11 Pneumonia Nursing Care Plans

Utilize this comprehensive nursing care plan and management guide to provide effective care for patients with pneumonia. Gain valuable insights on nursing assessment, interventions, goals, and nursing diagnosis specifically tailored for pneumonia in this guide.

Table of Contents

• What is Pneumonia?
• Nursing Care Plans & Management
  • Nursing Problem Priorities
  • Nursing Assessment
  • Nursing Diagnosis
  • Nursing Goals
  • Nursing Interventions and Actions
    • 1. Maintaining Patent Airway Clearance
    • 2. Improving Gas Exchange
    • 3. Promoting Effective Breathing Pattern and Breathing Exercises
    • 4. Administering Medications and Pharmacological Support
    • 5. Initiating Measures for Infection Control & Management
    • 6. Managing Acute Pain & Discomfort
    • 7. Promoting Rest and Improving Tolerance to Activity
    • 8. Maintaining Normal Body Thermoregulation
    • 9. Promoting Optimal Nutrition & Fluid Balance
    • 10. Providing Patient Education & Health Teachings
    • 11. Monitoring Potential Complications of Pneumonia
• Recommended Resources
• See Also
• References and Sources

What is Pneumonia?

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 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.

Pneumonia is categorized into four types: community-acquired pneumonia (CAP), health care–associated pneumonia (HCAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). HCAP was introduced in 2005 to identify patients at a higher risk for multidrug-resistant pathogens compared to those with community-acquired pneumonia. Subcategories of HCAP include pneumonia in immunocompromised hosts and aspiration pneumonia. The classification of specific pneumonias may overlap due to their occurrence in different settings.

For a comprehensive pathophysiology, medical and surgical management, please visit our Pneumonia nursing study guide

Nursing Care Plans & Management

Nursing care plan (NCP) and care management for patients with pneumonia start with assessing the patient’s medical history, performing a 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.

Nursing Problem Priorities

The following are the nursing priorities for patients with pneumonia:

• Improving airway patency
• Improving tolerance to activity
• Maintaining proper fluid volume
• Measures to prevent complications

Nursing Assessment

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 hypoxemia, respiratory failure, pleural effusion, empyema, lung abscess, and bacteremia. Initially, pneumonia patients experience a dry, irritating cough with minimal mucoid sputum. Symptoms may include sternal soreness, fever or chills, night sweats, headache, and general malaise. As the infection progresses, patients may develop shortness of breath, audible breathing sounds (inspiratory stridor and expiratory wheeze), and produce purulent sputum. In severe cases, blood-streaked secretions may occur due to airway mucosa irritation.

Assess for the following subjective and objective data:

• 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

Assess for factors related to the cause of pneumonia:

• Alteration of patient’s O2/CO2 ratio and hypoxia
• Decreased lung expansion and fluid-filled alveoli
• Inflammatory process, tracheal and bronchial inflammation, edema formation, increased sputum production
• Pleuritic pain and alveolar-capillary membrane changes
• Altered oxygen-carrying capacity of blood/release at cellular level
• Altered delivery of oxygen and hypoventilation
• Collection of mucus in airways

Nursing Diagnosis

Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with pneumonia based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities. 

Nursing Goals

Goals and expected outcomes may include:

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

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients with pneumonia may include:

• 1. Maintaining Patent Airway Clearance
• 2. Improving Gas Exchange
• 3. Promoting Effective Breathing Pattern and Breathing Exercises
• 4. Administering Medications and Pharmacological Support
• 5. Initiating Measures for Infection Control & Management
• 6. Managing Acute Pain & Discomfort
• 7. Promoting Rest and Improving Tolerance to Activity
• 8. Maintaining Normal Body Thermoregulation
• 9. Promoting Optimal Nutrition & Fluid Balance
• 10. Providing Patient Education & Health Teachings
• 11. Monitoring Potential Complications of Pneumonia

1. Maintaining Patent Airway Clearance

To address excessive secretions and ineffective coughing in pneumonia, the nurse encourages hydration, uses humidification, promotes voluntary or reflex coughing, and guides patients in performing effective directed coughs. Lung expansion maneuvers and external pressure assistance may be utilized to improve airway clearance.

