8+ Pneumonia Nursing Care Plans
Pneumonia Nursing Care Plans: 10 Nursing Diagnosis

In this guide are pneumonia nursing care plans and nursing diagnosis, nursing interventions and nursing assessment for pneumonia. Nursing interventions for pneumonia and care plan goals for patients with pneumonia include measures to assist in effective coughing, maintain a patent airway, decreasing viscosity and tenaciousness of secretions, and assist in suctioning.

Pneumonia is an inflammation of the lung parenchyma, associated with alveolar edema and congestion that impair gas exchange. Pneumonia is caused by a bacterial or viral infection that is spread by droplets or by contact and is the sixth leading cause of death in the United States.

The prognosis is typically good for people who have normal lungs and adequate host defenses before the onset of pneumonia. Pneumonia is a particular concern in high-risk patients: persons who are very young or very old, people who smoke, bedridden, malnourished, hospitalized, immunocompromised, or exposed to MRSA.

Types of Pneumonia

There are two types of pneumonia: community-acquired pneumonia (CAP), or hospital-acquired pneumonia (HAP) or also known as nosocomial pneumonia.

Pneumonia may also be classified depending on its location and radiologic appearance. Bronchopneumonia (bronchial pneumonia) involves the terminal bronchioles and alveoli. Interstitial (reticular) pneumonia involves inflammatory response within lung tissue surrounding the air spaces or vascular structures rather than the area passages themselves. Alveolar (or acinar) pneumonia involves fluid accumulation in the lung’s distal air spaces. Necrotizing pneumonia causes the death of a portion of lung tissue surrounded by a viable tissue.

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Pneumonia is also classified based on its microbiologic etiology – they can be viral, bacterial, fungal, protozoan, mycobacterial, mycoplasmal, or rickettsial in origin.

Aspiration pneumonia, another type of pneumonia, results from vomiting and aspiration of gastric or oropharyngeal contents into the trachea and lungs.

Signs and Symptoms

The main symptoms of pneumonia are coughing, sputum production, pleuritic chest pain, shaking chills, rapid shallow breathing, fever, and shortness of breath. If left untreated, pneumonia could complicate to hypoxemia, respiratory failure, pleural effusion, empyema, lung abscess, and bacteremia.

Nursing care plan (NCP) and care management for patients with pneumonia start with an assessment of the patient’ medical history, performing respiratory assessment every four (4) hours, physical examination, and ABG measurements. Supportive interventions include oxygen therapy, suctioning, coughing, deep breathing, adequate hydration, and mechanical ventilation. Other nursing interventions are detailed on the nursing diagnoses in the subsequent sections.

Here are ten (10) nursing diagnosis common to pneumonia nursing care plans (NCP), they are as follows: 

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  1. Ineffective Airway Clearance
  2. Impaired Gas Exchange
  3. Ineffective Breathing Pattern
  4. Risk for Infection
  5. Acute Pain
  6. Activity Intolerance
  7. Hyperthermia
  8. Risk for Deficient Fluid Volume
  9. Risk for Imbalanced Nutrition: Less Than Body Requirements
  10. Deficient Knowledge

1. Ineffective Airway Clearance

Ineffective Airway Clearance is a common NANDA nursing diagnosis for pneumonia nursing care plans. This diagnosis is related to excessive secretions and ineffective cough or nonproductive coughing. Inflammation and increased secretions in pneumonia make it difficult to maintain a patent airway.

Nursing Diagnosis

  • Ineffective Airway Clearance. Inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway.

Related Factors

The following are the common related factors for the nursing diagnosis Ineffective Airway Clearance related to pneumonia:

  • Tracheal bronchial inflammation, edema formation, increased sputum production
  • Pleuritic pain
  • Decreased energy, fatigue
  • Aspiration

Defining Characteristics

Here are the common assessment cues that could serve as defining characteristics or “as evidenced by” for ineffective airway clearance secondary to pneumonia.

  • Changes in rate, depth of respirations
  • Abnormal breath sounds (rhonchi, bronchial lung sounds, egophony)
  • Use of accessory muscles
  • Dyspnea, tachypnea
  • Cough, effective or ineffective; with/without sputum production
  • Cyanosis
  • Decreased breath sounds over affected lung areas
  • Ineffective cough
  • Purulent sputum
  • Hypoxemia
  • Infiltrates seen on chest x-ray film

Desired Outcomes

Below are the common expected outcomes for ineffective airway clearance secondary to pneumonia:

  • Patient will identify/demonstrate behaviors to achieve airway clearance.
  • Patient will display/maintain patent airway with breath sounds clearing; absence of dyspnea, cyanosis, as evidenced by keeping a patent airway and effectively clearing secretions.

Nursing Interventions and Rationale

In this section are the ineffective airway clearance nursing interventions and actions for pneumonia together with its rationales or scientific explanations. The following nursing assessment for pneumonia and nursing interventions are measures to promote airway patency, increase fluid intake, and teaching and encouraging effective cough and deep-breathing techniques.

