Care Plan for Open Heart Surgery
Category: Post-Operative Care
Assessment
Patient presents post-operatively from open-heart surgery with a median sternotomy incision.
Diagnosis
Risk for infection related to surgical incision.
Goals
Patient will remain free from signs of infection during the recovery period. Patient will demonstrate proper wound care techniques.
Interventions
Monitor the surgical site for signs of infection such as redness, swelling, and discharge. Educate patient on proper hand hygiene and wound care practices. Administer prescribed antibiotics as directed. Encourage deep breathing exercises and use of incentive spirometer to prevent respiratory complications.
Rationale
These interventions help prevent infection and promote healing of the surgical site.
Evaluation
Surgical site will be monitored for any signs of infection, and patient adherence to wound care will be assessed during follow-up visits.
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⚠️ Educational Care Plan Notice
This care plan is for educational purposes only and represents general nursing concepts.
All care plans must be individualized based on:
- Individual patient assessment and current condition
- Healthcare provider orders and facility protocols
- Current evidence-based practice guidelines
- Nursing scope of practice in your jurisdiction
Do not use as direct patient care instructions. Always follow your facility's policies, physician orders, and professional nursing judgment.