Pneumonia is a lung infection caused by bacteria, viruses, or fungi that leads to alveolar inflammation. The infection settles in the air sacs of the lungs and can cause coughing, dyspnea, fever, chills, and purulent secretions.
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Melissa Mills said:Administer medications, such as antibiotics and oxygen, per orders.
Rationale: Treats pneumonia and side effects.
Please note my usual distaste with seeing, once again, "nursing care plans" headlined as "for [medical diagnosis].” While this article goes to some length to describe possible nursing diagnostic criteria and interventions, this formatting choice perpetuates the idea that all nursing dx stem from medical dx. Any person whose condition warrants inpatient admission will likely have nursing diagnoses that have nothing to do with the medical plan of care, related to such as home environmental concerns, role, comfort, sexuality, and more. We are required by our nurse practice acts and the ANA Scope and Standards of Nursing Practice (yes, we are, even if we are not ANA members) to do independent assessment and planning for nursing care. Tying nursing dx to medical dx limits the nurse's ability to even consider anything else.
As for a nursing plan of care, if you ever find yourself writing “[do something] per physician order,” please remember that the nurse practice act already requires us to implement parts of the medical plan of care, but that is not the same as diagnosing and treating nursing diagnoses as a professional. I realize that this may be a higher-level concept that most nursing students are exposed to, because, largely, nursing education focuses on their hunger to acquire what they call "skills,” mostly manipulative or reactive actions.
But students should consider that they are in college to learn to THINK LIKE NURSES, not just as medical plan of care implementers. Move beyond the medical plan — don't ignore it or be ignorant of its components, because we are also legally bound to refuse to implement something prescribed that would be harmful— and step into the nursing role with more self-awareness and confidence.
Oh, yeah, one more thing: we are not in the damn army. The term "orders" is an anachronism dating back to the beginnings of professional nursing in military hospitals, where the physicians were, quite literally, superior officers. In the modern world, physicians, advanced nurse practitioners, and others provide a medical plan of care. They prescribe, they requisition, they request, they plan...but they are our colleagues, not superior officers, and they do not order. I have been gratified to have had some modest success teaching physicians this concept. Let's see more nurses do the same. Language shapes attitudes.
I think you have provided a very valuable look at the Winter occurrence of pneumonia for students currently completing their clinicals and actually writing care plans. These students are still learning what nursing is all about while they sort out what is medicine and what is nursing. Dissing a care plan that delivers a good part of nursing care is, how should I say it, "Low hanging fruit".
Hannahbanana said:Please note my usual distaste with seeing, once again, "nursing care plans" headlined as "for [medical diagnosis].”
Hannahbanana said:But students should consider that they are in college to learn to THINK LIKE NURSES, not just as medical plan of care implementers.
Yes we have to start somewhere. I would ask you to rewrite this post to jive with your wisdom. It is always easier to criticize than to provide a different point of view with what you consider to be the expert position. I look forward to reading your contribution of a care plan.
Alas, that is my point. I can't (and won't) "write a care plan" for a patient I have not assessed.
It takes time to get new students oriented to the idea of "thinking like a nurse" and not as servebot for prescribers; starting them out with the unstated yet insidiously powerful assumption that "following orders" is what we do (by thinking "care plans" follow medical dx) and who we are makes it devilishly difficult to get them to pivot to taking prime professional responsibility for what we are legally and professionally responsible for.
Developing a nursing plan of care requires a deeper thinking process. Imagine, if you will, a patient admitted to a hospital without a medical diagnosis. Does that mean nursing's off the hook for planning care? Of course not, says the experienced nurse (I hope). But say that to a new grad weaned on prefab care plans dependent on medical dx and you get that "The fabric of the universe has been rent!” mildly panicky look.