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 the discomfort of moving the chest wall and fluid in the lung due to a compensatory response to airway obstruction. Altered breathing patterns may occur together with accessory muscles to increase chest excursion to facilitate effective breathing.

Assess cough effectiveness and productivity
Coughing is the most effective way to remove secretions. Pneumonia may cause thick and tenacious secretions in patients. Effective secretion removal is crucial as retained secretions can impede gas exchange and delay recovery. The nurse promotes hydration of 2 to 3 liters per day to facilitate thinning and loosening of pulmonary secretions.

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, expiration due 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 warrant further intervention.

Assess the patient’s hydration status.
Airway clearance is hindered by inadequate hydration and the thickening of secretions.

Elevate the head of the bed and change position frequently.
Doing so would lower the diaphragm and promote chest expansion, aeration of lung segments, mobilization, and expectoration of secretions.

Suction as indicated: frequent coughing, adventitious breath sounds, desaturation related to airway secretions.
Stimulates cough or mechanically clears airway in a patient who cannot do so because of ineffective cough or decreased level of consciousness. Note: Suctioning can cause increased hypoxemia; hyperoxygenate 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 the mobilization and expectoration of secretions. Fluids help maintain hydration and increase ciliary action to remove secretions and reduce viscosity. Thinner secretions are easier to cough out.

Use humidified oxygen or humidifier at the bedside.
Increasing the humidity will decrease the viscosity of secretions. Clean the humidifier before use to avoid bacterial growth. Humidification is employed to facilitate secretion loosening and enhance ventilation. By utilizing a high-humidity face mask with compressed air or oxygen, warm and humidified air is delivered to the tracheobronchial tree. This technique aids in liquefying secretions and alleviating tracheobronchial irritation.

Monitor serial chest x-rays, ABGs, and pulse oximetry readings.
Follows progress and effects and extent of pneumonia. A therapeutic regimen may facilitate necessary alterations in therapy. Oxygen saturation should be maintained at 90% or greater. Imbalances in PaCO2 and PaO2 may indicate respiratory fatigue.

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 facilitate 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 the likelihood of vomiting with coughing and expectorations.

Assist with bronchoscopy and thoracentesis, if indicated.

• Bronchoscopy is occasionally needed to remove mucous plugs, drain purulent secretions, and 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 the patient’s condition deteriorates.
These interventions are necessary to address hypoxemia and improve oxygenation. Intubation may be required for effective deep suctioning and to provide additional oxygenation support. The nurse administers and adjusts oxygen therapy as per the prescribed guidelines or protocols. The effectiveness of oxygen therapy is evaluated by monitoring improvements in clinical signs and symptoms, ensuring patient comfort, and maintaining adequate oxygenation levels through the use of pulse oximetry or arterial blood gas analysis.

2. Improving Gas Exchange

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/indicative of the degree of lung involvement and underlying general health status as patients adapt their breathing patterns to facilitate effective gas exchange. Rapid, shallow breathing patterns and hypoventilation directly affect gas exchange. Hypoxia is associated with signs of increased breathing effort. Tripod positioning is evidence of significant dyspnea.

Observe the color of skin, mucous membranes, and nail beds, noting the 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 the level of consciousness.
Restlessness, irritation, confusion, and somnolence may reflect hypoxemia and decreased cerebral oxygenation and 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 a sense of security can reduce the psychological component, decreasing oxygen demand and adverse physiological responses.

Monitor heart rate and rhythm, and blood pressure.
Tachycardia is usually present due to fever and/or dehydration but may represent a response to hypoxemia—initial hypoxia and hypercapnia increase BP and HR. As hypoxia becomes more severe, BP may drop while HR tends 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.
It follows the progress of the disease process and facilitates alterations in pulmonary therapy. Pulse oximetry detects changes in oxygenation. O2 sats should be at 90% or greater.

Maintain bedrest by planning activity and rest periods to minimize energy use. Encourage the use of relaxation techniques and diversional activities.
It prevents over exhaustion and reduces oxygen demands to facilitate the resolution of infection. Relaxation techniques help conserve energy that can be used for effective breathing and coughing efforts.

