Pneumonia: 10 Nursing Diagnosis, Care Plans, and More

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. Nursing Students Student Assist Care Plan

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Pneumonia: 10 Nursing Diagnosis, Care Plans, and More

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.  

Diagnosis

Healthcare 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:

  • Chest x-ray -  visualizes the location and severity of the pneumonia
  • Blood tests - looks for increased WBCs and other indicators of infection and cultures to determine the pathogen causing the pneumonia 
  • Sputum test - determines the cause of the infection
  • Pulse oximetry - measures the blood's oxygen level
  • CT scan - to obtain detailed images of the lungs, common in hard-to-treat or worsening pneumonia
  • Pleural fluid culture - analyzes fluid from the lungs to determine the cause of the infection in hard-to-treat or worsening pneumonia

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: 

  • Hospital-acquired pneumonia happens in patients who have recently stayed in a hospital or healthcare setting. These patients may experience complications because the microorganism causing the infection may resist antibiotics. Patients at increased risk include patients who: 
    • Require oxygen support
    • Have difficulty coughing and deep breathing to remove mucus from their lungs
    • Have a tracheostomy 
    • Have a weakened immune system. 
  • Community-Acquired Pneumonia captures pneumonia outside of the hospital or healthcare setting. People with chronic lung conditions are at an increased risk of acquiring this condition.

The second way to classify pneumonia is based on the organism causing it. This includes: 

  • Bacterial Pneumonia is the most common type of community-acquired pneumonia in adults. Streptococcus pneumoniae is the most common cause of bacterial pneumonia. 
  • Viral Pneumonia is the second most common type. The following viruses commonly cause viral pneumonia:
  • Fungal Pneumonia is the least common cause of pneumonia but can lead to a severe illness if left untreated. This type of pneumonia is most common in vulnerable populations, such as those with an organ transplant, undergoing chemotherapy, or taking medications used to treat autoimmune conditions. 

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:

  • Fever, shaking, and chills
  • Wet cough that produces yellow, green, or bloody mucus
  • Pleuritic chest pain that may worsen with deep breathing or coughing
  • Dyspnea
  • Fatigue and general malaise
  • Lack of appetite
  • Shallow breathing in young adults, children, and babies 
  • Nasal flaring and accessory muscle use in young children
  • Nausea and vomiting in young children 
  • Confusion in older adults
  • Low body temperature in adults over 65 and those with chronic lung conditions

At-Risk Populations

Some 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:

  • Chronic lung conditions, like cystic fibrosis or asthma
  • Diseases causing the patient to be immunocompromised, such as cancer
  • Structural or genetic problems within the respiratory system

A child's environment can also place them at an increased risk. This includes:

  • Children who are underfed or lack the essential vitamins, nutrients, and minerals to help them fight infections 
  • Children exposed to secondhand smoke
  • Children exposed to mold, water damage, or indoor air pollution

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:  

Complications

Unfortunately, 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:

  • Pleural effusion 
  • Lung abscess
  • Bacteremia

Treatments

The healthcare provider will order treatments to cure the infection, reduce symptoms and discomfort, and prevent potential complications. Common treatments include: 

  • Antibiotics to treat bacterial infections
  • Antifungals to treat fungal infections
  • Cough suppressants and expectorants to loosen mucus and help expectorate it from the lungs
  • Fever reducers to lower body temperature and associated discomfort
  • Oxygen therapy for comfort and to increase blood oxygen
  • Diet rich in vitamins and minerals
  • Rest to allow the body to fight the infection

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 Pneumonia

Nurses 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

  • In-depth respiratory assessment to auscultate lung sounds, monitor respiratory effort, including respiratory rate and depth, assess for purulent sputum and use of accessory muscles during breathing
  • Head-to-assessment to watch for fever, tachycardia, bradycardia, pleuritic chest pain, and other physical symptoms 
  • Risk Assessment to identify at-risk populations such as seniors and children 

Nursing Care Plans Related to Pneumonia

A 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 Exchange

Impaired 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: 

  • Fluid-filled alveoli
  • Excess mucus in the airways
  • Inflammation of the alveoli and other airway structures
  • Hypoventilation
  • Changes in the alveolar-capillary membrane 
  • Disruption to the oxygen-carrying capacity of the blood

