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 includes preventing complications, promoting optional mobility, alleviate pain, and providing information about the diagnosis, prognosis, and treatment needs.
Here are five (5) nursing care plans 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: At increased risk for being invaded by pathogenic organisms.
Risk factors may include
- Inadequate primary defenses (broken skin, exposure of joint)
- Inadequate secondary defenses/immunosuppression (long-term corticosteroid use, cancer)
- Invasive procedures; surgical manipulation; implantation of 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.
- Achieve timely wound healing, be free of purulent drainage or erythema, and be afebrile.
|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 prosthesis.|
|Maintain patency of drainage devices (Hemovac, Jackson Pratt) when present. Note characteristics of wound drainage.||Reduces risk of infection by preventing 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 infectious process.|
|Assess skin/incision color, temperature, and integrity; note presence of erythema or inflammation, loss of wound approximation.||Provides information about status of 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 operative area may indicate developing infection in joint. Note: Infection is devastating, because joint cannot be saved once infection sets in, and prosthetic loss will occur.|
|Monitor temperature. Note presence of chills.||Although temperature elevations are common in 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.|
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Musculoskeletal Care Plans
Care plans related to the musculoskeletal system:
- Amputation | 4 Care Plans
- Congenital Hip Dysplasia | 4 Care Plans
- Fracture | 8 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
- Total Joint (Knee, Hip) Replacement | 5 Care Plans
Recommended books and resources:
- Nursing Care Plans: Diagnoses, Interventions, and Outcomes
- Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
- Nursing Diagnoses 2015-17: Definitions and Classification
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
- Manual of Psychiatric Nursing Care Planning
- Maternal Newborn Nursing Care Plans
- Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans