvement muscle
Color: reopened; 90 % Granulation 10 % slough
Moisture amount: moderate
Exudate: serous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: unavoidable due to above risk factors
Surg. Procedure: not recommended
Primary Dressing: Silvasorb gel cover with dry protective dressing daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
77)WOUND CARE CONSULTANT NOTE
WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Date of Service: 8/21/18
Room: A 609 A
Patient: Gerald Yarter
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 12/11/1965 (52)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Pain: no pain evident
Extremities: contracted
General/Appearance: normal
Location: Surgical site right lateral thigh
Etiology(+/-stage): surgical site
healed
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
78)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: A610/B
Patient: Foulkes, Gregory
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 8/21/53 (65 y/o)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Talwin, Contrast media Iodine.
PMH: ascorbic acid deficiency, cramp and spasm, panic disorder, diabetes, HIV, HTN,
polyneuropaty, opioid
dependence, vit deficiency, depressive disorder, asthma, CKD, Phlebitis and thrombophlebitis,
tinea pedis,
polyosteoarthritis, PU of heel and sacral region, hep C virus, vit D deficiency, bipolar, insomnia,
staph, cellulitis,
Chalazion, GERD, and anxiety disorder.
Meds pertinent to wound: acetaminophen, albuterol sulfate, baclofen, bactrim ds, clonazepam,
descovy, gabapentin,
humalog, isenstress, guetiapine, robitussin, symbicort, tamsulosin, solostar, and Xarelto.
Pertinent labs (7/30/17 CMP): Glucose 171.
RISK FACTORS: decreased mobility, positional difficulty, decreased sensation, diabetes, and
depression.
Vascular: diminished peripheral pules; Cap. Refill Equivocal
Extremities: see below
General/Appearance: normal
Location: Left heel
Etiology(+/-stage): vascular
Size LxWxD (cm): 3 x 5.5 x 0.4 cm
Undermining/tunneling: none
Hist. involvement: subcutaneous
Color: 80% eschar 20 % slough
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: indicated for periwound cellulitis
Objective: healing
Wound progress: unstable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Honey foam dressing daily and PRN
PAD with wound to left lateral bunion
Peripheral artery disease
1.8 x 2.5 x 0.5 cm
histological involvement SQ
70 % Granulation 30 % slough
Moisture moderate
exudate serous
improving
Primary Dressing: change to Honey foam dressing daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Recommends
patient to stay in bed and elevate legs and wear heel protectors. Above recommendations
discussed with nursing staff. Follow up: weekly prn. PLEASE CONTACT DR. Yehounatan (516)
423 4526
79)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: A610/A
Patient: Rosenberg, Richard
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 9/15/47
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: imipenem-cilastatin
PMH: HIV, asthma, COPD, HTN, dyspepsia, anorexia, GERD, pruritus, candidiasis, PU, burn,
hypothalamic
dysfunction, dysuria, influenza, and herpesviral ocular disease.
Meds pertinent to wound: aspirin, cetaphil, fentanyl, ferrous sulfate, lomax, intelence, isentress,
lyrica, marinol, MVI,
pravachol, and truvada.
RISK FACTORS: decreased mobility, positional difficulty, decreased sensation, and COPD.