Evidenced By 

The most common symptoms of impaired gas exchange include:

  • Tachypnea and dyspnea
  • Cyanosis
  • Dusky and pale skin color
  • Tachycardia
  • Restlessness
  • Changes in the level of consciousness
  • Hypotension
  • Hypoxemia
  • Confusion

Desired Outcomes 

Possible desired outcomes for an impaired gas exchange nursing diagnosis include:

  • The patient will maintain gas exchange within normal limits.
  • The patient's ABGs will be maintained within an acceptable range for them.
  • The patient will experience improved oxygenation and ventilation.
  • The patient will maintain blood oxygen levels above 90%.

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:

  1. Perform a thorough respiratory assessment, noting respirations' rate, rhythm, and depth and using accessory muscles and nasal flaring.
  2. Assess for abnormal lung sounds, such as crackles or rhonchi.
  3. Assess for peripheral and central cyanosis related to impaired perfusion and oxygenation.
  4. Monitor for changes in mental status and consciousness.
  5. Assess cardiac health, including heart rate, rhythm, and blood pressure.
  6. Monitor pulse oximetry and ABGs.
  7. Assess blood pH electrolytes.

Impaired Gas Exchange Nursing Interventions and Rationales

Common nursing interventions for impaired gas exchange include:

  1. Assist the patient in finding a comfortable position by elevating the head of the bed, sitting in a chair, or sitting up while leaning forward onto a table or other surface.
    Rationale: Maximizes chest expansion and comfort.
  2. Encourage coughing and deep breathing exercises.
    Rationale: Improves ventilation by mobilizing secretions.
  3. Institute energy conservation techniques, such as planned rest periods and clustering care activities. 
    Rationale: Reduces oxygen demands and prevents over-exhaustion.
  4. Administer oxygen therapy as indicated. (Note: Use caution in patients with chronic lung disease.)
    Rationale: Maintains PaO2 within normal limits.

Nursing Care Plan: Ineffective Airway Clearance

Ineffective 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:

  • Pleuritic chest pain
  • Extreme fatigue and low-energy
  • Aspiration
  • Inflammation in the trachea, bronchi, or other areas of the respiratory tract
  • Lung edema
  • Excessive mucus
  • Airway spasms

Evidenced By

Ineffective airway clearance may produce the following symptoms:

  • Orthopnea 
  • Hypoxemia 
  • Hypercapnia
  • Dyspnea
  • Tachypnea
  • Cyanosis
  • Dusky skin color
  • Hypotension
  • Confusion
  • Abnormal ABGs
  • Accessory muscle use

Desired Outcomes

Possible desired outcomes for a patient with ineffective airway clearance include the following:

  • The patient maintains clear airways with normal breath sounds, respiratory rate, and effort.
  • The patient experiences improved gas exchange. 
  • The patient demonstrates signs of improving respiratory status.

Ineffective Airways Clearance Nursing Assessment

Common nursing assessment strategies to include in a pneumonia nursing care plan include:

  1. Assess the respiratory rate, rhythm, depth, and accessory muscle use. 
  2. Auscultate the lungs for decreased breath sounds, wheezing, rales, rhonchi, stridor, crackles, or grunts.
  3. Monitor for confusion, restlessness, or anxiety.
  4. Assess for signs of atelectasis, including crackles, impaired diaphragmatic excursion, tracheal shift, or tubular breath sounds. 
  5. Monitor for changes in cardiac status, including heart rate and blood pressure.
  6. Assess the strength of the cough, bronchospasms, and secretions.
  7. Assess the amount, texture, and color of the sputum.
  8. Track and trend oxygen saturations.
  9. Monitor ABGs and chest x-ray reports.
  10. Assess the patient's nutritional status.
  11. Evaluate hydration status.