Elevate the head of the bed 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 a method that provides appropriate delivery within the patient’s tolerance. Note: Patients with underlying chronic lung diseases should be given oxygen cautiously.

3. Promoting Effective Breathing Pattern and Breathing Exercises

Teach and assist the patient with proper deep-breathing exercises. Demonstrate proper splinting of the chest and effective coughing while in an upright position. Encourage the patient to do so often.
Coughing can be voluntary or reflexive, and lung expansion maneuvers like deep breathing with an incentive spirometer can stimulate a cough. The nurse encourages patients to perform an effective directed cough to improve airway patency. This involves correct positioning, deep inspiration, closing the glottis, contracting expiratory muscles against the closed glottis, opening the glottis suddenly, and exhaling forcefully. The nurse may assist by placing hands on the lower rib cage to guide slow deep breaths and provide external pressure during exhalation if needed. These may include:

• Deep breathing exercises facilitate the maximum expansion of the lungs and smaller airways and improve the productivity of cough.
• Coughing is a reflex and a natural self-cleaning mechanism that assists the cilia in maintaining 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.

Assess and record respiratory rate and depth at least every 4 hours.
The average respiratory rate for adults is 10 to 20 breaths per minute. It is important to take action when there is an alteration in breathing patterns to detect early signs of respiratory compromise.

Assess ABG levels according to facility policy.
This monitors oxygenation and ventilation status.

Observe 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 to brain injury or metabolic abnormalities. Apneusis and ataxic breathing are related to the 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 the 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.

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 promote deep inspiration, which increases oxygenation and prevents atelectasis. Controlled breathing methods may also aid slow respirations in tachypneic patients. 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 the patient to mobilize their own secretions with successful coughing.
This facilitates adequate clearance of secretions.

Suction secretions, as necessary.
This is to clear the blockage in the 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 the 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 the 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 on proper breathing, coughing, and splinting methods.
These allow sufficient mobilization of secretions.

4. Administering Medications and Pharmacological Support

Administer prescribed antimicrobial agents as ordered.
Pneumonia treatment includes administering the appropriate antibiotic based on culture and sensitivity results. However, the causative organism is often unidentified in community-acquired pneumonia (CAP). Antibiotic selection follows guidelines considering resistance patterns, prevalent pathogens, patient risk factors, treatment setting, and antibiotic availability and cost. Antibiotic stewardship programs are crucial in monitoring and minimizing inappropriate antibiotic use, promoting evidence-based guidelines, and monitoring susceptibility patterns for pathogens.

Mucolytics increase or liquefy respiratory secretions.

Expectorants increase productive cough to clear the airways by liquefying lower respiratory tract secretions and reducing their 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.

5. Initiating Measures for Infection Control & Management

Monitor vital signs closely, especially during initiation of therapy and note that 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, the odor of secretions. Although the patient may find expectoration offensive and attempt to limit or avoid it, sputum must be disposed of safely. Changes in characteristics of sputum reflect the resolution of pneumonia or the development of secondary infection.

Assess the patient’s immunization status.
Immunizations with pneumococcal vaccine and seasonal influenza are used to reduce the risk of developing pneumonia.

Demonstrate and encourage good hand washing techniques.
Handwashing is the single most effective way to prevent infection. Effective means of reducing spread or acquisition of infection.

Change position frequently and provide good pulmonary hygiene.
Promotes expectoration, clearing of infection. Pulmonary hygiene helps the clearance of secretions and prevention and relief of atelectasis. The most effective method of clearing secretions is changing body position and vigorous coughing by the patient. When the patient cannot cough effectively, it is common practice to resort to chest physiotherapy and active suctioning of the trachea.

Limit visitors as indicated.
Reduces the likelihood of exposure to other infectious pathogens.

Institute isolation precautions as individually appropriate. Keep patients away from other patients who are at high risk for developing pneumonia.
Dependent on the 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 the 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 changes 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.

6. Managing Acute Pain & Discomfort

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 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.

Provide comfort measures: back rubs, position changes, quiet music, massage. Encourage the use of relaxation and/or breathing exercises.
Non-analgesic measures administered with a gentle touch can lessen discomfort and augment the therapeutic effects of analgesics. Patient involvement in pain control measures promotes independence and enhances the 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 the 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 nonproductive coughs or reduce excess mucus, thereby enhancing general comfort.

