Pneumonia is an infection of the lungs that can be caused by bacteria, fungi, or viruses. It involves the inflammation of the air sacs called alveoli.
When inflamed, the air sacs may produce fluid or pus which can cause productive cough and difficulty breathing.
Pneumonia can be mild but can also be fatal if left untreated. Severe pneumonia can be life-threatening for patients who are very young, very old (age 65 and above), and immunocompromised (e.g. cancer patients or COPD patients).
Signs and Symptoms of Pneumonia
- Productive cough (viral pneumonia may present as dry cough at first)
- Shortness of breath
- Tachypnea or rapid breathing
- Tachycardia or fast heartbeat
- Fever
- Fatigue
- Myalgia or muscle pain
- Headaches
- Chills
- Nausea
Types and Causes of Pneumonia
Types of Pneumonia According to Origin
- Community-Acquired Pneumonia. This type of pneumonia refers to getting the infection at home, in the workplace, in school, or other places in the community outside a hospital or care facility.
- Hospital-Acquired Pneumonia. Also called nosocomial pneumonia, this type of pneumonia originates from being admitted in the hospital. Hospital acquired pneumonia may be due to an infected tracheostomy tube, a weakened immune system, or an infected breathing machine, such as a ventilator.
- Ventilator-associated pneumonia is one of the subtypes of hospital-acquired pneumonia. The bacteria causing hospital-acquired pneumonia may be antibiotic-resistant, rendering this disease more difficult to treat than community-acquired pneumonia.
Types of Pneumonia According to Causative Agent
Bacterial Pneumonia. This type of pneumonia can spread through droplet transmission, that is, when an infected person sneezes or coughs, and the other person breathes the air droplets through the nasal or oral airways.
Streptococcus pneumoniae is the causative agent for most of the cases of adult community-acquired pneumonia.
Other bacteria that can cause pneumonia include H. influenzae, Mycoplasma pneumonia, Legionella pneumonia, and Chlamydia pneumoniae.
A less severe form of bacterial pneumonia is called walking or atypical pneumonia, in which the symptoms are very mild and the infected person can do his/her activities of daily living as normal.
Viral pneumonia. Viruses such as RSV (common cause in infants age 1 and below), flu and cold viruses can cause viral pneumonia, which is the second most common type of pneumonia.
It does not respond to antibiotics; therefore, the management is focused on symptom control and may also include the use of an antiviral drug.
Fungal pneumonia. Immunocompromised people are more susceptible to fungal pneumonia than healthy individuals.
Fungal pneumonia is caused by inhaling fungal spores that can come from dust, soil, and droppings of rodents, bats, birds or other animals.
Complications of Pneumonia
- Pleural effusion. If left untreated, pneumonia may cause excessive fluid buildup in the pleural cavity, which is the space between the lungs and the chest cavity. The fluid may also contain the pathogen, leading to pleuritis.
- Bacteremia. The bacteria may enter the blood stream and cause bacteremia, sepsis, or organ failure.
- Trouble sleeping. Coughing and difficulty of breathing may cause insomnia and difficulty to fall asleep. Some patients require to be attached to a breathing machine to allow healing of the lungs.
- Lung abscess. Pockets of pus may form inside the lungs or on their outer layers.
Diagnosis of Pneumonia
- Physical examination and vital signs – fever, tachypnea, tachycardia, and decreased oxygen saturation levels
- Blood tests – elevated white blood cell count may be a sign of an ongoing infection
- Sputum culture – to determine the causative agent
- Imaging – chest X-ray to determine active infection and its severity; bronchoscopy to check any blockage of the airways; CT scan for a more detailed lung imaging
- Arterial blood gas (ABG) test –using an arterial blood sample to measure the oxygen level
- Pleural fluid culture – taking a pleural fluid sample by inserting a needle between the pleural cavity and the ribs in order to determine the causative agent
Treatment of Pneumonia
- Antibiotics. The type of antibiotic is determined after a sputum culture result is obtained and the specific type of bacteria is known. If there is no improvement with the symptoms, the doctor may prescribe a different type of antibiotic. Macrolide antibiotics such as azithromycin and clarithromycin are commonly used as first-line drugs for pneumonia. Other antibiotics that may be used for pneumonia include doxycycline, levofloxacin, and combination of macrolide and beta-lactam (amoxicillin or amoxicillin/clavulanate known as Augmentin).
