Nursing Care Plan for Pneumonia

Pathophysiology of Pneumonia

Pneumonia is an infection that causes severe inflammation in the lungs. This makes the alveoli fill with mucus, fluid, and debris, leading to impaired gas exchange. 

Impaired gas exchange occurs when CO2 can’t get out, and oxygen can’t get in. This results in hypoxia (low oxygen).

• Community-acquired pneumonia is when a person gets pneumonia from the general population, instead of a medical center.
• Healthcare-acquired pneumonia occurs during or after a stay in a long-term care facility.
• Ventilator-acquired pneumonia occurs when a client gets sick after being on a ventilator.

Causes

Pneumonia is caused by viruses, bacteria, and fungi – but most commonly viruses and bacteria. These culprits include:

• Viruses (Influenza viruses, SARS-CoV-2, Respiratory syncytial virus (RSV))
• Bacteria (Streptococcus pneumoniae (pneumococcus) and Mycoplasma pneumoniae)
• Fungi (coccidioidomycosis, histoplasmosis, and blastomycosis)

Subjective (client May Report)

• Fever
• Chills
• Loss of appetite
• Coughing
• Shortness of breath

Objective

• High temperature
• Elevated white blood count 
• Rhonchi lung sounds
• Low oxygen rate

Risk Factors

• Being over 65 years old
• History of lung diseases
• Hospitalization
• Smoking

Pneumonia Symptoms

• Altered mental status 
• Restlessness, agitation, or confusion
• Fever (Over 100.4 F/ 38oC)
• Productive cough “yellow sputum”
• Fine or coarse crackles
• Dyspnea (shortness of breath)
• Pleuritic chest pain (pleural friction rub)

Nursing Assessment for Pneumonia

When assessing a client for pneumonia, you need to look for signs of respiratory distress. This includes listening closely to their clients’ lungs using a stethoscope. You’ll be able to hear the crackles and wheezes that are characteristic of this condition.

• Elevated white blood cell count (over 10,000)
• Positive sputum culture 

Cardiac Function

• Artery inflammation

Neurological & Sensory Functions

• Headaches
• Difficulty swallowing
• Possible CNS infection

Visual Appearance & Labs

• Chest X-ray (CXR)
• Elevated white blood cells
• Sputum Culture
• ABGs (respiratory acidosis) 

Pneumonia Nursing Interventions

• Encourage clients to drink more fluids to prevent dehydration. They should also be encouraged to cough and breathe deeply.
• Assess clients’ hydration status and keep electrolytes normal through oral rehydration solutions (ORS) or intravenous therapy as needed.
• Monitor oxygen levels by measuring pulse oximetry at least every 2-4 hours. Also monitor for side effects, such as nausea or vomiting.
• Administer oxygen (according to protocol or physician orders) and medications as prescribed (such as antibiotics). 
• Position clients in semi-Fowler position for easier breathing and lung expansion.
• Avoid administering cough suppressants (so reinfection doesn’t occur).

Pneumonia NCLEX Questions

Which nursing intervention is appropriate to prevent a client from developing pneumonia after surgery?

A. Instruct to report pain before it gets too intense.

B. Instruct them to move their legs and arms while in bed.

C. Instruct to use the incentive spirometer every hour while awake.

D. Instruct to turn in the bed every 4-6 hours.

Answer: B

A nursing intervention that helps prevent a client from developing pneumonia after surgery is teaching the client to use the incentive spirometer every hour while awake. As the client breathes in, an indicator on the device measures the client’s ability to inhale. 

Its use helps the client expand and fill the lungs with air by taking deep, slow breaths and attempting to meet specific, measurable goals.

The nurse plans for a nursing diagnosis of ineffective airway clearance for a client with pneumonia. Which intervention will the nurse identify as a priority in the plan of care?

A. Instruct on coughing, deep breathing, and hydration.

B. Give the client supplemental oxygen.

C. Contact the physician for a blocked airway and prepare a tracheostomy set-up.

D. The client will maintain head of bed in mid-fowlers for the next 48 hours.

Answer: A

Coughing, deep breathing, and maintaining adequate hydration are important for achieving effective airway clearance. Selection B is not a priority for the care plan for airway clearance needs since it does not affect the airway as a priority, like coughing/deep breathing and hydration (which will help mobilize secretions). 

Oxygenation helps diagnose impaired gas exchange and ineffective breathing related to abnormal oxygenation/carbon dioxide ratio. Selection C is unnecessary for a priority when other less invasive interventions are available. Selection D is stated as a goal/outcome, not an intervention. (HINT: Make sure question stems and answers on the nursing process coincide).

Sources

https://www.cdc.gov/pneumonia/index.html

https://www.ncbi.nlm.nih.gov/books/NBK526116/