Nursing care
Nursing care plan for knee replacement: clot, pain, mobility, infection and falls in order
Written and reviewed by Nicole Ramirez, BSN, RN, CMSRN · 4 min read · Updated November 2026
Short answer
A nursing care plan for knee replacement usually ranks risk for venous thromboembolism first, because a clot that travels to the lung threatens life. Acute pain is next, since uncontrolled pain blocks the early walking that prevents clots and stiffness. Impaired physical mobility, risk for surgical site infection and risk for falls complete the plan.
Post-op knee replacement care plan table
Labels follow NANDA-I, the source taxonomy most nursing programs use, described in plain words. The client is hypothetical: a 70-year-old on the evening of surgery after an elective total knee replacement under a regional block, already up to the chair once with the physical therapist.
| Nursing diagnosis | Goal or outcome | Nursing interventions | Rationale |
|---|---|---|---|
| 1. Risk for venous thromboembolism related to surgery and reduced movement | No calf swelling, no chest pain or sudden breathlessness | Apply compression stockings or boots as prescribed, coach ankle and foot pumps hourly while awake, walk as ordered, give prescribed anticoagulant, check legs each shift | Foot and ankle movement, compression and blood thinners lower clot risk after knee surgery |
| 2. Acute pain related to surgical tissue injury | Pain controlled enough to complete each therapy session | Assess pain and sedation, time prescribed analgesics before therapy, use ice and positioning as ordered, monitor the nerve block | Pain control is multimodal and lets the client move early |
| 3. Impaired physical mobility related to pain, swelling and new joint | Walks a set distance with a walker by discharge | Follow the therapy exercise plan, assist with transfers, encourage exercises several times a day | Therapy starts within hours and restores knee movement and strength |
| 4. Risk for surgical site infection | Incision clean and dry, no fever | Inspect the incision, use aseptic dressing care, teach signs to report | Fever above 100 degrees F, chills, spreading redness or drainage suggest infection |
| 5. Risk for falls related to block weakness and assistive device use | No falls in hospital or at home | Assist with first walks, keep the call light and walker close, teach stair safety and home hazard removal | A regional block can leave the leg weak, and stairs are an early hazard |
Anticoagulant choice, block settings and weight-bearing orders come from the surgeon. The nursing contribution is making the plan happen on time and noticing the first sign it is going wrong.
Why clot prevention outranks pain on the first night
Pain is the loudest problem after knee surgery, so it is a common first pick. The clot row wins because its worst outcome is a pulmonary embolism. CDC notes that about half of people with a deep vein clot have no symptoms, and that a PE can occur without any leg signs, so prevention cannot wait for a swollen calf.
Pain still ranks high because it is linked to the first row. A client who will not move the leg because it hurts does fewer ankle pumps and walks less, which raises clot and stiffness risk. That is why the pain goal on this page is about finishing therapy, not reaching a zero.
Findings that should change the plan
CDC lists swelling, pain or tenderness, warmth and redness in the limb as possible clot signs, and difficulty breathing, a fast or irregular heartbeat, chest pain worse on a deep breath, coughing up blood and fainting as possible PE signs. Sudden breathlessness in a post-op knee client is an emergency to report at once, even with a normal-looking leg.
Some calf swelling is expected after knee surgery, which makes clot signs harder to judge. Compare both legs, note whether swelling is new or rising, and report rather than decide on your own. OrthoInfo lists fever above 100 degrees F, chills, increasing redness or drainage at the incision and pain at rest as reasons to call; those belong in discharge teaching.
Writing the statement and judging outcomes
Hypothetical statement: acute pain related to surgical tissue injury as evidenced by a pain rating of 7 out of 10, guarding of the right knee and stopping a walk after 3 meters. Goal: client will rate pain at or below a level that lets them complete the afternoon therapy session and walk 15 meters with a walker by day one.
Evaluation uses what the client did. Completed therapy, walked the distance and took ankle pumps without reminders means the pain plan is working. A client who refuses therapy because of pain, or who is too drowsy to take part, needs the plan revised with the provider. OrthoInfo describes return to most daily activities in 3 to 6 weeks, which helps set realistic discharge goals.
Sources and further reading
Total Knee Replacement - OrthoInfo - AAOS. Compression stockings and boots, blood thinners and foot and ankle movement for clot prevention; multimodal pain control and regional blocks; therapy starting within hours; infection warning signs including fever above 100 degrees F; stairs as an early hazard; return to daily activities in 3 to 6 weeks.
About Venous Thromboembolism (Blood Clots) | CDC. About half of DVTs have no symptoms; DVT signs in the limb; PE signs; PE can occur without DVT symptoms; moving as soon as possible after surgery.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our med-surg practice questions are the closest set to what this page covers.
One question from the med-surg set
A client with chronic obstructive pulmonary disease has an oxygen saturation of 88% on 2 L/min via nasal cannula and is alert with no distress. What should the nurse do first?
Rationale
In COPD a saturation of 88–92% is the therapeutic target, not an emergency, and this client is alert with no distress. The first action is the independent nursing intervention that is least invasive and most likely to help: sit them up and reassess. Turning the oxygen up to 6 L/min risks blunting the hypoxic drive, and calling rapid response or drawing an ABG escalates ahead of an assessment you have not finished.
Answer: B
Common questions
What is the priority nursing diagnosis for total knee replacement?
Risk for venous thromboembolism is usually first, because a clot that moves to the lungs can be fatal and many clots cause no early leg symptoms. Acute pain is a close second because it limits the movement that prevents clots.
What are nursing interventions for total knee replacement?
Compression devices and ankle pumps, prescribed anticoagulant, early walking with therapy, pain assessment with analgesia timed before therapy, sedation checks, incision inspection, fall precautions with walker use, and teaching infection and clot warning signs.
What are SMART goals for a patient with total knee replacement?
Examples: client will complete each therapy session with pain at an agreed level through day two; client will walk 15 meters with a walker by day one; incision will be clean and dry at discharge; client will name three signs of a clot before going home.
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