Because that takes time to develop professionalism in students, we get nurses who focus on tasks they call "bedside skills,” not wholistic caregivers. Those aren't just buzzwords, as any of us who have been in those beds can tell you. If formal nursing education to prepare nurses can't be at least as long as the education we require of kindergarten teachers, we'd better start working really, really hard at getting adequate practice-setting staffing to allow for a year's internship. That will take a lot of time and money to make it worth a nurse's time to take a position, to pay good clinicians enough to be faculty, and to support ruinous tuition costs.
So. While I regret disappointing you that I'm not providing you a canned nursing plan of care for a human with pneumonia or CHF or bowel obstruction or pelvic fracture or cerebral palsy, please look for more emphasis on independent nursing assessments of human response to illness or injury beyond " ... as ordered" when you create or critique a teaching tool.
We are, of course colleagially related to physicians by implementing parts (not all) of the medical plan of care, nobody denies that. We abrogate our legal and responsibility if we don't do our part to look at the human responses as of coequal importance and our plans of care to treat them as equally important.
Table of Contents
This respiratory infection can vary in severity, ranging from mild to severe, and can worsen over time and even become life-threatening if not treated. Specific populations, such as older adults, those with chronic lung conditions, or young children, are more vulnerable to the infection and often experience the most severe consequences of the disease.
Many people with pneumonia require acute treatment with antibiotics and other modalities, and some even require emergency room visits or hospitalization. The CDC reports that 1.5 million Americans needed emergent care for pneumonia in 2020 and that pneumonia accounted for more than 41,000 deaths in 2021 alone.
This article provides general nursing diagnoses and care plans for patients with pneumonia you can use to create patient-centered nursing care plans for those you care for during nursing school and beyond.
DiagnosisHealthcare providers use the presence of specific symptoms to confirm the diagnosis of pneumonia. For example, the physician may perform a physical exam, including auscultating lung sounds, and review the patient's medical history. If pneumonia is suspected, the healthcare provider may order the following tests:
Diagnosing pneumonia in patients with atypical symptoms, such as children, is challenging. Pediatric patients don't have the respiratory drive of adults, so it's crucial to observe the patient closely and start treatments quickly before the situation becomes life-threatening.
Types of Pneumonia
There are a few different ways to classify pneumonia. Classifications are done by determining where the patient acquired the disease and by the organism that caused it.
First, pneumonia may be classified by where the patient acquired the condition. The two classifications include:
The second way to classify pneumonia is based on the organism causing it. This includes:
Symptoms of Pneumonia
Nurses must be aware of the most common signs and symptoms of pneumonia. Hospitalized patients and those at high risk for contracting the condition should be monitored closely. Report new or worsening signs to the healthcare provider for further assessment and treatment.
Some of the most common symptoms of pneumonia include the following:
At-Risk PopulationsSome individuals are at a higher risk of contracting pneumonia. We'll review each group below.
Older Adults
As we age, our immunity decreases, increasing our risk of infections like pneumonia. In addition, many older people also have comorbidities, such as COPD, asthma, or heart disease, that compound their risk further. Older adults may also be less likely to engage in physical activity, which can help clear their lungs and reduce the risk of pneumonia and other lung infections.
Young Children
Some children may be at an increased risk of developing pneumonia because of other health conditions, such as:
A child's environment can also place them at an increased risk. This includes:
People with Comorbid Conditions
Adults with specific comorbid conditions are at an increased risk of developing pneumonia. People at increased risk include those with the following:
ComplicationsUnfortunately, sometimes pneumonia worsens, even when treated. It can cause severe dyspnea and breathing difficulties in the patient that can become life-threatening and lead to long-term complications or even death.
Common complications of pneumonia include:
TreatmentsThe healthcare provider will order treatments to cure the infection, reduce symptoms and discomfort, and prevent potential complications. Common treatments include:
Patients with severe pneumonia may require hospitalization. Although this is less common, it may be necessary for those immunocompromised patients due to chronic health conditions, age, and other factors. It is also essential for patients whose symptoms have worsened dramatically, such as those with very shallow breathing, who require mechanical ventilation, or who have bradycardia.