Nursing InterventionsRationale
Assessment
Assess the rate, rhythm, and depth of respiration, chest movement, and use of accessory muscles.Tachypnea, shallow respirations and asymmetric chest movement are frequently present because of discomfort of moving chest wall and/or fluid in lung due to a compensatory response to airway obstruction. Altered breathing pattern may occur together with use of accessory muscles to increase chest excursion to facilitate effective breathing.
Assess cough effectiveness and productivityCoughing is the most effective way to remove secretions. Pneumonia may cause thick and tenacious secretions to patients.
Auscultate lung fields, noting areas of decreased or absent airflow and adventitious breath sounds: crackles, wheezes.Decreased airflow occurs in areas with consolidated fluid. Bronchial breath sounds can also occur in these consolidated areas. Crackles, rhonchi, and wheezes are heard on inspiration and/or expiration in response to fluid accumulation, thick secretions, and airway spasms and obstruction.
Observe the sputum color, viscosity, and odor. Report changes.Changes in sputum characteristics may indicate infection. Sputum that is discolored, tenacious, or has an odor may increase airway resistance and may warrant further intervention.
Assess the patient’s hydration status.Airway clearance is hindered with inadequate hydration and thickening of secretions.
Therapeutic Interventions
Elevate head of bed, change position frequently.Doing so would lower the diaphragm and promote chest expansion, aeration of lung segments, mobilization and expectoration of secretions.
Teach and assist patient with proper deep-breathing exercises. Demonstrate proper splinting of chest and effective coughing while in upright position. Encourage him to do so often.
  • Deep breathing exercises facilitates maximum expansion of the lungs and smaller airways, and improves the productivity of cough.
  • Coughing is a reflex and a natural self-cleaning mechanism that assists the cilia to maintain patent airways. It is the most helpful way to remove most secretions.
  • Splinting reduces chest discomfort and an upright position favors deeper and more forceful cough effort making it more effective.
Suction as indicated: frequent coughing, adventitious breath sounds, desaturation related to airway secretions.Stimulates cough or mechanically clears airway in patient who is unable to do so because of ineffective cough or decreased level of consciousness. Note: Suctioning can cause increased hypoxemia; hyper oxygenate before, during, and after suctioning.
Maintain adequate hydration by forcing fluids to at least 3000 mL/day unless contraindicated (e.g., heart failure). Offer warm, rather than cold, fluids.Fluids, especially warm liquids, aid in mobilization and expectoration of secretions. Fluids help maintain hydration and increases ciliary action to remove secretions and reduces the viscosity of secretions. Thinner secretions are easier to cough out.
Assist and monitor effects of nebulizer treatment and other respiratory physiotherapy: incentive spirometer, IPPB, percussion, postural drainage.

Perform treatments between meals and limit fluids when appropriate.

  • Nebulizers humidify the airway to thin secretions and facilitates liquefaction and expectoration of secretions.
  • Postural drainage may not be as effective in interstitial pneumonias or those causing alveolar exudate or destruction.
  • Incentive spirometry serves to improve deep breathing and helps prevent atelectasis.
  • Chest percussion helps loosen and mobilize secretions in smaller airways that cannot be removed by coughing or suctioning.
  • Coordination of treatments and oral intake reduces likelihood of vomiting with coughing, expectorations.
Encourage ambulation.Helps mobilize secretions and reduces atelectasis.
Administer medications as indicated:

  • Mucolytics increase or liquefy respiratory secretions.
  • Expectorants increase productive cough to clear the airways. They liquefy lower respiratory tract secretions by reducing its viscosity.
  • Bronchodilators are medications used to facilitate respiration by dilating the airways.
  • Analgesics are given to improve cough effort by reducing discomfort, but should be used cautiously because they can decrease cough effort and depress respirations.
Use humidified oxygen or humidifier at bedside.Increasing the humidity will decrease the viscosity of secretions. Clean the humidifier before use to avoid bacterial growth.
Monitor serial chest x-rays, ABGs, pulse oximetry readings.Follows progress and effects and extent of pneumonia. Therapeutic regimen, and may facilitate necessary alterations in therapy. Oxygen saturation should be maintain at 90% or greater. Imbalances in PaCO2 and PaO2 may indicate respiratory fatigue.
Assist with bronchoscopy and/or thoracentesis, if indicated.Bronchoscopy is occasionally needed to remove mucous plugs, drain purulent secretions, obtain lavage samples for culture and sensitivity.

Thoracentesis is done to drain associated pleural effusions and prevent atelectasis.

Anticipate the need for supplemental oxygen or intubation if patient’s condition deteriorates.These measures are needed to correct hypoxemia. Intubation is needed for deep suctioning efforts and provide a source for augmenting oxygenation.
Urge all bedridden and postoperative patients to perform deep breathing and coughing exercises frequently.To promote full aeration and drainage of secretions.

2. Impaired Gas Exchange

This nursing diagnosis for pneumonia nursing care plans is usually written as Impaired Gas Exchange related to retained secretions and inflammatory pulmonary.

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Nursing Diagnosis

  • Impaired Gas Exchange: excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane.

