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
Risk for Imbalanced Nutrition
Dyspnea is a common risk factor for the risk nursing diagnosis Imbalanced Nutrition: Less Than Body Requirements in pneumonia.
- Risk for Imbalanced Nutrition: Less Than Body Requirements
The following are the common risk factors for this nursing diagnosis:
- 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
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.
|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.|
|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 products||Milk 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.|
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.
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.