Nurse's Role Caring for a Patient With PneumoniaNurses play a crucial role in caring for a patient with pneumonia and performing routine assessments to monitor for new or worsening symptoms. A comprehensive nursing assessment includes auscultating lung sounds, assessing blood oxygen levels and respiratory effort, and assessing for fever.
Nurses also administer treatments as ordered by the physician, including antibiotics, IV fluids, antipyretics, breathing treatments, and oxygen therapy.
Education is another critical task nurses perform when caring for patients with pneumonia. Patients must understand self-care, including how and when to take antibiotics, how to use home oxygen, and when to call the healthcare provider or seek emergency medical treatment.
Nursing Protocols for Pneumonia
Nursing Care Plans Related to PneumoniaA well-written nursing care plan establishes essential assessments, interventions, and patient outcomes. Below, you will find pneumonia nursing care plans you can use as a basis for patients in your care. This list of nursing care plans is not exhaustive, and, of course, all nursing care plans must be individualized to the patient's specific care needs.
Nursing Care Plan: Impaired Gas ExchangeImpaired gas exchange occurs when the exchange of oxygen and carbon dioxide across the alveolar-capillary barrier is impaired. Certain conditions, such as pneumonia, can cause changes in lung function and alveolar collapse, negatively affecting ventilation. In addition, impaired gas exchange can lead to hypoxemia, fluid shifting into interstitial spaces, and pulmonary edema.
Potentially Related To
Impaired gas exchange may be related to the following factors:
Evidenced By
The most common symptoms of impaired gas exchange include:
Desired Outcomes
Possible desired outcomes for an impaired gas exchange nursing diagnosis include:
Impaired Gas Exchange Nursing Assessment
A thorough nursing assessment helps you determine the baseline and ongoing status of the patient's condition. Your nursing assessment may include the following:
Impaired Gas Exchange Nursing Interventions and Rationales
Common nursing interventions for impaired gas exchange include:
Rationale: Maximizes chest expansion and comfort.
Rationale: Improves ventilation by mobilizing secretions.
Rationale: Reduces oxygen demands and prevents over-exhaustion.
Rationale: Maintains PaO2 within normal limits.
Nursing Care Plan: Ineffective Airway ClearanceIneffective airway clearance commonly occurs in patients with pneumonia. The patient's ability to clear their airway may be related to a weak or non-producing cough or excessive lung mucus build-up. In severe cases of infective airway clearance, the patient may require an artificial airway or ventilatory support.
Potentially Related To
Ineffective airways clearance may be related to the following:
Evidenced By
Ineffective airway clearance may produce the following symptoms:
Desired Outcomes
Possible desired outcomes for a patient with ineffective airway clearance include the following:
Ineffective Airways Clearance Nursing Assessment
Common nursing assessment strategies to include in a pneumonia nursing care plan include:
Ineffective Airway Clearance Nursing Interventions and Rationales
Nursing interventions for ineffective airways clearance include:
Rationale: Allows chest expansion and maximizes oxygen exchange.
Rationale: Increases oxygen exchange and movement of mucus.
Rationale: Assists in loosening mucus and maintaining overall body strength.
Rationale: Improves oxygenation and reduces complications.
Rationale: Assists removing mucus if the patient cannot do it independently.
Rationale: Assists with oxygenation and mucus removal.
Rationale: Treats pneumonia and improves oxygenation.
Rationale: Promotes self-care to improve oxygenation and expectoration of mucus.
Rationale: Promotes self-care to thin mucus.
Rationale: Promotes self-care strategies to cure pneumonia and treat symptoms.
Nursing Care Plan: Ineffective Breathing PatternSymptoms of pneumonia, such as fever and chest pain, can change the patient's breathing patterns. These changes lead to compensatory tachypnea to meet the body's metabolic demands. The ineffective breathing pattern happens because affected alveoli are impaired and cannot effectively exchange oxygen and carbon dioxide.