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: normal
General/Appearance: normal
Location: right hip #1
Etiology(+/-stage): NPUAP Stage 3 (resolving)
Size LxWxD (cm): 0.2 x 0.2 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: subcutaneous tissue
Color: 100% pink
Moisture amount: scant
Exudate: serous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Betadine cover with dry protective dressing daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none. Above
recommendations
discussed with nursing staff. Thank you for the consult. Follow up: weekly prn. PLEASE
CONTACT DR. Yehounatan (516) 423 4526
80)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C707 A
Patient: William Kendall
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 2/23/1956 (62)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Bactrim, Cephalexin
Vascular: diminished peripheral pules; Cap. Refill Equivocal
Extremities: see below
General/Appearance: normal
Location: Open wound right elbow
Etiology(+/-stage): skin tear
Size LxWxD (cm): 0.7 x 0.5 x 0.5 cm
Undermining/tunneling: none
Hist. involvement: SQ
Color: 90 % Granulation 10 % slough
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Bactroban BID and PRN
Location: Open wound left forearm
Etiology(+/-stage): skin tear
healed
Location: Open wound Right lower extremity
Etiology(+/-stage): skin tear
Size LxWxD (cm): 3 x 3.2 x 0.3 cm
Undermining/tunneling: none
Hist. involvement: SQ
Color: 90 % Granulation 10 % slough
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Opticel silver daily and PRN
Location: Venous stasis left posterior calf
Etiology(+/-stage): Venous stasis
Size LxWxD (cm): 0.3 x 0.3 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: SQ
Color: 100 % Granulation 20 % slough
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Calcium alginate daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Recommends
patient to stay in bed and elevate legs and wear heel protectors. Above recommendations
discussed with nursing staff. Follow up: weekly prn. PLEASE CONTACT DR. Yehounatan (516)
423 4526
81)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C707/B
Patient: Graham, Ventora
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 03/04/1968 (50 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: schizophrenia, GERD, TB, vit defieincy, TB, HIV, xerorsis cutis, hemorrhoids, abrasion,
GAD, anemia, diarrhea, polyneuropathy, hyperlipidemia, candidiasis, cough, postherpetic
polyneuropathy, enterocolitis, diaper dermatitis, pruritus, acute atopic conjunctivitis, vitamin D
deficiency, allergic rhinitis, cerebral cryptoococcosis, and insomnia.
Meds pertinent to wound: atovaquone, cholecalciferol, clonazepam, epzicmon, fenofibrate,
fluconazole, gabapentin, ibuprofen, lorazepam, Mapap, Pravachol, quetiapine, Seroquel,
sertraline, tamsulosin, Tivicay, and zolpidem.
RISK FACTORS: decreased mobility, positional difficulty, decreased sensation, anemia, and
possible tissue hypoxia.
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: left heel
Etiology(+/-stage): NPUAP Stage 4
Size LxWxD (cm): 2.5 x 2.5 x 0.5 cm
Undermining/tunneling: none
Hist. involvement: muscle
Color:10% yellow and 90% pink
Moisture amount: moderate
Exudate: serous
Odor: foul
Periwound: macerated
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: unstable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Honey foam dressing daily and PRN
Location: left anterior leg
Etiology(+/-stage): vascular
Size LxWxD (cm): 8 x 8 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: subcutaneous
Color: 80% yellow and 20% pink
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: extremely macerated
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: unstable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Honey foam dressing daily and PRN
Note: arterial and venous doppler recommended.
Vascular surgery consult
Open wound right shin
1 x 1.5 x 0.2 cm
100 % Granulation
improving
change to Honey foam dressing daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound
and periwound area with normal saline solution prior to applying primary dressing and cover
secondarily with gauze
and tape. Periwound should be treated with routine cleaning protocol. Offload wound. Adhere
to facility repositioning
and decubitus prevention protocol. Pain was addressed where appropriate. Nutritionist
involvement and weight
monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: arterial and
venous doppler recommended.; Vascular surgery consult Above recommendations discussed
with nursing staff. Thank you for the consult. Follow up: weekly prn. THANK YOU FOR THIS
CONSULT. FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
82)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C 711 A
Patient: Fragosa, Edwin
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 6/10/1959 (59)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Heparin
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Open wound right lower extremity
Etiology(+/-stage): excoriation
Size LxWxD (cm): 4 x 2.0 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: muscle
Color:10% yellow and 90% granulation
Moisture amount: scant
Exudate: serous
Odor: foul
Periwound: macerated
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: initial evaluation
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Xeroform daily and PRN
Location: left anterior leg
Etiology(+/-stage): vascular
Size LxWxD (cm): 8 x 8 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: subcutaneous
Color: 80% yellow and 20% pink
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: extremely macerated
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: unstable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: change to Honey foam dressing daily and PRN
Note: arterial and venous doppler recommended.
Vascular surgery consult
Open wound right shin
1 x 1.5 x 0.2 cm
100 % Granulation
improving
change to Honey foam dressing daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound
and periwound area with normal saline solution prior to applying primary dressing and cover
secondarily with gauze
and tape. Periwound should be treated with routine cleaning protocol. Offload wound. Adhere
to facility repositioning
and decubitus prevention protocol. Pain was addressed where appropriate. Nutritionist
involvement and weight
monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: arterial and
venous doppler recommended.; none consult Above recommendations discussed with nursing
staff. Thank you for the consult. Follow up: weekly prn. THANK YOU FOR THIS CONSULT.
