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
Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)
Desired Outcomes/Evaluation Criteria—Client Will
Achieve timely wound healing, be free of purulent drainage or erythema, and be afebrile.
Nursing intervention with rationale:
1. Promote good hand washing by staff and client.
Rationale: Reduces risk of cross-contamination.
2. Use strict aseptic or clean technique, as indicated, to reinforce or change dressings and when handling drains. Instruct client not to touch or scratch incision.
Rationale: Prevents contamination and risk of wound infection, which could require removal of prosthesis.
3. Maintain patency of drainage devices (e.g., Hemovac, Jackson-Pratt) when present. Note characteristics of wound drainage.
Rationale: Reduces risk of infection by preventing accumulation of blood and secretions in the joint space, which is a 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.
4. Assess skin and incision color, temperature, and integrity; note presence of erythema, inflammation, and loss of wound approximation.
Rationale: Provides information about status of healing process and alerts staff to early signs of infection.
5. Investigate reports of increased incisional pain and changes in characteristics of pain.
Rationale: Deep, dull, aching pain in operative area may indicate developing infection in joint. Note: Infection can be devastating because, once infection sets in, joint may not be salvagable and prosthetic loss may occur.
6. Monitor temperature. Note presence of chills.
Rationale: Although temperature elevations are common in early postoperative phase, elevations occurring 5 or more days postoperatively and/or presence of chills usually require intervention to prevent more serious complications, such as sepsis, osteomyelitis, tissue necrosis, and prosthetic failure.
7. Encourage fluid intake coupled with a high-protein diet with roughage.
Rationale: Maintains fluid and nutritional balance to support tissue perfusion and provide nutrients necessary for cellular regeneration and tissue healing.
8. Maintain reverse or protective isolation, if appropriate.
Rationale: May be done initially to reduce contact with sources of possible infection, especially in an elderly, immunosuppressed, or diabetic client.
9. Administer antibiotics, as indicated.
Rationale: Used prophylactically in the operating room and for the first 24 hours to prevent infection. Late infections may require intravenous (IV) antibiotic treatments for several weeks, in an effort to save the prosthetic joint.