Nursing Care Plan for Total Joint Replacement

Nursing diagnosis: knowledge deficit related to lack of exposure or recall, information misinterpretation

Possibly evidenced by
Questions, request for information, statement of misconception
Inaccurate follow-through of instructions, development of preventable complications

Desired Outcomes/Evaluation Criteria—Client Will
Knowledge: Disease Process
Verbalize understanding of surgical procedure and prognosis.
Correctly perform necessary procedures and explain reasons for the actions.

Nursing intervention with rationale:
1. Review disease process, surgical procedure, and future expectations.
Rationale: Provides knowledge base from which client can make informed choices. The majority of total joint surgeries are elective, and preoperative education is done in some form in the surgeon’s office or in the admitting facility. Postsurgical review of process and expectations may be needed, or desired.

2. Encourage alternating rest periods with activity.
Rationale: Conserves energy for healing and prevents undue fatigue, which can increase risk of injury or fall.

3. Stress importance of continuing prescribed exercise and rehabilitation program within client’s tolerance—crutch or cane walking, weight-bearing exercises, stationary bicycling, or swimming.
Rationale: Increases muscle strength and joint mobility. Most clients will be involved in formal outpatient rehabilitation, home-care programs, or be followed in extended-care facilities by physical therapists. Note: Muscle aching indicates too much weightbearing or activity, signaling a need to cut back.

4. Review activity limitations, depending on joint replaced: for hip or knee—sitting for long periods or in low chair or toilet seat, recliner; jogging, jumping, excessive bending, lifting, twisting, or crossing legs.
Rationale: Prevents undue stress on implant. Long-term restrictions depend on individual situation and physician protocol.

5. Discuss need for safe environment in home including removing scatter rugs and unnecessary furniture, and use of assistive devices, such as hand rails in tub and toilet, raised toilet seat, and cane for long walks.
Rationale: Reduces risk of falls and excessive stress on joints.

6. Review and have client or caregiver demonstrate incisional or wound care.
Rationale: Promotes independence in self-care, reducing risk of complications.

7. Identify signs and symptoms requiring medical evaluation: fever or chills, incisional inflammation, unusual wound drainage, pain in calf or upper thigh, or development of sore throat or dental infections.
Rationale: Bacterial infections require prompt treatment to prevent progression to osteomyelitis in the operative area and prosthesis failure, which could occur at any time, even years later.

8. Review procedure for removal of painball catheter if not discontinued before discharge.
Rationale: Medication may infuse for up to 5 days and if client removes catheter after discharge it is important to check for black marking on tip to ensure tubing is removed intact.

9. Review drug regimen, for example, anticoagulants or antibiotics for invasive procedures (e.g., tooth extraction).
Rationale: Prophylactic therapy may be necessary for a prolonged period after discharge to limit risk of thromboemboli and infection. Procedures known to cause bacteremia can lead to osteomyelitis and prosthesis failure.

10. Identify bleeding precautions—for example, use of soft toothbrush, electric razor, avoidance of trauma, or forceful blowing of nose—and necessity of routine laboratory follow-up.
Rationale: Reduces risk of therapy-induced bleeding or hemorrhage.