- Cough suppressants. To help alleviate cough and allow the patient to rest, cough suppressants may be given at low doses.
- Fever reducers and pain relievers. Medications such as paracetamol, ibuprofen, and acetaminophen can help lower body temperature and alleviate discomfort.
Nursing Care Plans for Pneumonia
Pneumonia Nursing Care Plan 1
Nursing Diagnosis: Hyperthermia related to the disease process of bacterial pneumonia as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, and profuse sweating.
Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.
| Nursing Interventions for Pneumonia | Rationales |
| Assess the patient’s vital signs at least every 4 hours. | To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs (e.g. Tylenol) administered. |
| Remove excessive clothing, blankets and linens. Adjust the room temperature. | To regulate the temperature of the environment and make it more comfortable for the patient. |
| Administer the prescribed antibiotic and anti-pyretic medications. | Use the antibiotic to treat the bacterial pneumonia, which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature. |
| Offer a tepid sponge bath. | To facilitate the body in cooling down and to provide comfort. |
| Elevate the head of the bed. | Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively. |
Pneumonia Nursing Care Plan 2
Nursing Diagnosis: Ineffective Airway Clearance related to the disease process of bacterial pneumonia as evidenced by shortness of breath, wheeze, SpO2 level of 85%, productive cough, difficulty to expectorate greenish phlegm
Desired Outcome: The patient will be able to maintain airway patency and improved airway clearance as evidenced by being able to expectorate phlegm effectively, have respiratory rates between 12 to 20 breaths per minutes, oxygen saturation above 96%, and verbalize ease of breathing.
| Nursing Interventions for Pneumonia | Rationales |
| Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. | To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. |
| Encourage coughing up of phlegm. Suction secretions as needed. Perform steam inhalation or nebulization as required/ prescribed. | To help clear thick phlegm that the patient is unable to expectorate. |
| Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician. | To increase the oxygen level and achieve an SpO2 value of at least 96%. |
| Administer the prescribed airway medications (e.g. bronchodilators) and antibiotic medications. | Bronchodilators: To dilate or relax the muscles on the airways. Steroids: To reduce the inflammation in the lungs. Antibiotics: To treat bacterial pneumonia. |
| Elevate the head of the bed and assist the patient to assume semi-Fowler’s position. | Head elevation and proper positioning help improve the expansion of the lungs, enabling the patient to breathe more effectively. |
Pneumonia Nursing Care Plan 3
Ineffective Breathing Pattern
Nursing Diagnosis: Ineffective Breathing Pattern related to decreased lung expansion secondary to pneumonia as evidenced by a respiratory rate of 22, usage of accessory muscles, and labored breathing.
Desired Outcomes:
- At the end of the span of care, the patient will be able to have an effective, regular, and improved respiratory pattern within a normal range (12-20 cycles per minute).
- The patient’s blood oxygen saturation (SpO2) will also be within the target levels set by the physician (usually 96 to 100 percent; 88 to 92% for most COPD patients).
- The patient will also be able to reach maximum lung expansion with proper ventilation to keep up with the demands of the body.