Potentially Related To
Possible related factors for ineffective breathing pattern includes the following:
Evidenced By
The most frequent signs and symptoms of an ineffective breathing pattern include the following:
Desired Outcomes
The desired outcomes of an ineffective breathing pattern are:
Ineffective Breathing Pattern Nursing Assessment
Appropriate nursing assessments for ineffective breathing patterns may include:
Ineffective Breathing Pattern Nursing Interventions and Rationales
Appropriate nursing interventions may include:
Rationale: Improves chest expansion and oxygenation.
Rationale: Promotes chest expansion and reduces the risk of atelectasis.
Rationale: Treats symptoms of underlying pneumonia and improves oxygenation.
Rationale: Maintain a clear airway.
Rationale: Promotes mobility and movement of fluid in the lungs.
Rationale: Provides specialized assessment of patient's dietary needs.
Rationale: Promotes energy conservation.
Rationale: Promotes self-care.
Nursing Care Plan: Risk for InfectionWhile pneumonia is typically not a life-threatening condition, it can lead to a secondary infection or sepsis, especially in immunocompromised patient populations. Sepsis and other severe secondary infections can lead to respiratory failure and even death if left untreated.
Potentially Related To
The risk for infection may be related to the following:
Evidenced By
The common signs of infection are:
Desired Outcomes
The common signs of infection are:
Desired Outcomes
The most common desired outcomes are:
Risk for Infection Nursing Assessment
Appropriate nursing assessments include:
Risk for Infection Nursing Interventions and Rationales
Rationale: Reduces the spread of infection and re-infection.
Rationale: Reduces the spread of infection and re-infection.
Rationale: Reduces the spread of infection.
Rationale: Reduces the spread of infection in the community setting.
Rationale: Protects healthcare workers and visitors from infection.
Rationale: Treats pneumonia and side effects.
Rationale: Identifies the need for medication adjustments.
Rationale: Promotes self-care and a healing diet.
Rationale: Prevents the spread of infection.
Rationale: Thins mucus in the lungs to assist with mobilization and expectoration.
Rationale: Promotes activity, chest expansion, and oxygenation.
Rationale: Assists with energy conservation.
Rationale: Identifies signs of worsening infection.
Nursing Care Plan: Risk for Imbalanced Nutrition: Less Than Body RequirementsThe risk for imbalanced nutrition is when a person does not consume the proper nutrients or calories required to maintain a healthy weight. For example, patients with pneumonia may not have much of an appetite from the illness or might not feel they can eat, related to their dyspnea and labored breathing.
Potentially Related ToPatients with the following conditions are at higher risk of developing imbalanced nutrition while they have pneumonia:
Evidenced By
The most common signs of imbalanced nutrition include:
Desired Outcomes
The desired outcomes for the patient include the following:
Risk for Imbalanced Nutrition Nursing Assessment
Risk for Imbalanced Nutrition Nursing Interventions and Rationales
Rationale: Provides a specialized assessment of the patient's nutritional needs.
Rationale: Reduces side effects such as nausea just before meals.
Rationale: Improves oxygenation and chest expansion.
Rationale: Promotes healing and provides needed nutrients.
Rationale: Provides a pleasant environment during mealtime.
Rationale: Promotes weight gain.
Rationale: Reduces mouth sores and dryness to increase food intake.
Rationale: Provides additional calories and nutrients.
Nursing Care Plan: Acute PainPleuritic chest pain is a common side effect of pneumonia. This condition can cause sharp or stabbing pain with coughing or deep breathing. In addition, pleuritic chest pain can cause the patient to avoid coughing, causing an increase in mucus in the lungs and creating more pain. This vicious cycle can be challenging to treat.
Potentially Related to
Acute pain is caused by the following:
Evidenced By
Signs of acute pain include:
Desired Outcomes
Acute Pain Nursing Assessment
Acute Pain Nursing Interventions and Rationales
Rationale: Treats the pain appropriately.
Rationale: Reduces pain and allows for self-care.