Related Factors

The following are the common related factors for impaired gas exchange related to pneumonia:

  • Alveolar-capillary membrane changes (inflammatory effects)
  • Altered oxygen-carrying capacity of blood/release at cellular level (fever, shifting oxyhemoglobin curve)
  • Altered delivery of oxygen (hypoventilation)
  • Collection of mucus in airways
  • Inflammation of airways and alveoli
  • Fluid-filled alveoli

Defining Characteristics

The common assessment cues that could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

  • Dyspnea, Tachypnea
  • Pale, dusky, skin color
  • Cyanosis
  • Tachycardia
  • Restlessness, irritability, changes in mentation
  • Hypoxemia
  • Hypotension
  • Disorientation

Desired Outcomes

Common expected outcomes for the nursing diagnosis impaired gas exchange secondary to pneumonia:

  • Patient will demonstrate improved ventilation and oxygenation of tissues by ABGs within patient’s acceptable range and absence of symptoms of respiratory distress.
  • Patient will maintain optimal gas exchange.
  • Patient will participate in actions to maximize oxygenation.

Nursing Interventions and Rationales

Here are the nursing interventions and rationales to address the nursing diagnosis impaired gas exchange secondary to pneumonia. They are mostly measures to maintain oxygen saturations above 90%.

Nursing InterventionsRationale
Assessment
Assess respirations: note quality, rate, rhythm, depth, use of accessory muscles, ease, and position assumed for easy breathing.Manifestations of respiratory distress are dependent on/and indicative of the degree of lung involvement and underlying general health status as patients will adapt their breathing patterns to facilitate effective gas exchange.

Rapid, shallow breathing patterns and hypoventilation directly affects gas exchange. Hypoxia is associated with signs of increased breathing effort. Tripod positioning is an evidence of significant dyspnea.

Observe color of skin, mucous membranes, and nail beds, noting presence of peripheral cyanosis (nail beds) or central cyanosis (circumoral).As oxygenation and perfusion become impaired, peripheral tissues become cyanotic. Cyanosis of nail beds may represent vasoconstriction or the body’s response to fever/chills; however, cyanosis of earlobes, mucous membranes, and skin around the mouth (“warm membranes”) is indicative of systemic hypoxemia.
Assess mental status, restlessness, and changes in level of consciousness.Restlessness, irritation, confusion, and somnolence may reflect hypoxemia and decreased cerebral oxygenation and may require further intervention. Check pulse oximetry results with any mental status changes in older adults.
Assess anxiety level and encourage verbalization of feelings and concerns.Anxiety is a manifestation of psychological concerns and physiological responses to hypoxia. Providing reassurance and enhancing sense of security can reduce the psychological component, thereby decreasing oxygen demand and adverse physiological responses.
Monitor heart rate and rhythm and blood pressure.Tachycardia is usually present as a result of fever and/or dehydration but may represent a response to hypoxemia. Initial hypoxia and hypercapnia increases BP and HR. As hypoxia becomes more severe, BP may drop while HR tends to continue to be rapid with dysrhythmias.
Monitor body temperature, as indicated. Assist with comfort measures to reduce fever and chills: addition or removal of bedcovers, comfortable room temperature, tepid or cool water sponge bath.High fever (common in bacterial pneumonia and influenza) greatly increases metabolic demands and oxygen consumption and alters cellular oxygenation.
Observe for deterioration in condition, noting hypotension, copious amounts of bloody sputum, pallor, cyanosis, change in LOC, severe dyspnea, and restlessness.Shock and pulmonary edema are the most common causes of death in pneumonia and require immediate medical intervention.
Monitor ABGs, pulse oximetry.Follows progress of disease process and facilitates alterations in pulmonary therapy. Pulse oximetry detects changes in oxygenation. O2 sats should be at 90% or greater.
Therapeutic Interventions
Maintain bedrest by planning activity and rest periods to minimize energy use. Encourage use of relaxation techniques and diversional activities.Prevents over exhaustion and reduces oxygen demands to facilitate resolution of infection. Relaxation techniques helps conserve energy that can be used for effective breathing and coughing efforts.
Elevate head and encourage frequent position changes, deep breathing, and effective coughing.These measures promote maximum chest expansion, mobilize secretions and improve ventilation.
Administer oxygen therapy by appropriate means: nasal prongs, mask, Venturi mask.The purpose of oxygen therapy is to maintain PaO2 above 60 mmHg. Oxygen is administered by the method that provides appropriate delivery within the patient’s tolerance. Note: Patients with underlying chronic lung diseases should be given oxygen cautiously.

3. Ineffective Breathing Pattern

In this case, the nursing diagnosis Ineffective Breathing Pattern is related to compensatory tachypnea due to an inability to meet metabolic demands. It is experienced by many clients with pneumonia. Changes in breathing pattern occur because affected alveoli cannot effectively exchange oxygen and carbon dioxide, as a result of chest pain, and increased body temperature.

Nursing Diagnosis

  • Ineffective Breathing Pattern: Inspiration and/or expiration that does not provide adequate ventilation.