| Nursing Interventions for Pneumonia | Rationale |
| Take an initial assessment of the patient’s respiratory rate and blood oxygen saturation using a pulse oximeter. | It is very important to take and record the patient’s respiratory assessment to make it a basis if there are any abnormal findings in the future. |
| Using a sphygmometer, auscultate the patient’s breath sounds for at least every 4 hours. | A patient with pneumonia shows inflammation in their lung parenchyma causing it to have edema and congestion. It is only proper to auscultate the lungs to know if there is an increase or decrease of breath sounds that might be fatal when left untreated. |
| Place the patient in a comfortable position. Most people with pneumonia are preferred to be placed on a moderate high back rest (also called semi-Fowler’s position) or placed pillows on the back. The nurse can also teach him or her to use the bedside table with a pillow and lean on it. | Assisting the patient in moderate-high backrest will facilitate better lung expansion thus they can breathe better and would feel comfortable. |
| Assist the patient when they are doing their activities of daily living. | A patient with pneumonia is at high risk of getting fatigued and overexertion because of the increased need for oxygen demands in the body. So to avoid that, they must be assisted in any activities to help conserve their energy. |
| If the patient is complaining about the difficulty of breathing, provide supplemental oxygen as ordered. | Supplemental oxygen will help in the increased demand of the body and will lower the risk of having respiratory distress and low oxygen perfusion in the body. |
| Advised the patient to dispose of and let out the secretions. If he or she can not do it, then provide a suction machine always at the bedside. | Building up secretions in the airway will only cause a problem since it will obstruct the airflow from going in and out of the body. To avoid the formation of a mucus plug, suction it as needed. It is important to pre-oxygenate the patient before the nurse suctions to avoid respiratory distress. |
| Arrange the tasks of the patient when providing care to him/her. | Organizing the tasks will provide a sufficient rest period for the patient. Doing activities at the same time will only increase the demands of oxygen in the body, and patients with pneumonia cannot tolerate it. |
| Teach the proper technique of doing pursed-lip breathing, various ways of relaxation, and abdominal breathing. | These techniques mentioned will greatly help the patient to avoid respiratory distress and assist the body to take in oxygen and avoid hypoxia. |
| Give health teachings about the importance of taking prescribed medication on time and with the right dose. | It is important to let the patient know the pros of taking an accurate dosage and the right timing of medication for fast recovery. |
| Advised the patient that he or she will be evaluated if he or she can tolerate exercise and develop a special exercise to help his or her recovery. | Exercise most especially in the lungs plays the importance in promoting respiratory conditioning and it is also vital for the patient’s well-being. |
Pneumonia Nursing Care Plan 4
Impaired Gas Exchange
Nursing Diagnosis: Impaired Gas Exchange related to the overproduction of mucus in the airway passage secondary to pneumonia as evidenced by cyanosis, restlessness, and irritability.
Desired Outcome: At the end of the span of care, the patient will manifest better lung ventilation and improve tissue perfusion, and maximum optimal gas exchange by having normal arterial blood gas results, minimum to no symptoms of respiratory distress, and normal production of mucus in the airway.
| Nursing Interventions for Pneumonia | Rationale |
| Have an initial assessment of the patient’s respiratory rate, rhythm, and oxygen saturation every 4 hours or depending on the need. | It is important to have an initial assessment of the patient and use it as a comparison for future reference or referral. Checking the respiratory status depending on the need will help know the impending respiratory changes of the patient. |
| Visualize and note some changes when it comes to the color of the skin, quality of mucous production, and nail beds. | Since the patient is manifesting impaired gas exchange, one of the good indications that the oxygen absorption inside the body is not improving is through the skin changes, nail bed discoloration, and mucous production. These symptoms are very crucial and the patient must be given immediate care and intervention to avoid hypoxia. |
| Allow the patient to have enough bed rest and avoid strenuous activities. | The patient must have enough rest so that the body will not be exhausted and avoid an increase in the oxygen demand. |
| Teach the patient some useful relaxation techniques and diversional activities such as proper deep breathing exercises. | This is needed to help the patient conserve his or her energy and also effective relaxation when the patient feels anxious and having a hard time concentrating and breathing. |
| Assist patient in a comfortable position. Usually, people with pneumonia preferred their heads elevated with a pillow. Encourage to always change position to facilitate mucous drainage in the lungs. | These interventions help facilitate optimum lung expansion and improve lungs ventilation. The patient will most likely feel comfortable and easy to breathe when their head is elevated in bed. |
| Give supplemental oxygen treatment when needed. | Since the patient’s body is having difficulty with gas exchange due to pneumonia, it will benefit him/her to have some supplementary oxygen treatment to assist in the demands of the body. The body needs more oxygen since it is trying to fight the virus or bacteria causing pneumonia. |
| Avoid environmental irritants inside the patient’s room. Place or install an air filter in the room to prevent the accumulation of dust inside. | Environmental irritants such as flowers, dust, and strong perfume smell or any strong smelling substance will only worsen the patient’s condition. |
| Teach the patient to use the incentive spirometer as advised by their attending physician | Educating him/her to use the incentive spirometer will encourage him/her to exercise deep inspiration that will help get more oxygen in the lungs and prevent hypoxia. |
| Suction the mouth or the oral airway as needed. | If the patient is having increased mucous production, encourage him or her to clear the airway. If he or she cannot do it alone, make sure to place suction secretions at the bedside to use anytime. If there is airway obstruction this will only block and cause problems in gas exchange. |
| Teach the importance of complying with the prescribed treatment and medication. | One way to have a good prognosis and help fasten recovery is to comply with the prescribed treatment. The available treatments of pneumonia can give a good prognosis to the patient for as long as he or she complies with it. |
Pneumonia Nursing Care Plan 5
Deficient Knowledge
Nursing diagnosis: Deficient knowledge about the disease process and treatment of pneumonia related to lack of information as evidenced by failure to comply with treatment.