Ineffective Airway Clearance Nursing Interventions and Rationales

Nursing interventions for ineffective airways clearance include:

  1. Assist the patient in a comfortable position with the head raised. 
    Rationale: Allows chest expansion and maximizes oxygen exchange. 
  2. Assist the patient in repositioning every two hours if on bed rest. 
    Rationale: Increases oxygen exchange and movement of mucus.
  3. Encourage ambulation if indicated. 
    Rationale: Assists in loosening mucus and maintaining overall body strength. 
  4. Maintain oxygen saturation at 90% or higher. 
    Rationale: Improves oxygenation and reduces complications.
  5. Suction as necessary. 
    Rationale: Assists removing mucus if the patient cannot do it independently.
  6. Encourage coughing and deep breathing. 
    Rationale: Assists with oxygenation and mucus removal. 
  7. Administer oxygen, antibiotics, and other medications as ordered. 
    Rationale: Treats pneumonia and improves oxygenation.
  8. Educate the patient on proper positioning, coughing and deep breathing exercises, and the importance of movement.
    Rationale: Promotes self-care to improve oxygenation and expectoration of mucus. 
  9. Educate the patient on increasing fluid intake.
    Rationale: Promotes self-care to thin mucus.
  10. Educate the patient on understanding medications, therapies, and inhalers.
    Rationale: Promotes self-care strategies to cure pneumonia and treat symptoms.

Nursing Care Plan: Ineffective Breathing Pattern

Symptoms 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:

  • Hypoxia
  • Anxiety
  • Pleuritic chest pain
  • O2/CO2 ratio alterations
  • Decreased lung expansion
  • Inflammation in the lungs

Evidenced By

The most frequent signs and symptoms of an ineffective breathing pattern include the following:

  • Tachypnea 
  • Dyspnea 
  • Orthopnea 
  • Use of accessory muscles or nasal flaring
  • Changes in respiratory patterns, such as rate and depth
  • Abnormal breath sounds, such as rhonchi, bronchial lung sounds, and egophony
  • Decreased breath sounds over affected areas of the lungs
  • Productive cough
  • Non-productive cough
  • Reduced vital capacity
  • Purulent sputum
  • Hypoxemia
  • Cyanosis
  • Presence of infiltrates on chest x-ray

Desired Outcomes

The desired outcomes of an ineffective breathing pattern are:

  1. The patient maintains respiratory rate and rhythm within normal limits.
  2. The patient maintains an oxygen blood saturation above 90%.

Ineffective Breathing Pattern Nursing Assessment

Appropriate nursing assessments for ineffective breathing patterns may include:

  1. Assess and record respiratory rate every 2-4 hours as indicated.
  2. Monitor breathing patterns for abnormalities.
  3. Monitor for paradoxical motion.
  4. Monitor ABG levels.
  5. Auscultate breath sounds.  
  6. Assess for nasal flaring and accessory muscle use.
  7. Evaluate oxygen levels in the blood.
  8. Observe and record sputum characteristics, such as color, amount, and consistency.
  9. Evaluate the nutrition and activity levels of the patient. 
  10. Monitor vital signs for fever and tachycardia.

Ineffective Breathing Pattern Nursing Interventions and Rationales

Appropriate nursing interventions may include:

  1. Assist the patient to an upright position.
    Rationale: Improves chest expansion and oxygenation.
  2. Encourage deep breathing exercises.
    Rationale: Promotes chest expansion and reduces the risk of atelectasis.
  3. Administer medications and supplemental oxygen as needed.
    Rationale: Treats symptoms of underlying pneumonia and improves oxygenation.
  4. Encourage coughing and expectoration of mucus. 
    Rationale: Maintain a clear airway. 
  5. Encourage ambulation and light activity as tolerated.
    Rationale: Promotes mobility and movement of fluid in the lungs.
  6. Request a dietary consult.
    Rationale: Provides specialized assessment of patient's dietary needs. 
  7. Encourage the patient to take frequent rest periods and to cluster activities. 
    Rationale: Promotes energy conservation.
  8. Educate the patient on the medication regimen, energy conservation, breathing techniques, and when to seek additional treatment before discharge from the hospital setting. 
    Rationale: Promotes self-care. 

