NURSING DIAGNOSIS: Risk for infection: operative knee

related to:
  1. introduction of pathogens into the wound during or following surgery;
  2. increased susceptibility to infection associated with decreased effectiveness of immune system if client is elderly and immununosuppression if client has been taking corticosteroids to treat the joint disorder necessitating the surgery (e.g. rheumatoid arthritis);
  3. hematogenous seeding of wound from distant sites (e.g. urinary tract).
Desired Outcome
The client will remain free of infection in the operative knee (see Standardized Postoperative Care Plan, Diagnosis 17, for outcome criteria).
Nursing Actions and Selected Purposes/Rationales
  1. Assess for and report the following:
    1. continuous drainage of fluid from incision (may indicate a sinus tract)
    2. sloughing or necrosis of skin in operative area
    3. signs and symptoms of wound infection (e.g. chills; fever; altered mental status; redness, heat, and swelling of wound area; unusual wound drainage; foul odor from wound area; persistent or increased pain in knee; elevated sedimentation rate).
  2. Refer to Standardized Postoperative Care Plan, Diagnosis 17, for measures related to prevention of wound infection.
  3. Implement additional measures to reduce risk for infection in the operative knee:
    1. use strict sterile technique when performing wound care and emptying wound drainage device
    2. maintain patency of the wound drainage device in order to prevent accumulation of drainage in surgical area
    3. keep CPM machine off the floor when not in use
    4. avoid urinary catheterization but if it becomes necessary, take precautions to prevent urinary tract infection (e.g. use strict sterile technique during catheter insertion, remove catheter as soon as possible); the presence of a urinary catheter increases the risk for a urinary tract infection, which can lead to hematogenous seeding of the knee wound
    5. administer prophylactic antimicrobials if ordered.
  4. If signs and symptoms of wound infection occur:
    1. administer antimicrobials as ordered
    2. prepare client for surgical debridement and/or revision arthroplasty if planned.