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

Administer analgesics as prescribed. Encourage the 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.

7. Promoting Rest and Improving Tolerance to Activity

The nurse promotes rest and advises the debilitated patient to avoid overexertion and assume a comfortable position, such as semi-Fowler’s position, to support rest and breathing. Position changes are encouraged for better lung function. Outpatients are instructed to engage in moderate activity during initial treatment.

Determine the 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 the choice of interventions.

Assess the patient’s baseline level of function and activity tolerance.
Using a standardized tool such as the Functional Independence Measure (FIM) can provide a baseline of function and activity tolerance and can help determine the appropriate interventions and monitor the patient’s progress.

Provide a quiet environment and limit visitors during the acute phase as indicated.
Encourage the use of stress management and diversional activities as appropriate.

Encourage the patient to perform deep-breathing exercises.
Deep-breathing exercises can help reduce stress and when used together with a spirometer can help clear secretions from the lungs.

Explain the importance of rest in the treatment plan and the necessity of balancing rest activities.
During the acute phase, bedrest is maintained to reduce metabolic demands and conserve energy for healing. Subsequent activity restrictions are determined based on the patient’s response to activity and the resolution of respiratory insufficiency. The nurse emphasizes the importance of rest and advises the debilitated patient to avoid excessive exertion, as it can exacerbate symptoms. Encouraging a comfortable position, such as semi-Fowler’s position, supports rest and optimal breathing. Frequent position changes are encouraged to aid in clearing secretions and improve pulmonary ventilation and blood flow. Outpatients receive education on the importance of avoiding overexertion and engaging in moderate activity during the early stages of treatment.

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 a comfortable position for rest and sleep.
The patient may be comfortable with an elevated head of the bed, sleeping in a chair, or leaning forward on an overbed table with pillow support.

Assist with self-care activities as necessary. Provide for a progressive increase in activities during the recovery phase and demand.
Minimizes exhaustion and helps balance oxygen supply and demand.

Encourage the patient to set realistic goals for activity and progress.
Setting realistic goals can help the patient stay motivated and feel a sense of accomplishment as they progress.

Encourage the patient to have adequate rest and sleep as needed. Encourage activities such as walking or stretching.
Rest is necessary for the body to heal, but too much rest can actually contribute to fatigue. Encouraging the patient to engage in gentle activities can help improve energy levels and prevent deconditioning.

Refer the patient to a rehabilitation specialist for further fatigue management strategies.
A rehab specialist can provide additional support and specialized insights for the client to manage their fatigue.

8. Maintaining Normal Body Thermoregulation

Monitor the patient’s HR, BP, and especially the tympanic or rectal temperature every 4 hours.
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 of the inability to control body temperature.

Monitor fluid intake and urine output. If the patient is unconscious, central venous or pulmonary artery pressure should be measured to monitor fluid status.
Fluid resuscitation may be required to correct dehydration. The significantly dehydrated patient 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.

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 the patient’s temperature.

Eliminate excess clothing and covers. Encourage patient to dress in lightweight clothing and keep the room at a comfortable temperature.
Exposing skin to room air decreases warmth, increases evaporative cooling, and promotes patient comfort.

Administer 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 oxygen demand.

Encourage the patient to drink plenty of fluids to prevent dehydration.
The body needs an adequate amount of fluids to regulate temperature effectively. Fever itself can cause dehydration because it can increase the body’s metabolic rate and lead to an increased fluid loss. This can create a vicious cycle in which fever exacerbates dehydration. Dehydration can worsen fever and increase the risk of complications.

Provide tepid sponge baths as necessary.
Tepid sponge baths can help reduce fever by lowering the patient’s temperature and improving patient comfort.

9. Promoting Optimal Nutrition & Fluid Balance

Patients with pneumonia experience an elevated respiratory rate due to the increased effort required for breathing and the presence of fever. This heightened respiratory rate can result in higher fluid loss during exhalation and potentially lead to dehydration. Thus, it is important to promote increased fluid intake (at least 2 L/day), unless there are specific contraindications. However, in patients with preexisting conditions like heart failure, hydration should be approached cautiously and monitored closely.

