5 Total Joint (Knee, Hip) Replacement Nursing Care Plans

March 7, 2014

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 (5) nursing care plans (NCP) and nursing diagnosis for patients undergoing Total Joint Replacements:

Risk for Infection

Risk for Infection: At increased risk for being invaded by pathogenic organisms.

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.