FOR ANY QUESTIONS, PLEASE CONTACT DR. Yehounatan (516) 423 4526
83)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C712 B
Patient: Arnold Cintron
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 5/27/1960 (58)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: HTN, HIV, Hypothyroidism, COPD, immobility, immunodeficiency, pressure ulcers on
admission
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Pressure ulcer Occipital
NPUAP stage 3
histological involvement SQ
2.5 x 2 x 0.2 cm
10 % slough 90 % granulation
moisture dry
exudate none
improving
healing potential unavoidable
therahoney gel daily and PRN
Surgical site Abdomen
5 x 1.7 x 0.5 cm
histological involvement SQ
Moisture scant
exudate serous
improving
Pack with continuous moist dressing with normal saline BID and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Follow up
with surgery . Above recommendations discussed with nursing staff. Thank you for the consult.
Follow up: weekly prn. PLEASE CONTACT DR. Yehounatan MD
84)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C704 B
Patient: Shirley Mayton
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 7/29/1957 (61)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Stavudine
PMH: HIV, , immobility, immunodeficiency
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Open wound Coccyx
excoriation
histological involvement Dermis
2.0 x 1 x 0.2 cm
100 % granulation
moisture scant
exudate serous
initial evaluation
healing potential suboptimal
Zinc Oxide Q shift and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: None . Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. PLEASE CONTACT DR. Yehounatan MD
85)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: A707 B
Patient: Earl McBride
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 7/7/1960 (58)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: HIV, HTN, hyperlipidemia, recurrent abscess left shin. dementia, depression CHF
RISK FACTORS: decreased mobility, positional difficulty, decreased sensation, HIV, DM2, and
anemia.
Vascular: diminished peripheral pulses; Cap. Refill equivocal
Pain: no pain evident
Extremities: normal
General/Appearance: normal
Location: left shin abscess
Etiology(+/-stage): left shin abscess
Size LxWxD (cm): 0.6 x 0.6 x 0.1 cm
Undermining: none
Hist. involvement: subcutaneous
Color: 100% pink
Moisture amount: scant
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: indicated
Objective: healing
Wound progress: stable
Healing potential: reasonable
Surg. Procedure: not recommended
Primary Dressing: Bactroban BID and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: none . Above
recommendations discussed with nursing staff. Thank you for the consult. . PLEASE CONTACT
DR. Yehounatan MD (516) 423 4526
86)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: A711/A
Patient: Bryce, Raymond
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 03/06/1955 (63)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: bananas
PMH: HIV, HTN, HLD, DM2, vit deficiency, anemia, and dermatitis.
Meds pertinent to wounds: amlodipine, filtrate, losartan, metformin, metoprolol tartrate,
pravastatin, tamsulosin, and vit D3.
Pertinent labs (03/15/2018 CBC, CMP): Glu 122.
RISK FACTORS: decreased mobility, positional difficulty, decreased sensation, HIV, DM2, and
anemia.
Vascular: diminished peripheral pulses; Cap. Refill equivocal
Pain: no pain evident
Extremities: normal
General/Appearance: normal
Location: left buttock
Etiology(+/-stage): lesion (recurrent)wart; surgical wound
healed
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Needs an
appointment with his surgeon for follow up. Above recommendations discussed with nursing
staff. Thank you for the consult. . PLEASE CONTACT DR. Yehounatan MD (516) 423 4526
87)WOUND PHYSICIAN: Dr Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C709/B
Patient: Hill, Arnold
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 12/29/1967 (50 y)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: HIV disease, shortness of breath, increased secretion of gastrin, vitamin deficiency,
pruritus, HTN, toxoplasmosis, malignant neoplasm of anus, malignant melanoma of anal skin,
adjustment disorder, rash and other nonspecific skin eruption.
Pertinent meds: acetaminophen, amlodipine, atovaquone, cyanocobalamin, famotidine,
ipratropium albuterol, levetiracetam, and Triumeq.
Risk factors: decreased mobility, positional difficulty, decreased sensation, HIV disease, HTN,
malignant neoplasm of anus, malignant melanoma of anal skin, and adjustment disorder.