Assess vital sign changes: increasing temperature, prolonged fever, orthostatic hypotension, tachycardia.
Elevated temperature and prolonged fever increase 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.
The presence of these symptoms reduces oral intake.

Monitor intake and output (I&O), noting color, the character of urine. Calculate fluid balance. Be aware of insensible losses. Weigh as indicated.
Provides information about the adequacy of fluid volume and replacement needs.

Force fluids to at least 3000 mL/day or as individually appropriate.
Meets basic fluid needs, reducing the risk of dehydration and mobilizing secretions, and promotes expectoration.

Administer medications as indicated: antipyretics, antiemetics.
To reduce fluid losses.

Provide supplemental IV fluids as necessary.
In the presence of reduced intake and/or excessive loss, the parenteral route may correct the deficiency.

Identify factors contributing to nausea or vomiting: copious sputum, aerosol treatments, severe dyspnea, pain.
Choice of interventions depends on the underlying cause of the problem.

Provide a covered container for sputum and remove it 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 the 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 the use of milk products.
Milk products may increase sputum production.

Elevate the patient’s head and neck, and check for tube 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 due to 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 appeal to the patient.
Patients experiencing symptoms such as shortness of breath, fatigue, and decreased appetite may benefit from consuming fluids to maintain hydration and provide essential nutrients. These measures may enhance intake even though appetite may be slow to return.

Evaluate general nutritional state, obtain baseline weight.
The presence of chronic conditions (COPD or alcoholism) or financial limitations can contribute to malnutrition, lowered resistance to infection, and/or delayed response to therapy.

Monitor and record intake and output accurately. Observe urine color. Watch out for urinary output <30ml per hour.
Helps assess fluid balance. Urinary output less than 30 ml for two consecutive hours is a sign of fluid volume deficit. Dark-colored urine reflects increased urine concentration.

Weigh the patient daily at the same time of the day in the same clothes using the same scale; Monitor for trends (weight changes of 1-1.5 kg day).
Aids in establishing accurate measurement of weight. A fluid volume deficit or excess indicator is a weight change of 1- 1.5 kg/day.

Assess skin turgor and mucous membranes for any indication of dehydration.
Dryness of the tongue and mucous membranes of the mouth, longitudinal tongue furrows are symptoms of deficient fluid volume.

Monitor and record vital signs.
Changes in vital signs seen in a patient with hypovolemia include increased temperature, increased heart rate, and decreased blood pressure.

Encourage frequent oral hygiene.
Oral hygiene can moisten dried mucous membranes and allows the patient to react to the sensation of thirst.

Advice patient to increase fluid intake for at least 2.5 L/day as appropriate.
This measure helps in maintaining adequate hydration.

Maintain intravenous fluid therapy as indicated.
Parenteral fluid replacement is administered to prevent the occurrence of shock.

Provide humidified oxygen therapy as indicated.
Humidity lessens convective moisture losses while in oxygen therapy.

10. Providing Patient Education & Health Teachings

Patients and their families receive education on pneumonia causes, symptom management, and when to report concerning signs. They learn about factors contributing to pneumonia and strategies for recovery and prevention. Hospitalized patients are informed about management strategies and the importance of adherence. Clear, written instructions and alternative formats are provided as needed. Repeat explanations may be necessary due to symptom severity.

Determine the patient’s understanding of pneumonia complications and their treatment regimen.
Provides a starting point in patient education and to identify strengths and weaknesses in teaching.

Review normal lung function, pathology of the condition.
Promotes understanding of the current situation and the importance of cooperating with the treatment regimen.

Discuss debilitating aspects of the 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.
The 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.

Provide information in written and verbal form.
Fatigue and depression can affect the ability to assimilate information and follow the therapeutic regimen.

Reinforce the importance of continuing effective coughing and deep-breathing exercises.
During the initial 6–8 wk after discharge, the patient is at greatest risk for recurrence of pneumonia.

Emphasize the necessity for continuing antibiotic therapy for a 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 processes 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 the 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 the 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, the 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 pneumonia may require treatment with more toxic antibiotics.