Nursing Care Plan: Risk for Infection

While 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:

  • Presence of existing pneumonia
  • Suctioning, intubation, and other invasive procedures
  • Ineffective lung function caused by mucus
  • Secondary problems, such as immobility or malnutrition

Evidenced By

The common signs of infection are:

  • Fever
  • Chills
  • Body sweats
  • Muscle aches
  • Cough
  • Increased white blood cells

Desired Outcomes

The common signs of infection are:

  • Fever
  • Chills
  • Body sweats
  • Muscle aches
  • Cough
  • Increased white blood cells

Desired Outcomes

The most common desired outcomes are:

  1. The patient is free of the primary infection, and it does not create a secondary infection.

Risk for Infection Nursing Assessment

Appropriate nursing assessments include: 

  1. Monitor for signs of a secondary infection. 
  2. Monitor the patient's vital signs and laboratory values for signs of a worsening condition. 

Risk for Infection Nursing Interventions and Rationales

  1. Disinfect and sterilize any equipment. 
    Rationale: Reduces the spread of infection and re-infection.
  2. Teach patients how to wash their hands and perform adequate hygiene. 
    Rationale: Reduces the spread of infection and re-infection.
  3. Restrict visitors per hospital protocols. 
    Rationale: Reduces the spread of infection.
  4. Educate the patient about disinfecting items at home.
    Rationale: Reduces the spread of infection in the community setting.
  5. Institute isolation protocols as needed. 
    Rationale: Protects healthcare workers and visitors from infection. 
  6. Administer medications, such as antibiotics and oxygen, per orders.
    Rationale: Treats pneumonia and side effects. 
  7. Monitor the effectiveness of all drug therapies.
    Rationale: Identifies the need for medication adjustments. 
  8. Teach the patient about a nutrient-rich diet.
    Rationale: Promotes self-care and a healing diet.
  9. Remove waste, clean the room, and wear gloves and other PPE as indicated.
    Rationale: Prevents the spread of infection.
  10. Increase the patient's fluid intake as indicated.
    Rationale: Thins mucus in the lungs to assist with mobilization and expectoration. 
  11. Educate the patient regarding breathing and physical activity exercises.
    Rationale: Promotes activity, chest expansion, and oxygenation.
  12. Encourage frequent rest periods and necessary clustering activities.
    Rationale: Assists with energy conservation.
  13. Assess for changes in condition.
    Rationale: Identifies signs of worsening infection.

Nursing Care Plan: Risk for Imbalanced Nutrition: Less Than Body Requirements

The 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 To

Patients with the following conditions are at higher risk of developing imbalanced nutrition while they have pneumonia:

  • Difficulty breathing
  • Excessive coughing
  • Increased metabolic needs secondary to infection and fever
  • Swallowing air that leads to abdominal distention and discomfort

Evidenced By

The most common signs of imbalanced nutrition include:

  • Weight loss
  • Physical weakness 
  • Swollen mucus membranes
  • Confusion
  • Pale skin
  • Fatigue 

Desired Outcomes

The desired outcomes for the patient include the following:

  • The patient maintains a healthy appetite, food consumption, and weight. 

Risk for Imbalanced Nutrition Nursing Assessment

  1. Assess the patient's weight regularly.
  2. Monitor intake and output.

Risk for Imbalanced Nutrition Nursing Interventions and Rationales

  1. Request a nutritional consult. 
    Rationale: Provides a specialized assessment of the patient's nutritional needs.
  2. Schedule respiratory treatments and medications that cause stomach upset at least an hour after meals.
    Rationale: Reduces side effects such as nausea just before meals. 
  3. Provide small frequent meals and snacks.
    Rationale: Improves oxygenation and chest expansion.
  4. Consider a high-calorie, high-protein diet if not contraindicated.
    Rationale: Promotes healing and provides needed nutrients.
  5. Keep the patient's area clean and remove any secretions or waste before meals.
    Rationale: Provides a pleasant environment during mealtime.
  6. Educate the patient on the prescribed diet after discharge.
    Rationale: Promotes weight gain.
  7. Encourage oral hygiene.
    Rationale: Reduces mouth sores and dryness to increase food intake.
  8. Provide supplements as ordered. 
    Rationale: Provides additional calories and nutrients.

Nursing Care Plan: Acute Pain 

Pleuritic 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:

  • Pleuritic chest pain
  • Excessive coughing 

Evidenced By

Signs of acute pain include:

  • Verbalization of chest pain
  • Avoiding coughing and deep breathing
  • Changes in behavior or personality 
  • Changes in sleep patterns
  • Grimacing with movement or coughing

Desired Outcomes

  • The patient will be pain-free within 2 hours after administration of pain medications. 
  • The patient will demonstrate non-pharmacologic methods to control pain, such as frequent position changes and meditation.