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: Right perianal
Etiology(+/-stage): surgical; h/o malignant melanoma of anus
Size LxWxD (cm): 2 x 2.0 x 2 cm
Undermining/tunneling: none
Hist. involvement: subcutaneous
Color: 80% pink 20 % slough
Moisture amount: moderate
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: not recommended
Metrogel BID and PRN
surgical consult
As per staff patient is refusing dressing changes leading to wound not healing
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: surgical
consult . Above recommendations
discussed with nursing staff. Thank you for the consult. Follow up: weekly prn. PLEASE
CONTACT DR. Yehounatan (516) 423 4526
88)WOUND PHYSICIAN: Dr Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: A 802 S
Patient: Roberto Vidal
Family Hx: ] NC Soc Hx: _XTob _EtOH [X] NC DOB/Age: 7/5/1950 (68)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
Risk factors to wound healing: Immunodeficiency, anemia, HIV, Hepatitis B , Burns , malignant
neoplasm, Nicotine dependence
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Surgical site right anterior thigh
surgical donor site
healed
Surgical site right lateral thigh
surgical donor site
histological involvement dermis
3 x 4 x 0.1 cm
100 % Granulation
moisture scant
exudate serous
healing potential suboptimal
unstable
Xeroform daily and PRN
Right below elbow burn site
second degree burn
healed
Open wound left medial ankle
excoriation
healed
left medial thigh burn site
second degree burn
healed
left upper lateral thigh burn site
second degree burn
histological involvement dermis
1 x 1 x 0.1 cm
100 % Granulation
moisture scant
exudate serous
healing potential suboptimal
improving
Xeroform daily and PRN
left posterior thigh scattered lesions burn site
second degree burn
healed
left forearm burn site
second degree burn
histological involvement dermis
1.4 x 3 x 0.1 cm
100 % Granulation
moisture scant
exudate serous
healing potential suboptimal
improving
Xeroform daily and PRN
left lateral elbow burn site
second degree burn
histological involvement dermis
healed
surgical site left AVF site
surgical site
histological involvement full thickness
healed
left lower back burn site
second degree burn
histological involvement dermis
2 x 1 x 0.1 cm
100 % Granulation
moisture scant
exudate serous
healing potential suboptimal
improving
Xeroform daily and PRN
surgical site right neck
surgical site
histological involvement SQ
healed
surgical site Mid abdomen
surgical site
histological involvement muscle
9 x 2.5 x 1 cm
100 % Granulation
moisture scant
exudate serous
healing potential suboptimal
improving
Xeroform daily and PRN
left lateral back burn site
second degree burn
histological involvement dermis
1 x 1 x 0.1 cm
100 % Granulation
moisture scant
exudate serous
healing potential suboptimal
improving
Xeroform daily and PRN
Burn site left forehead
0.5 x 1 x 0.1 cm
100 % scab
xeroform daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: follow up with
surgery Above recommendations
discussed with nursing staff. Thank you for the consult. Follow up: weekly prn. PLEASE
CONTACT DR. Yehounatan (516) 423 4526
89)WOUND PHYSICIAN: Dr Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: A806/A
Patient: Wilkins, Grady
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 64 (02/11/1954)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: cellulitis, HIV, depressive disorder, hypokalemia, COPD, pruritus, constipation, fever, vit D
deficiency, viral hepatitis C, cachexia, polyneuropathy, nutritional deficiency, PU, edema, tinea
corporis, atopic dermatitis, diarrhea, HTN, bacterial infection, and GI hemorrhage.
Pertinent meds: acetaminophen, citalopram, gabapentin, keppra, megestrol, and MVI.
Risk factor: depression, pulse not palpable, possible tissue hypoxia, positional difficulty, hep C,
COPD, and depression.
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Right second toe: healed
Surgical site abdomen
surgical site
histological involvement dermis
0.2 x 0.2 x 0.1 cm
100 % Pink epithelial
moisture moderate
exudate serous
stable
Monitor site
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Recommend
arterial and venous doppler and vascular consult if results are abnormal. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. PLEASE CONTACT DR. Yehounatan (516) 423 4526
90)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: A825/B
Patient: Fowler, David
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 66 (02/11/1954)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Shellfish and/or shellfish containing products
PMH: osteomyelitis, venous insufficiency, mononeuropathy, nutritional, pain, functional
dyspepsia, candidiasis, constipation, psychoactive substance dependence, cellulitis, pruritus,
autonomic neuropathy, pneumonia, insomnia, infectious gastroeneteritis and colitis, COPD,
edema, postnasal drop, conjunctivitis, sepsis, atopic dermatitis, and allergic rhinitis.