Related Factors

Common related factors for ineffective breathing pattern:

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  • Alteration of patient’s O2/CO2 ratio
  • Anxiety
  • Hypoxia
  • Decreased lung expansion
  • Inflammatory process
  • Pain

Defining Characteristics

The common assessment cues that could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

  • Changes in rate, depth of respirations
  • Abnormal breath sounds (rhonchi, bronchial lung sounds, egophony)
  • Use of accessory muscles
  • Dyspnea, tachypnea
  • Cough, effective or ineffective; with/without sputum production
  • Cyanosis
  • Decreased breath sounds over affected lung areas
  • Ineffective cough
  • Purulent sputum
  • Hypoxemia
  • Infiltrates seen on chest x-ray film
  • Reduced vital capacity

Desired Outcomes

Common goals and outcomes for ineffective breathing pattern:

  • Patient maintains an effective breathing pattern, as evidenced by relaxed breathing at normal rate and depth and absence of dyspnea.
  • Patient’s respiratory rate remains within established limits.

Nursing Interventions and Rationales

The following are nursing actions to address ineffective breathing pattern. These interventions include: positioning the client to facilitate effective breathing (raising head of bed to 45 degrees), teaching how to splint chest wall with a pillow, and use of incentive spirometry.

Nursing InterventionsRationales
Assessment
Assess and record respiratory rate and depth at least every 4 hours.The average rate of respiration for adults is 10 to 20 breaths per minute. It is important to take action when there is an alteration in the pattern of breathing to detect early signs of respiratory compromise.
Assess ABG levels, according to facility policy.This monitors oxygenation and ventilation status.
Observe for breathing patterns.Unusual breathing patterns may imply an underlying disease process or dysfunction. Cheyne-Stokes respiration signifies bilateral dysfunction in the deep cerebral or diencephalon related with brain injury or metabolic abnormalities. Apneusis and ataxic breathing are related with failure of the respiratory centers in the pons and medulla.
Auscultate breath sounds at least every four (4) hours.This is to detect decreased or adventitious breath sounds.
Assess for use of accessory muscle.Work of breathing increases greatly as lung compliance decreases.
Monitor for diaphragmatic muscle fatigue or weakness (paradoxical motion).Paradoxical movement of the abdomen (an inward versus outward movement during inspiration) is indicative of respiratory muscle fatigue and weakness.
Observe for retractions or flaring of nostrils.These signs signify an increase in respiratory effort.
Therapeutic Interventions
Place patient with proper body alignment for maximum breathing pattern.A sitting position permits maximum lung excursion and chest expansion.
Encourage sustained deep breaths by:

  • Using demonstration: highlighting slow inhalation, holding end inspiration for a few seconds, and passive exhalation
  • Utilizing incentive spirometer
  • Requiring the patient to yawn
These techniques promotes deep inspiration, which increases oxygenation and prevents atelectasis. Controlled breathing methods may also aid slow respirations in patients who are tachypneic. Prolonged expiration prevents air trapping.
Encourage diaphragmatic breathing for patients with chronic disease.This method relaxes muscles and increases the patient’s oxygen level.
Maintain a clear airway by encouraging patient to mobilize own secretions with successful coughing.This facilitates adequate clearance of secretions.
Suction secretions, as necessary.This is to clear blockage in airway.
Stay with the patient during acute episodes of respiratory distress.This will reduce the patient’s anxiety, thereby reducing oxygen demand.
Ambulate patient as tolerated with doctor’s order three times daily.Ambulation can further break up and move secretions that block the airways.
Encourage frequent rest periods and teach patient to pace activity.Extra activity can worsen shortness of breath. Ensure the patient rests between strenuous activities.
Encourage small frequent meals.This prevents crowding of the diaphragm.
Help patient with ADLs, as necessary.This conserves energy and avoids overexertion and fatigue.
Avail a fan in the room.Moving air can decrease feelings of air hunger.
Educate patient or significant other proper breathing, coughing, and splinting methods.These allow sufficient mobilization of secretions.
Teach patient about:

  • pursed-lip breathing
  • abdominal breathing
  • performing relaxation techniques
  • performing relaxation techniques
  • taking prescribed medications (ensuring accuracy of dose and frequency and monitoring adverse effects)
  • scheduling activities to avoid fatigue and provide for rest periods
These measures allow patient to participate in maintaining health status and improve ventilation.

4. Risk for Infection

The NANDA nursing diagnosis Risk for Infection is chosen to prevent the spread of infection.

Nursing Diagnosis

  • Risk for [Spread] of Infection: at increased risk for being invaded by pathogenic organisms.

Risk Factors

The following are the common risk factors:

  • Inadequate primary defenses (decreased ciliary action, stasis of respiratory secretions)
  • Inadequate secondary defenses (presence of existing infection, immunosuppression), chronic disease, malnutrition

Desired Outcomes

Goals and expected outcomes for Risk for Infection secondary to pneumonia.

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  • Achieve timely resolution of current infection without complications.
  • Identify interventions to prevent/reduce risk/spread of/secondary infection.