Encourage Pneumovax and annual flu shots for high-risk patients.
Pneumococcal vaccination is highly effective in reducing pneumonia cases, hospitalizations, and deaths in older adults. Two types of pneumococcal vaccines, PCV13 and PPSV23, are recommended for adults based on age and specific risk factors. PCV13 is for adults 65 years and older and those with weakened immune systems, while PPSV23 is for adults 65 years and older, smokers, and adults 19-64 years with asthma. Both vaccines are important for maximum protection. Stay updated with the CDC’s current recommendations for pneumococcal vaccination. Other preventive measures are also available.

11. Monitoring Potential Complications of Pneumonia

Pneumonia can cause serious complications like hypotension, septic shock, and respiratory failure, especially in older adults with delayed treatment, resistant infections, comorbidities, or weakened immune systems. Bacterial pneumonia often leads to pleural effusion, requiring thoracentesis or chest tube insertion. Severe cases may develop into empyema, necessitating extended antibiotic treatment and sometimes surgery.

Assess and monitor for signs of shock and respiratory failure.
In pneumonia, severe complications like hypotension, septic shock, and respiratory failure can arise, especially in older adults with inadequate or delayed treatment. These complications are more likely when the infecting organism is resistant to therapy, comorbid diseases complicate pneumonia, or the patient has a compromised immune system (Vanoni et al., 2019). Monitoring vital signs, pulse oximetry, and hemodynamic parameters is crucial for detecting signs of septic shock and respiratory failure. Any deterioration in the patient’s condition should be promptly reported, and appropriate measures such as administering IV fluids and medications should be taken to address shock. Intubation and mechanical ventilation may be required in cases of respiratory failure.

Assess and monitor for signs of pleural effusion and empyema.
A pleural effusion refers to fluid accumulation between the pleural layers of the lung. Parapneumonic effusions occur in bacterial pneumonia, lung abscess, or bronchiectasis. Thoracentesis is performed to remove fluid for analysis after detection on a chest x-ray. During thoracentesis, the procedure is explained to the patient. Following the procedure, close monitoring is conducted for signs of pneumothorax or recurrence of pleural effusion. If a chest tube is required, respiratory status is carefully monitored. Parapneumonic effusions are categorized into three stages: uncomplicated, complicated, and thoracic empyema. Empyema involves the accumulation of thick, purulent fluid with fibrin development and localized infection. Chest tube insertion may be necessary for proper drainage. Treatment includes a course of antibiotics for 4 to 6 weeks, and in some cases, surgical management may be required.

Assess and monitor for signs of delirium, especially in older adults.
The Confusion Assessment Method (CAM) is a widely used screening tool for this purpose. Delirium and cognitive changes resulting from pneumonia are unfavorable prognostic indicators. Delirium may be associated with factors such as hypoxemia, fever, dehydration, sleep deprivation, sepsis, and underlying comorbid conditions. Nursing interventions should focus on addressing and correcting these underlying factors, while ensuring patient safety remains a priority.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See Also

Other recommended site resources for this nursing care plan:

• Nursing Care Plans (NCP): Ultimate Guide and Database ^{MUST READ!}
  Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
• Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
  Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.

Other nursing care plans related to respiratory system disorders:

• Asthma
• Aspiration Risk & Aspiration Pneumonia
• Airway Clearance Therapy & Coughing
• Bronchiolitis
• Bronchopulmonary Dysplasia (BPD)
• Chronic Obstructive Pulmonary Disease (COPD)
• Cystic Fibrosis
• Hemothorax and Pneumothorax
• Influenza (Flu)
• Ineffective Breathing Pattern (Dyspnea)
• Impairment of Gas Exchange
• Lung Cancer
• Mechanical Ventilation
• Near-Drowning
• Pleural Effusion
• Pneumonia
• Pulmonary Embolism
• Pulmonary Tuberculosis
• Tracheostomy

References and Sources

Recommended journals, books, and other interesting materials to help you learn more about pneumonia nursing care plans and nursing diagnosis:

