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

Risk for Infection

Nursing Diagnosis

• Risk for Infection

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

• The client will achieve timely wound healing, be free of purulent drainage or erythema, and be afebrile.

Nursing Assessment and Rationales

1. Assess skin/incision color, temperature, and integrity; note the presence of erythema or inflammation, and loss of wound approximation.
Provides information about the status of the healing process and alerts staff to early signs of infection.

2. Investigate reports of increased incisional pain and changes in the characteristics of pain.
Deep, dull, aching pain in the operative area may indicate a developing infection in a joint.

3. Monitor temperature. Note the presence of chills.
Although temperature elevations are common in the early postoperative phase, elevations occurring 5 or more days postoperatively and/or the presence of chills usually require intervention to prevent more serious complications, e.g., sepsis, osteomyelitis, tissue necrosis, and prosthetic failure.

Nursing Interventions and Rationales

1. Promote good hand washing by staff and patients.
Hand washing is the single most effective way to prevent infection.

2. 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 the removal of the prosthesis.

3. 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, nonserious, odorous drainage is indicative of infection, and continuous drainage from the incision may reflect a developing skin tract, which can potentiate the infectious process.

4. Encourage fluid intake and a high-protein diet with roughage.
Maintains fluid and nutritional balance to support tissue perfusion and provide nutrients necessary for cellular regeneration and tissue healing.

5. Maintain reverse or protective isolation, if appropriate.
May be done initially to reduce contact with sources of possible infection, especially in an elderly, immunosuppressed, or diabetic patient.

6. Administer antibiotics as indicated.
Used prophylactically in the operating room and first 24 hr to prevent infection.