Nursing Interventions and Rationales

The following measures are to prevent the spread of infection. These are the nursing interventions for pneumonia nursing care plans with Risk for Infection nursing diagnosis:

Nursing InterventionsRationale
Assessment
Monitor vital signs closely, especially during initiation of therapy.During this period of time, potentially fatal complications (hypotension, shock) may develop.
Instruct patient concerning the disposition of secretions: raising and expectorating versus swallowing; and reporting changes in color, amount, odor of secretions.Although patient may find expectoration offensive and attempt to limit or avoid it, it is essential that sputum be disposed of in a safe manner. Changes in characteristics of sputum reflect resolution of pneumonia or development of secondary infection.
Assess patient’s immunization status.Immunizations with pneumococcal vaccine and seasonal influenza are used to reduce the risk for developing pneumonia.
Therapeutic Interventions
Demonstrate and encourage good hand washing technique.Effective means of reducing spread or acquisition of infection.
Change position frequently and provide good pulmonary toilet.Promotes expectoration, clearing of infection.
Limit visitors as indicated.Reduces likelihood of exposure to other infectious pathogens.
Institute isolation precautions as individually appropriate. Keep patient away from other patients who are at high risk for developing pneumonia.Dependent on type of infection, response to antibiotics, patient’s general health, and development of complications, isolation techniques may be desired to prevent spread from other infectious processes. Nosocomial pneumonia is at high risk of development for immunocompromised patients, provide careful room assignments when patients are in semiprivate rooms.
Encourage adequate rest balanced with moderate activity. Promote adequate nutritional intake.Facilitates healing process and enhances natural resistance.
Monitor effectiveness of antimicrobial therapy.Signs of improvement in condition should occur within 24–48 hr. Note any changes.
Investigate sudden change in condition, such as increasing chest pain, extra heart sounds, altered sensorium, recurring fever, changes in sputum characteristics.Delayed recovery or increase in severity of symptoms suggests resistance to antibiotics or secondary infection.
Prepare and assist with diagnostic studies as indicated.Fiberoptic bronchoscopy (FOB) may be done in patients who do not respond rapidly (within 1–3 days) to antimicrobial therapy to clarify diagnosis and therapy needs.
Administer prescribed antimicrobial agents as ordered.To prevent relapse of pneumonia, the patient needs to complete the course of antibiotics as prescribed.

5. Acute Pain

Increased sputum production in pneumonia comes with frequent coughing. Persistent coughing can be painful therefore the need for Acute Pain nursing diagnosis.

Nursing Diagnosis

  • Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

Related Factors

Common related factors for acute pain nursing diagnosis:

  • Inflammation of lung parenchyma
  • Cellular reactions to circulating toxins
  • Persistent coughing

Defining Characteristics

The common assessment cues that could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

  • Reports of discomfort: pleuritic chest pain, headache, muscle/joint pain
  • Guarding of affected area
  • Self-focused
  • Moaning, restlessness
  • Facial mask, distraction behaviors
  • Irritability
  • Tachycardia
  • Increased BP
  • Tachypnea

Desired Outcomes

Goals and expected outcomes for acute pain nursing diagnosis:

  • Patient will verbalize relief/control of pain at level less than 3 to 4 using a rating scale of 0 to 10.
  • Patient will demonstrate relaxed manner, resting/sleeping and engaging in activity appropriately.
  • Patient will verbalize understanding of nonpharmacological interventions for pain relief.

Nursing Interventions and Rationales

The following measures are to address acute pain related to persistent coughing. These nursing interventions and actions are for pain relief to facilitate effective mobilization of secretions through coughing and deep breathing exercises.

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Nursing InterventionsRationale
Assessment
Assess pain characteristics: sharp, constant, stabbing. Investigate changes in character, location, or intensity of pain. Assess reports of pain with breathing or coughing.Chest pain, usually present to some degree with pneumonia, may also herald the onset of complications of pneumonia, such as pericarditis and endocarditis.
Monitor vital signs.Changes in heart rate or BP may indicate that patient is experiencing pain, especially when other reasons for changes in vital signs have been ruled out.
Therapeutic Interventions
Provide comfort measures: back rubs, position changes, quite music, massage. Encourage use of relaxation and/or breathing exercises.Non-analgesic measures administered with a gentle touch can lessen discomfort and augment therapeutic effects of analgesics. Patient involvement in pain control measures promotes independence and enhances sense of well-being.
Offer frequent oral hygiene.Mouth breathing and oxygen therapy can irritate and dry out mucous membranes, potentiating general discomfort.
Instruct and assist patient in chest splinting techniques during coughing episodes.Aids in control of chest discomfort while enhancing the effectiveness of cough effort.
Administer antitussives as indicated. Do not suppress a productive cough; moderate amounts of analgesics are used to relieve pleuritic pain.These medications may be used to suppress non-productive cough or reduce excess mucus, thereby enhancing general comfort.

Coughing is necessary to mobilize secretions and suppressing cough will cause retained secretions and delay resolution of pneumonia.

Administer analgesics as prescribed. Encourage patient to take analgesics before discomfort becomes severe.Medications allow for pain relief and the ability to deep breathe and cough. Analgesics help prevent peak periods of pain.

