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Potential for Infection
(_)Actual (_) Potential
| (_)
Alteration in skin integrity:___________________________ __________________________________________________ (_) Bone marrow depression. (_) Indwelling catheter:________________________________ (_) Nutritional deficiencies:______________________________ __________________________________________________ (_) Surgical/invasive procedures:________________________ __________________________________________________ (_) Other:__________________________________________ _________________________________________________ __________________________________________________ |
| Major:
(Must be present) |
(_)
Altered production of leukocytes. (_) Altered immune response. |
| Minor:
(May be present) |
(_)
Altered circulation. (_) Presence of favorable conditions for infection. (_) History of infection. |
| Date & Sign. |
Plan and Outcome [Check those that apply] |
Target Date: |
Nursing Interventions [Check those that apply] |
Date Achieved: |
| The
patient will: (_) Remain infection free A.E.B.:
(_) Demonstrate complete recovery from infection A.E.B.:
(_) Other: |
(_)
Assess temperature q ___ hrs. (_) Inspect and record signs of erythema, induration, foul smelling drainage, from or around wound, skin, invasive line, mouth/throat, or other site q ___ hrs. (_) Asses for cloudiness of urine q ___ hrs. (_) Report abnormal changes in WBC count and/or pathogenic growth on cultures. (_) Utilize good handwashing techinque. (_) Visitors and health care workers with active infection are to avoid contact with patient. (_) Avoid invasive prodecures; i.e. rectal temperatures, bladder catheters, etc. (_) Encourage high protein/high carbohydrate foods/fluids when indicated. (_) Explore with patient potential etiological factors which potentiate infection and include appropriate health teaching. (_)
Other:________________ |
__________________________
Patient/Significant other signature
__________________________
RN signature
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