Desired Outcome: At the end of the span of care, the patient will be able to understand the transmission, disease process, and available treatments for pneumonia.
The patient will also be able to demonstrate and verbalize understanding about the desired therapeutic regimen. He or she will also comply and participate in the special treatment program designed for his or her condition. The patient will also be able to fully understand how pneumonia is being transmitted to avoid having the disease transfer from other family members.
| Nursing Interventions for Pneumonia | Rationales |
| Assess the patient’s knowledge about Pneumonia. Start asking what they know about the disease and further discuss it with the patient. | Identify up to what extent does the patient knows about pneumonia. It is important to acknowledge their limited information about the disease process and start educating him/her from there. They will further understand the topic since they already have an idea of what is it about. |
| Discuss to the patient the different types of pneumonia and the difference between him/her. Try to use words that can be understood by normal people. | The patient will further understand their disease when they understand why they have it and it will help him/her better comply with the treatment regimen. Also, they will effectively help spread the disease process since they know the mode of transmission and how to break the cycle of transmitting it to other family members. |
| Identify the ability of the patient to perform self-care and do activities of daily living. | It is important to assess the ability of the patient to do self-care ost especially if he or she is having respiratory symptoms. patients with pneumonia need assistance when performing activities of daily living |
| Provide factual information about the disease process in a written or verbal form. | patients will better understand the health teachings if there is a written or oral guide for him/her to look back to. Don’t forget to include some emergency contact numbers just in case there is an emergency. It must include the local 911 numbers, hospitals, and immediate keen of the patient. |
| Let the patient do a return demonstration when giving lectures about medication and therapeutic regimens. | The patient will have a big chance to remember how to administer or perform any therapeutic regimen if they are given the chance to demonstrate and have him/her verbalize their understanding about it. Place some timetable as to when each medication should be administered to ensure compliance and timely administration of medication. |
| Discuss to him/her the different pros and cons of complying with the treatment regimen. | Treatment for pneumonia needs to be complied with completely to ensure a good prognosis and improve health. Most of the problems in connection to the reoccurrence of pneumonia are poor compliance to the prescribed treatment. The treatment and medication should be prescribed by the attending physician and do not take meds that are not prescribed to prevent unnecessary drug interaction. |
| Encourage the patient to see their medical attending physician for approval and safe treatment. | The patient must understand the importance of seeing an attending physician and not rely on what they see or hear on the internet. Most of the cases of poor prognosis of pneumonia are undertreatment or not being able to be assessed earlier. |
| Teach patients some signs and symptoms that prompt immediate medical attention such as dyspnea. | Some signs and symptoms such as dyspnea should not be taken for granted and must be immediately be assessed by an attending physician. Do not wait for the symptoms to worsen to prevent further problems. |
| Allow patients to ask a question or clarify regarding their treatment. | Attend to the patient’s queries regarding their pneumonia treatment. If there are some questions or clarifications when it comes to their medicines, make sure to find time to explain to him/her so that this will ensure compliance with the treatment. |
| Promote a well-ventilated environment so that the patient will have good oxygen exchange in the body. Make sure to avoid flowers, strong smell scents, dust, and other allergens that are present in the room. | When taking care of a patient with pneumonia, it is important to ensure the environment is well ventilated, conducive for good rest, and accessible when the patient needs assistance or help. The nurse can install an air filter machine that will help create a dust-free environment that will be ideal for a patient with pneumonia. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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