6. Activity Intolerance

The nursing diagnosis Activity Intolerance is related to decreased oxygen levels for metabolic demands. For these pneumonia nursing care plans, energy reserves are also depleted due to insufficient intake of food during periods of dyspnea.

Nursing Diagnosis

  • Activity Intolerance: Insufficient physiologic or physiological energy to endure or complete required or desired activity.

Related Factors

Common related factors for activity intolerance secondary to pneumonia:

  • Imbalance between oxygen supply and demand
  • General weakness
  • Exhaustion associated with interruption in usual sleep pattern because of discomfort, excessive coughing, and dyspnea

Defining Characteristics

The common assessment cues that could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

  • Verbal reports of weakness, fatigue, exhaustion
  • Exertional dyspnea, tachypnea
  • Tachycardia in response to activity
  • Development/worsening of pallor/cyanosis

Desired Outcomes

Common goals and expected outcomes:

  • Report/demonstrate a measurable increase in tolerance to activity with absence of dyspnea and excessive fatigue, and vital signs within patient’s acceptable range.

Nursing Interventions and Rationales

Nursing interventions for activity intolerance in this pneumonia nursing care plan should include assessment of the client’s baseline activity level and response to activity and noting how well the client tolerates activity. Next is to schedule activities after treatment or medications and providing emotional support and a quiet environment to reduce anxiety and promote rest.

Nursing InterventionsRationale
Assessment
Determine patient’s response to activity. Note reports of dyspnea, increased weakness and fatigue, changes in vital signs during and after activities.Establishes patient’s capabilities and needs and facilitates choice of interventions.
Therapeutic Interventions
Provide a quiet environment and limit visitors during acute phase as indicated. Encourage use of stress management and diversional activities as appropriate.Reduces stress and excess stimulation, promoting rest
Explain importance of rest in treatment plan and necessity for balancing activities with rest.Bedrest is maintained during acute phase to decrease metabolic demands, thus conserving energy for healing. Activity restrictions thereafter are determined by individual patient response to activity and resolution of respiratory insufficiency.
Pace activity for patients with reduced activity.Effective coughing may exhaust an already compromised patient. Fatigue may be a contributing factor to ineffective coughing.
Assist patient to assume comfortable position for rest and sleep.Patient may be comfortable with head of bed elevated, sleeping in a chair, or leaning forward on overbed table with pillow support.
Assist with self-care activities as necessary. Provide for progressive increase in activities during recovery phase. and demand.Minimizes exhaustion and helps balance oxygen supply and demand.

7. Hyperthermia

Hyperthermia in pneumonia is caused by the inflammatory process and is related to dehydration and infection.

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Nursing Diagnosis

  • Hyperthermia: Body temperature elevated above normal range.

Related Factors

  • Dehydration
  • Infection
  • Increased metabolic rate

Defining Characteristics

  • Body temperature above the normal range
  • Hot, flushed skin
  • Increased heart rate
  • Increased respiratory rate

Desired Outcomes

  • Patient maintains body temperature within normal range.
  • Patient maintains BP and HR within normal limits.

Nursing Interventions and Rationales

For this pneumonia nursing care plan, interventions for hyperthermia includes measures to maintain body temperature within normal range.

Nursing InterventionsRationales
Assessment
Monitor the patient’s HR, BP, and especially the tympanic or rectal temperature.HR and BP increase as hyperthermia progresses. Tympanic or rectal temperature gives a more accurate indication of core temperature.
Determine the patient’s age and weight.Extremes of age or weight increase the risk for the inability to control body temperature.
Monitor fluid intake and urine output. If the patient is unconscious, central venous pressure or pulmonary artery pressure should be measured to monitor fluid status.Fluid resuscitation may be required to correct dehydration. The patient who is significantly dehydrated is no longer able to sweat, which is necessary for evaporative cooling.
Review serum electrolytes, especially serum sodium.Sodium losses occur with profuse sweating and accidental hyperthermia.
Therapeutic Interventions
Adjust and monitor environmental factors like room temperature and bed linens as indicated.Room temperature may be accustomed to near normal body temperature and blankets and linens may be adjusted as indicated to regulate temperature of the patient.
Eliminate excess clothing and covers.Exposing skin to room air decreases warmth and increases evaporative cooling.
Give antipyretic medications as prescribed.Antipyretic medications lower body temperature by blocking the synthesis of prostaglandins that act in the hypothalamus.
Ready oxygen therapy for extreme cases.Hyperthermia increases the metabolic demand for oxygen.

8. Risk for Deficient Fluid Volume

Risk for Deficient Fluid Volume may be related to the common risk factors manifested by patients with pneumonia: fever, diaphoresis, and mouth breathing.

Nursing Diagnosis

  • Risk for Deficient Fluid Volume: At risk for decreased intravascular, interstitial, and intracellular fluid.

Risk Factors

The following are the common risk factors for the nursing diagnosis Risk for Deficient Fluid Volume:

  • Excessive fluid loss (fever, profuse diaphoresis, mouth breathing/hyperventilation, vomiting)
  • Decreased oral intake

Desired Outcomes

Common goals and expected outcomes:

  • Patient demonstrates fluid balance evidenced by individually appropriate parameters, e.g., moist mucous membranes, good skin turgor, prompt capillary refill, stable vital signs.