Meds pertinent to wound: aveeno, fenofibrate, kaletra, lisinopril, lunesta, lyrica, methadone,
mirtazapine, mvi,
oxycodone, selsun blue naturals, senna-gen, and truvada.
Pertinent lab (02/14/18 CBC, CMP): Cl 91, CO2 31, BUN/Cr 6/0.71, Glu 130.
RISK FACTORS: decreased mobility, positional difficulty, decreased sensation, COPD and HIV.
Vascular: peripheral pulses grossly intact; Cap. Refill <3 secs
Pain: no pain evident
Extremities: see below
General/Appearance: normal
Location: left lateral ankle
Etiology(+/-stage): Venous stasis
Size LxWxD (cm): 1.3 x 0.7 x 0.1 cm
Undermining: none
Hist. involvement: muscle
Color: 90% pink and 10% yellow
Moisture amount: scant
Exudate: serous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: suboptimal
Surg. Procedure: not recommended
Primary Dressing: Honey foam dressing daily and PRN
Location: right medial ankle
Etiology(+/-stage): Venous stasis
Size LxWxD (cm): 11 x 8 x ? cm
Undermining: none
Hist. involvement: subcutaneous
Color: 70% yellow and 30% pink
Moisture amount: scant
Exudate: serosanguinous
Odor: none
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: Unstable
Healing potential: suboptimal
Surg. Procedure: not recommended
Primary Dressing: PICO weekly and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with normal saline solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: Vascular
surgery consult . Above recommendations discussed with nursing staff. Thank you for the
consult. Follow up: weekly prn. PLEASE CONTACT DR. Yehounatan (516) 423 4526
91)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C807
Patient: Answer, Shane
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 47 (06/15/1971)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: NKA
PMH: HIV, spinal stenosis, hyperglyceridemia, fever, UTI, diarrhea, xerosis cutis, and abscess.
Meds pertinent to wound: abacavir, Colace, MVI, secura, tricor, Tylenol, viread, and vitamin A
and D.
RISK FACTORS: decreased mobility, positional difficulty, decreased sensation, and HIV.
Location: left plantar surface of foot
Etiology(+/-stage): vascular
Size LxWxD (cm): 2 x 2 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: muscle
Color: 100% granulation
Moisture amount: large
Exudate: serosanguinous
Odor: foul
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: improving
Healing potential: reasonable
Surg. Procedure: none
Primary Dressing: Puracol cover with hydrogel daily and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with 1/4 strength dakin's solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: None. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. PLEASE CONTACT DR. Yehounatan MD (516) 423 4526
92)WOUND PHYSICIAN: Joseph Yehounatan MD
Facility: Terence Cardinal Cooke Health Care Center
Wound Care Consultant Note
Date of Service: 8/21/18
Room: C808 B
Patient: Greene Tina
Family Hx: [X] NC Soc Hx: _Tob _EtOH [X] NC DOB/Age: 12/5/1956 (61)
Chief complaint: active wound or compromise in skin integrity (see descriptions below)
Allergies: Penicillin
Location: Open wound Sacrum
Etiology(+/-stage): excoriation
Size LxWxD (cm): 1 x 1 x 0.2 cm
Undermining/tunneling: none
Hist. involvement: dermis
Color: 100% granulation
Moisture amount: large
Exudate: serosanguinous
Odor: foul
Periwound: normal
Tissue edema: none
Infection/Abx: none
Objective: healing
Wound progress: initial evaluation
Healing potential: reasonable
Surg. Procedure: none
Primary Dressing: Zinc Oxide Q shift and PRN
Treatment and Dressing Plan: Advise pain evaluation and pre-medication prn with dressing
changes. Clean wound and periwound area with 1/4 strength dakin's solution prior to applying
primary dressing and cover secondarily with gauze and tape. Periwound should be treated with
routine cleaning protocol. Offload wound. Adhere to facility repositioning and decubitus
prevention protocol. Pain was addressed where appropriate. Nutritionist involvement and
weight monitoring, as per protocol.
RECOMMENDATIONS: Consults +/- Diagnostic tests recommended at this time: None. Above
recommendations discussed with nursing staff. Thank you for the consult. Follow up: weekly
prn. PLEASE CONTACT DR. Yehounatan MD (516) 423 4526