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

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