1. Abe, S., Ishihara, K., Adachi, M., & Okuda, K. (2006). Oral hygiene evaluation for effective oral care in preventing pneumonia in dentate elderly. Archives of gerontology and geriatrics, 43(1), 53-64.
2. Britton, S., Bejstedt, M., & Vedin, L. (1985). Chest physiotherapy in primary pneumonia. Br Med J (Clin Res Ed), 290(6483), 1703-1704.
3. Calverley, P. M., Stockley, R. A., Seemungal, T. A., Hagan, G., Willits, L. R., Riley, J. H., … & Investigating New Standards for Prophylaxis in Reduction of Exacerbations (INSPIRE) Investigators. (2011). Reported pneumonia in patients with COPD: findings from the INSPIRE study. Chest, 139(3), 505-512.
4. Cason, C. L., Tyner, T., Saunders, S., & Broome, L. (2007). Nurses’ implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention. American journal of critical care, 16(1), 28-37.
5. Eisenhut, M., & Mizgerd, J. P. (2008). Acute lower respiratory tract infection. New Engl J Med, 358, 2413-4.
6. Farrell, J. J., & Petrik, S. C. (2009). Hydration and nosocomial pneumonia: killing two birds with one stone (a toothbrush). Rehabilitation Nursing, 34(2), 47-50.
7. Fujita, J., Touyama, M., Chibana, K., Koide, M., Haranaga, S., Higa, F., & Tateyama, M. (2007). Mechanism of formation of the orange-colored sputum in pneumonia caused by Legionella pneumophila. Internal Medicine, 46(23), 1931-1934.
8. Grief, S. N., & Loza, J. K. (2018). Guidelines for the evaluation and treatment of pneumonia. Primary Care: Clinics in Office Practice, 45(3), 485-503.
9. HASH, R. B., STEPHENS, J. L., LAURENS, M. B., & VOGEL, R. L. (2000). The relationship between volume status, hydration, and radiographic findings in the diagnosis of community-acquired pneumonia. Journal of Family Practice, 49(9), 833-833.
10. 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 nursing, 4(2), 95-105.
11. Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd.
12. Ignatavicius, D. D., & Workman, M. L. (2015). Medical-Surgical Nursing-E-Book: Patient-Centered Collaborative Care. Elsevier Health Sciences.
13. Keeley, L. (2007). Reducing the risk of ventilator‐acquired pneumonia through head of bed elevation. Nursing in critical care, 12(6), 287-294.
14. Kubo, T., Osuka, A., Kabata, D., Kimura, M., Tabira, K., & Ogura, H. (2021). Chest physical therapy reduces pneumonia following inhalation injury. Burns, 47(1), 198-205.
15. Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2016). Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical Problems, Single Volume. Elsevier Health Sciences.
16. Luna, C. M., Famiglietti, A., Absi, R., Videla, A. J., Nogueira, F. J., Fuenzalida, A. D., & Geneé, R. J. (2000). Community-acquired pneumonia: etiology, epidemiology, and outcome at a teaching hospital in Argentina. Chest, 118(5), 1344-1354.
17. Sattar, S. B. A., Sharma, S., & Headley, A. (2021). Bacterial Pneumonia (Nursing). StatPearls [Internet].
18. Scannapieco, F. A. (2006). Pneumonia in nonambulatory patients: the role of oral bacteria and oral hygiene. The Journal of the American Dental Association, 137, S21-S25.
19. See, C. M. E. Urgent Care Evaluation of Pneumonia.
20. Ticona, J. H., Zaccone, V. M., & McFarlane, I. M. (2021). Community-acquired pneumonia: A focused review. American journal of medical case reports, 9(1), 45.
21. Vanoni, N. M., Carugati, M., Borsa, N., Sotgiu, G., Saderi, L., Gori, A., … & Blasi, F. (2019). Management of acute respiratory failure due to community-acquired pneumonia: a systematic review. Medical Sciences, 7(1), 10.
22. Yamaya, M., Yanai, M., Ohrui, T., Arai, H., & Sasaki, H. (2001). Interventions to prevent pneumonia among older adults. Journal of the American Geriatrics Society, 49(1), 85-90.
23. Yoneyama, T., Yoshida, M., Ohrui, T., Mukaiyama, H., Okamoto, H., Hoshiba, K., … & Of The Oral Care Working Group, M. (2002). Oral care reduces pneumonia in older patients in nursing homes. Journal of the American Geriatrics Society, 50(3), 430-433.

Originally published January 10, 2010.