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.
Pneumonia is also classified based on its microbiologic etiology – they can be viral, bacterial, fungal, protozoan, mycobacterial, mycoplasmal, or rickettsial in origin.
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 11 nursing diagnosis common to pneumonia nursing care plans (NCP), they are as follows:
- Ineffective Airway Clearance
- Impaired Gas Exchange
- Ineffective Breathing Pattern
- Risk for Infection
- Acute Pain
- Activity Intolerance
- Risk for Deficient Fluid Volume
- Risk for Imbalanced Nutrition: Less Than Body Requirements
- Deficient Knowledge
- Deficient Fluid Volume
Increased sputum production in pneumonia comes with frequent coughing. Persistent coughing can be painful therefore the need for Acute Pain nursing diagnosis.
- Acute Pain
Common related factors for acute pain nursing diagnosis:
- Inflammation of lung parenchyma
- Cellular reactions to circulating toxins
- Persistent coughing
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
- Moaning, restlessness
- Facial mask, distraction behaviors
- Increased BP
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.
|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.|
|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.|
You may also like the following posts and care plans:
- Nursing Care Plan: The Ultimate Guide and Database – the ultimate database of nursing care plans for different diseases and conditions! Get the complete list!
- Nursing Diagnosis: The Complete Guide and List – archive of different nursing diagnoses with their definition, related factors, goals and nursing interventions with rationale.
Related Nursing Care Plans
Related nursing diagnoses you can use to craft another pneumonia nursing care plans.
- Impaired Dentition. May be related to dietary habits, poor oral hygiene, chronic vomiting, possibly evidenced by erosion of tooth enamel, multiple carries, abraded teeth.
- Impaired oral mucous membrane. Maybe related to breathing through the mouth, malnutrition or vitamin deficiency, poor oral hygiene, chronic vomiting, possibly evidenced by sore, inflamed buccal mucosa, swollen salivary glands, ulcerations, and reports of sore mouth and/or throat.
- Legacy care plans (via Scribd): Ineffective Airway Clearance, Risk for Infection, Ineffective Breathing Pattern, Impaired Gas Exchange, Hyperthermia
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 nursing, 4(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. Jama, 286(18), 2235-2236. [Link]
Originally published January 10, 2010.