Nursing Diagnosis for Anemia: Risk for Infection related to Inadequate secondary defenses.
Objectives: Infection does not occur.
Expected outcomes are:
- Identify the behaviors to prevent / reduce the risk of infection.
- Improve wound healing, free of purulent drainage or erythema, and fever.
Nursing Interventions for Anemia Risk for Infection
Independent
1. Increase good hand washing; by care givers and patients.
Rationale: to prevent cross contamination / bacterial colonization. Note: patients with severe anemia / aplastic can be risky due to the normal flora of the skin.
2. Maintain strict aseptic techniques in the procedure / treatment of wounds.
Rational: reduce the risk of colonization / infection of bacteria.
3. Give skin care, peri-anal and oral carefully.
Rational: reduce the risk of damage to the skin / tissue and infection.
4. Motivation changes in position / ambulation that often, coughing and deep breathing exercises.
Rational: improving the ventilation of all lung segments and help mobilize secretions to prevent pneumonia.
5. Increase enter adequate fluids.
Rational: to assist in breathing secret dilution to facilitate spending and prevent stasis of body fluids such as respiratory and renal
6. Monitor / limit visitors. Provide isolation if possible.
Rational: limiting exposure to bacteria / infections. Protection of insulation required in aplastic anemia, when the immune response is impaired.
7. Monitor body temperature. Note the presence of chills and tachycardia with or without fever.
Rational: the process of inflammation / infection requires evaluation / treatment.
8. Observe erythema / wound fluid.
Rational: indicators of local infection. Note: the formation of pus may not exist when granulocytes depressed.
Collaboration
1. Take a specimen for culture / sensitivity as indicated.
Rational: to distinguish the presence of infection, identifying the specific pathogen and affects treatment options.
2. Give topical antiseptic; systemic antibiotics.
Rational: may be used for prophylactic treatment to reduce colonization or local infection process.
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