Rationale: Reduces pain and increases chest expansion.
Rationale: Indicates the need for new treatment modalities.
Nursing Care Plan: Decreased Activity TolerancePneumonia may cause the patient to experience decreased activity tolerated due to poor oxygenation and increased metabolic demands. As a result, the condition may deplete the patient's energy reserves and reduce the intake of adequate nutrients.
Potentially Related To
Common factors that cause activity intolerance in those with pneumonia include:
The most common risk factors are:
Evidenced By
Signs of decreased activity tolerance may be:
Desired Outcomes
Decreased Activity Tolerance Nursing Assessment
Decreased Activity Tolerance Nursing Interventions and Rationales
Rationale: Mobilizes mucus and improves oxygenation.
Rationale: Promotes sleep and healing.
Rationale: Promotes energy conservation.
Ratonale: Reduces exhaustion.
Nursing Care Plan: Deficient KnowledgeSome patients may be unfamiliar with pneumonia and common treatments. Educating the patient on the condition and self-care techniques can aid full recovery.
Potentially Related To
Deficient knowledge can be caused by the following:
Evidenced By
Common signs of deficient knowledge of pneumonia care include:
Desired Outcomes
Deficient Knowledge Nursing Assessment
Deficient Knowledge Nursing Interventions and Rationales
Rationale: Establishes a baseline understanding.
Rationale: Provides a positive learning environment.
Rationale: Establishes the need for ongoing care.
Rationale: Promotes learning and retention.
Rationale: Promotes learning and retention.
Rationale: Promotes a natural progression to more challenging information
Rationale: Ensures timely follow-up for worsening or recurrent infection.
AnxietyDyspnea and other signs of impaired breathing can evoke anxiety in patients. The patient's care team must treat the anxiety holistically so the patient can relax and rest.
Potentially Related To
Anxiety can be caused by the following:
Evidenced By
The most common signs of anxiety include:
Desired Outcomes
Anxiety Nursing Assessment
Anxiety Nursing Interventions and Rationale
Rationale: Reduces anxiety symptoms.
Rationale: Reduces symptoms of anxiety.
Rationale: Improves relaxation.
Rationale: Promotes recognition of anxiety and self-care strategies.
More Pneumonia DiagnosisPneumonia NCLEX Test QuestionsNursing students often wonder what kind of questions might be on the NCLEX. There is a good chance you'll encounter questions about caring for patients with pneumonia. Below are sample questions you might see on the NCLEX.
a. Suppress the patient's cough
b. Relax the bronchial airway
I. Rationale: Aminophylline inhibits isoenzymes and soothes the lungs, vessels, and throat muscles.
c. Prevent infection
d. Enhance expectoration
a. Congestion
b. Anxiety
I. Rationale: Proventil/Albuterol can cause anxiety, nervousness, tremors, headaches, and palpitations.
c. Lethargy
d. Hyperkalemia
a. Brown
b. Yellow
c. Clear
I. Rationale: Acute rhinitis presents with clear secretions, mouth breathing, dark eye circles, and sniffling.
d. Gray
a. Altered mental status
I. Rationale: Lower mental acuity, confusion, dehydration, and loss of appetite are the first symptoms in elderly patients.
b. Fever
c. Hemoptysis
d. Cough
a. Efusion
b. Inflammation
I. Rationale: Macrophages cause lung inflammation.
c. Bronchiectasis
d. Malnutrition
Additional Readings and ResourcesIf you need more information about pneumonia, check out these great articles on AllNurses:
Wrapping Up Pneumonia Nursing Care PlansWhile pneumonia is a common illness, it's critical to understand that it can become life-threatening without proper diagnosis and treatment. Use these nursing care plans as a basis for your nursing assessments and interventions to provide holistic and comprehensive care for your patients or clients.
CitationsAbout Melissa Mills, BSN
Melissa is a nurse with over two decades of experience in leadership and workforce development. She loves to help other healthcare professionals advance their careers.
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