Nursing Interventions and Rationale

Interventions and actions for the nursing diagnosis Risk for Deficient Fluid Volume in this pneumonia nursing care plan are as follows:

Nursing InterventionsRationale
Assessment
Assess vital sign changes: increasing temperature, prolonged fever, orthostatic hypotension, tachycardia.Elevated temperature and prolonged fever increases metabolic rate and fluid loss through evaporation. Orthostatic BP changes and increasing tachycardia may indicate systemic fluid deficit.
Assess skin turgor, moisture of mucous membranes.Indirect indicators of adequacy of fluid volume, although oral mucous membranes may be dry because of mouth breathing and supplemental oxygen.
Investigate reports of nausea and vomiting.Presence of these symptoms reduces oral intake.
Monitor intake and output (I&O), noting color, character of urine. Calculate fluid balance. Be aware of insensible losses. Weigh as indicated.Provides information about adequacy of fluid volume and replacement needs.
Therapeutic Interventions
Force fluids to at least 3000 mL/day or as individually appropriate.Meets basic fluid needs, reducing risk of dehydration and to mobilize secretions and promote expectoration.
Administer medications as indicated: antipyretics, antiemetics.To reduce fluid losses.
Provide supplemental IV fluids as necessary.In presence of reduced intake and/or excessive loss, use of parenteral route may correct deficiency.

9. Risk for Imbalanced Nutrition: Less Than Body Requirements

Dyspnea is a common risk factor for the risk nursing diagnosis Imbalanced Nutrition: Less Than Body Requirements in pneumonia.

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Nursing Diagnosis

  • Risk for Imbalanced Nutrition: Less Than Body Requirements: At risk for intake of nutrients insufficient to meet metabolic needs.

Risk Factors

The following are the common risk factors for this nursing diagnosis:

  • Dyspnea
  • Increased metabolic needs secondary to fever and infectious process
  • Anorexia associated with bacterial toxins, the odor and taste of sputum, and certain aerosol treatments
  • Abdominal distension/gas associated with swallowing air during dyspneic episodes

Desired Outcomes

Here are the expected outcomes for this nursing diagnosis:

  • Patient demonstrates increased appetite.
  • Patient maintains/regains desired body weight.

Nursing Interventions and Rationale

Here are the nursing interventions and actions for this pneumonia nursing care plans.

Nursing InterventionsRationale
Assessment
Identify factors that are contributing to nausea or vomiting: copious sputum, aerosol treatments, severe dyspnea, pain.Choice of interventions depends on the underlying cause of the problem.
Therapeutic Interventions
Provide covered container for sputum and remove at frequent intervals. Assist and encourage oral hygiene after emesis, after aerosol and postural drainage treatments, and before meals.Eliminates noxious sights, tastes, smells from the patient environment and can reduce nausea.
Schedule respiratory treatments at least 1 hr before meals.Reduces effects of nausea associated with these treatments.
Maintain adequate nutrition to offset hypermetabolic state secondary to infection. Ask the dietary department to provide a high-calorie, high-protein diet consisting of soft, easy-to-eat foods.To replenish lost nutrients.
Consider limiting use of milk productsMilk products may increase sputum production.
Elevate the patient’s head and neck, and check for tube’s position during NG tube feedings.To prevent aspiration. Note: Don’t give large volumes at one time; this could cause vomiting. Keep the patient’s head elevated for at least 30 minutes after feeding. Check for residual formula regular intervals.
Auscultate for bowel sounds. Observe for abdominal distension.Bowel sounds may be diminished if the infectious process is severe. Abdominal distension may occur as a result of air swallowing or reflect the influence of bacterial toxins on the gastrointestinal (GI) tract.
Provide small, frequent meals, including dry foods (toast, crackers) and/or foods that are appealing to patient.These measures may enhance intake even though appetite may be slow to return.
Evaluate general nutritional state, obtain baseline weight.Presence of chronic conditions (COPD or alcoholism) or financial limitations can contribute to malnutrition, lowered resistance to infection, and/or delayed response to therapy.

10. Deficient Knowledge

Deficient Knowledge nursing diagnosis for pneumonia nursing care plan includes all the teaching plan and interventions for the patient and caregiver to achieve understanding of the disease condition and prognosis.

Nursing Diagnosis

  • Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

Related Factors

Common related factors:

  • Lack of exposure
  • Misinterpretation of information
  • Altered recall
  • Unfamiliarity with the disease process and/or transmission of disease

Defining Characteristics

The common assessment cues that could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

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  • Requests for information
  • Questions to health care team
  • Statement of misconception
  • Failure to improve/recurrence
  • Confusion about treatment
  • Inability to comply with treatment regimen, including appropriate isolation procedures

Desired Outcomes

Common goals and expected outcomes for Deficient Knowledge nursing diagnosis:

