Joint replacements are indicated for irreversibly damaged joints with loss of function and unremitting pain, selected fractures, joint instability and congenital hip disorders. Total Joint Replacement can be performed on any joint except the spine. Hip and knee replacements are the most common procedures. The prosthesis may be metallic or polyethylene (or a combination) implanted with a methylmethacrylate cement, or it may be a porous, coated implant that encourages bony ingrowth.
Nursing Care Plans
Nursing care planning and goals for patients who underwent total joint replacement include preventing complications, promoting optional mobility, alleviate pain, and providing information about the diagnosis, prognosis, and treatment needs.
Here are five nursing care plans and nursing diagnosis for patients undergoing Total Joint Replacements:
- Risk for Infection
- Impaired Physical Mobility
- Risk for Peripheral Neurovascular Dysfunction
- Acute Pain
- Deficient Knowledge
- Other Possible Nursing Care Plans
Risk for Infection
Nursing Diagnosis
May be related to
- Inadequate primary defenses (broken skin, exposure of joint)
- Inadequate secondary defenses/immunosuppression (long-term corticosteroid use, cancer)
- Invasive procedures; surgical manipulation; implantation of a foreign body
- Decreased mobility
Possibly evidenced by
- Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
Desired Outcomes
- Client will achieve timely wound healing, be free of purulent drainage or erythema, and be afebrile.
| Nursing Interventions | Rationale |
|---|---|
| Promote good hand washing by staff and patient. | Hand washing is the single most effective way to prevent infection. |
| Use strict aseptic or clean techniques as indicated to reinforce or change dressings and when handling drains. Instruct patient not to touch or scratch incision. | Prevents contamination and risk of wound infection, which could require removal of the prosthesis. |
| Maintain patency of drainage devices (Hemovac, Jackson Pratt) when present. Note characteristics of wound drainage. | Reduces the risk of infection by preventing the accumulation of blood and secretions in the joint space (medium for bacterial growth). Purulent, nonserous, odorous drainage is indicative of infection, and continuous drainage from incision may reflect developing skin tract, which can potentiate the infectious process. |
| Assess skin/incision color, temperature, and integrity; note the presence of erythema or inflammation, loss of wound approximation. | Provides information about the status of the healing process and alerts staff to early signs of infection. |
| Investigate reports of increased incisional pain, changes in characteristics of pain. | Deep, dull, aching pain in the operative area may indicate a developing infection in joint. |
| Monitor temperature. Note presence of chills. | Although temperature elevations are common in the early postoperative phase, elevations occurring 5 or more days postoperatively and/or presence of chills usually requires intervention to prevent more serious complications, e.g., sepsis, osteomyelitis, tissue necrosis, and prosthetic failure. |
| Encourage fluid intake, high-protein diet with roughage. | Maintains fluid and nutritional balance to support tissue perfusion and provide nutrients necessary for cellular regeneration and tissue healing. |
| Maintain reverse or protective isolation, if appropriate. | May be done initially to reduce contact with sources of possible infection, especially in elderly, immunosuppressed, or diabetic patient. |
| Administer antibiotics as indicated. | Used prophylactically in the operating room and first 24 hr to prevent infection. |
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses as reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of it’s evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions show how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans for musculoskeletal disorders and conditions:
- Amputation | 4 Care Plans
- Congenital Hip Dysplasia | 4 Care Plans
- Fracture | 11 Care Plans
- Juvenile Rheumatoid Arthritis | 4 Care Plans
- Laminectomy (Disc Surgery) | 8 Care Plans
- Osteoarthritis | 4 Care Plans
- Osteoporosis | 4 Care Plans
- Rheumatoid Arthritis | 6 Care Plans
- Scoliosis | 4 Care Plans
- Spinal Cord Injury | 12 Care Plans
- Total Joint (Knee, Hip) Replacement | 5 Care Plans
I found the care plans very thorough and helpful to me. I will definitely use this in the future.