Acute Pain Nursing Assessment

  1. Ask the patient about the pain's location, intensity, rating, and duration.
  2. Use the FACES Scale to evaluate the intensity of the pain.
  3. Observe for grimacing, crying, or other signs of pain.
  4. Evaluate the patient's mental ability to perform a multimodal approach to pain relief.
  5. Assess the patient's response to pain management strategies.

Acute Pain Nursing Interventions and Rationales

  1. Provide pain relief measures per the facility protocol.
    Rationale: Treats the pain appropriately.
  2. Educate the patient on non-pharmacologic pain relief strategies. 
    Rationale: Reduces pain and allows for self-care. 
  3. Encourage the patient to change positions frequently.
    Rationale: Reduces pain and increases chest expansion.
  4. Evaluate the effectiveness of pain management techniques. 
    Rationale: Indicates the need for new treatment modalities.

Nursing Care Plan: Decreased Activity Tolerance

Pneumonia 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:

  • Exhaustion
  • General weakness
  • Decreased oxygenation

The most common risk factors are:

  • Decreased oxygenation

Evidenced By

Signs of decreased activity tolerance may be:

  • Weakness and fatigue
  • Poor activity tolerance
  • Dyspnea and tachypnea
  • Change in vital signs during activity

Desired Outcomes

  • The patient will report improved tolerance to activity. 
  • The patient will be free of signs of respiratory distress. 

Decreased Activity Tolerance Nursing Assessment

  1. Assess the patient's response to physical activity.

Decreased Activity Tolerance Nursing Interventions and Rationales

  1. Encourage coughing and deep breathing. 
    Rationale: Mobilizes mucus and improves oxygenation.
  2. Encourage rest and monitor the patient's sleep pattern.
    Rationale: Promotes sleep and healing.
  3. Educate on the importance of pacing oneself and clustering activities. 
    Rationale: Promotes energy conservation.
  4. Assist with care tasks that cause the patient to tire quickly.
    Ratonale: Reduces exhaustion.

Nursing Care Plan: Deficient Knowledge

Some 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:

  • Lack of exposure to the condition
  • Inability to comprehend information
  • Inability to learn
  • Refusal to learn 
  • Lack of access to learning protocols or educational resources 

Evidenced By

Common signs of deficient knowledge of pneumonia care include:

  • Lack of remembering of information
  • Requesting information or asking questions
  • Stating misconceptions
  • Worsening or recurrent pneumonia
  • Confusion about pneumonia treatments
  • Non-compliance with prescribed treatment regimens

Desired Outcomes

  • The patient verbalizes the cause, side effects, and treatments of pneumonia.
  • The patient and caregiver verbalize understanding of the treatment regimen.
  • The patient participates in the treatment program.
  • The patient's pneumonia resolves, and no secondary infection occur.

Deficient Knowledge Nursing Assessment

  1. Assess the person's ability to comprehend new information and desire to learn.
  2. Ask the patient about previous healthcare experiences and note any misconceptions or poor experiences that may inhibit learning.
  3. Assess self-care and home caregiver needs. 

Deficient Knowledge Nursing Interventions and Rationales

  1. Educate on the signs, symptoms, and treatment of pneumonia.
    Rationale: Establishes a baseline understanding. 
  2. Create a peaceful mental and physical atmosphere for the patient. 
    Rationale: Provides a positive learning environment.
  3. Educate on the need to follow up with a care provider.
    Rationale: Establishes the need for ongoing care.
  4. Utilize the teach-back method.
    Rationale: Promotes learning and retention.
  5. Keep the informational sessions short and easy to understand.
    Rationale: Promotes learning and retention.
  6. Slowly progress the complexity of the material over time. 
    Rationale: Promotes a natural progression to more challenging information
  7. Educate on signs and symptoms that require the patient to notify the healthcare provider. 
    Rationale: Ensures timely follow-up for worsening or recurrent infection. 