  • Patient and caregiver will verbalize understanding of condition, disease process, and prognosis.
  • Patient and caregiver will verbalize understanding of therapeutic regimen.
  • Patient will initiate necessary lifestyle changes.
  • Patient will participate in treatment program.
Nursing InterventionsRationale
Assessment
Determine patient’s understanding of pneumonia complications and its treatment regimen.Provides a starting point in education.
Review normal lung function, pathology of condition.Promotes understanding of current situation and importance of cooperating with treatment regimen.
Discuss debilitating aspects of disease, length of convalescence, and recovery expectations. Identify self-care and homemaker needs.Information can enhance coping and help reduce anxiety and excessive concern. Respiratory symptoms may be slow to resolve, and fatigue and weakness can persist for an extended period. These factors may be associated with depression and the need for various forms of support and assistance.
Assess potential home care needs.Therapeutic regimen will continue after hospital discharge and home care needs will depend on the availability of supportive people including the patient’s energy level and cognitive level.
Therapeutic Interventions
Provide information in written and verbal form.Fatigue and depression can affect ability to assimilate information and follow therapeutic regimen.
Reinforce importance of continuing effective coughing and deep-breathing exercises.During initial 6–8 wk after discharge, patient is at greatest risk for recurrence of pneumonia.
Emphasize necessity for continuing antibiotic therapy for prescribed period.Full-course antibiotic treatment is required to reduce the recurrence of pneumonia and promote a healthy immune system. Early discontinuation of antibiotics may result in failure to completely resolve infectious process and may cause recurrence or rebound pneumonia.
Review the importance of cessation of smoking.Smoking destroys tracheobronchial ciliary action, irritates bronchial mucosa, and inhibits alveolar macrophages, compromising body’s natural defense against infection.
Outline steps to enhance general health and well-being: balanced rest and activity, well-rounded diet, avoidance of crowds during cold/flu season and persons with URIs.Increases natural defense, limits exposure to pathogens.
Stress importance of continuing medical follow-up and obtaining vaccinations as appropriate.May prevent recurrence of pneumonia and/or related complications.
Identify signs and symptoms requiring notification of health care provider: increasing dyspnea, chest pain, prolonged fatigue, weight loss, fever, chills, persistence of productive cough, changes in mentation.Prompt evaluation and timely intervention may prevent complications.
Instruct patient to avoid using antibiotics indiscriminately during minor viral infections.This may results in upper airway colonization with antibiotic-resistant bacteria. If the patient then develops pneumonia, the organisms producing the pneumonia may require treatment with more toxic antibiotics.
Encourage Pneumovax and annual flu shots for high-risk patients.To help prevent occurrence of the disease.

Related Nursing Care Plans

Related nursing diagnoses you can use to craft another pneumonia nursing care plans.

References and Sources

Recommended journals, books, and other interesting materials to help you learn more about Pneumonia Nursing Care Plans:

  • Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier. [Link]
  • Dempsey, C. L. (1995). Nursing Home‐Acquired Pneumonia: Outcomes from a Clinical Process Improvement Program. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 15(1P2), 33S-38S. [Link]
  • Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. FA Davis. [Link]
  • Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences. [Link]
  • Head, B. J., Scherb, C. A., Reed, D., Conley, D. M., Weinberg, B., Kozel, M., … & Moorhead, S. (2011). Nursing diagnoses, interventions, and patient outcomes for hospitalized older adults with pneumonia. Research in gerontological nursing4(2), 95-105. [Link]
  • Yoshino, A., Ebihara, T., Ebihara, S., Fuji, H., & Sasaki, H. (2001). Daily oral care and risk factors for pneumonia among elderly nursing home patients. Jama286(18), 2235-2236. [Link]

This post is updated as of February 2019. 

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27 COMMENTS

  1. I am a nurse in Angkor Hospital for Children in Cambodia. I had read this article website. I am very interested in this article because it is understandable and easy to remember,and it can help me use it to improve my knowledge.And also I can take this article to teach and present in my class and my colleagues.

  2. Am a student nurse at The Nairobi women’s Hospital Medical Training college i came across this website yesterday and its just wonderful and i really liked it ,its simple and easy to understand

  3. I am a nursing student at the University of Eastern Africa,Eldoret Kenya.This article is one of the best that explains the Nursing care plan.it has explained very well the nursing process.

  4. Hello, I am Reta Anggita. I am a student of bachelor nursing in University of Indonesia :). I am so helped by this article :)

  5. Hi. I am a Nursing student in Florida, USA. Doing a concept map on pneumonia and this greatly assisted me. Thank you.

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  7. I am a Nurning Student year 2 in Tonga,i am very glad to read this information on pneumonia i get alot of knowledge from this page and use it in my daily practice

  8. Thank you for this wonderful website. Currently, I am a 2nd year nursing student at San Beda College. This article is really helpful to me because I duty in the OB Ward and one of my patient has Pneumonia by the CXR. Thank you again! PAX!

  9. I JUST LOVE HOW SIMPLIFIED THIS NCP IS AND ITS EVIDENCE BASED,I TRIED TO DO SOME OF THE INTERVENTIONS AND THEY WORKED FOR MY PATIENT,THIS SITE HAS REALLY HELPED ME ALOT IN MY STUDIES AS A STUDENT,THANKS MATT!

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