Potential for Infection

Potential
for Infection

(_)Actual (_)
Potential

Related
To:
[Check
those that apply]
(_)
Alteration in skin integrity:___________________________
__________________________________________________
(_) Bone marrow depression.

(_) Indwelling catheter:________________________________
(_) Nutritional
deficiencies:______________________________
__________________________________________________
(_) Surgical/invasive procedures:________________________
__________________________________________________
(_) Other:__________________________________________

_________________________________________________
__________________________________________________

 

As
evidenced by:
[Check
those that apply]
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