Anxiety 

Dyspnea 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:

  • Shortness of breath
  • Feelings of not being able to breathe deeply
  • Pain during breathing
  • General feelings of illness

Evidenced By

The most common signs of anxiety include:

  • Nervous feeling
  • Hyperventilation 
  • Excessive worrying
  • Increased difficulty breathing

Desired Outcomes

  • The patient will experience reduced anxiety symptoms after using anxiety-reducing strategies, such as medications or relaxation.

Anxiety Nursing Assessment

  1. Ask the patient if they feel anxious or nervous.
  2. Observe for signs of anxiety, such as nervousness, inability to sleep or rest, or poor concentration.

Anxiety Nursing Interventions and Rationale

  1. Administer medications as prescribed. 
    Rationale: Reduces anxiety symptoms.
  2. Educate on using relaxation techniques, such as meditation and deep breathing. 
    Rationale: Reduces symptoms of anxiety.
  3. Play soft music and keep the lighting in the room low.
    Rationale: Improves relaxation.
  4. Educate the patient on the signs and symptoms of anxiety and strategies to reduce symptoms.
    Rationale: Promotes recognition of anxiety and self-care strategies.

More Pneumonia Diagnosis

  • Risk for Deficient Fluid Volume
  • Deficient Fluid Volume

Pneumonia NCLEX Test Questions

Nursing 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. 

  1. Aminophylline is prescribed for a patient with acute bronchitis. The nurse knows the primary purpose of this medication is to:
    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 
  2. Dr. Smith prescribes Proventil for a patient with asthma. While teaching the patient about the side effects of this drug, the nurse should explain how this drug may cause:
    a.     Congestion
    b.     Anxiety 
               I.     Rationale: Proventil/Albuterol can cause anxiety, nervousness, tremors, headaches, and palpitations. 
    c.     Lethargy
    d.     Hyperkalemia 
  3. Sally, a student with acute rhinitis, sees the on-campus nurse due to excessive nasal passage drainage. The nurse asks Sally about the color of the nasal drainage to diagnose the patient. Typically, the color of acute rhinitis drainage is:
    a.     Brown
    b.     Yellow
    c.     Clear 
                  I.     Rationale: Acute rhinitis presents with clear secretions, mouth breathing, dark eye circles, and sniffling. 
    d.     Gray 
  4. A senior client with pneumonia usually has _____ as their first symptom.
    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 
  5. _____ is a pathophysiological mechanism that facilitates pneumonia development.
    a.     Efusion
    b.     Inflammation 
                 I.     Rationale: Macrophages cause lung inflammation. 
    c.     Bronchiectasis
    d.     Malnutrition 

Additional Readings and Resources

If you need more information about pneumonia, check out these great articles on AllNurses: 

Wrapping Up Pneumonia Nursing Care Plans

While 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.

Citations

  1. https://www.CDC.gov/nchs/fastats/pneumonia.htm 
  2. https://pubmed.ncbi.nlm.nih.gov/22621820/ 
  3. New evidence of risk factors for community-acquired pneumonia: a population-based study 
  4. Identification of new risk factors for pneumonia: population-based case-control study 
  5. https://onlinelibrary.wiley.com/doi/10.1002/dmrr.682 
  6. COPD and Pneumonia: The Dangers of COPD and Pneumonia Together (copdhealth.today)
  7. Hospital-acquired and ventilator-associated pneumonia: Diagnosis, management, and prevention | Cleveland Clinic Journal of Medicine (ccjm.org)
  8. Bacterial Pneumonia: Symptoms, Causes, and Treatment (healthline.com)
  9. RSV (Respiratory Syncytial Virus) | CDC
  10. Pneumonia in Adults With Asthma: Impact on Subsequent Asthma Exacerbations | Open Forum Infectious Diseases | Oxford Academic (oup.com)
2 Votes
Melissa Mills

About Melissa Mills, BSN

Workforce Development Columnist

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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Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
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. 

 

2 Votes
Specializes in Workforce Development, Education, Advancement.

Thanks for your thoughts and comments, @Hannahbanana.

 

Melissa

1 Votes
Specializes in oncology.

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. 

3 Votes
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.

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. 

1 Votes
Specializes in oncology.
Quote

. I have worked as a legal nurse consultant but have never held myself out as a testifying expert on curriculum design or accreditation

Your words not mine. 

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