Nursing Care Plan for Pneumonia- A Student’s Guide
Introduction
Pneumonia is a serious lung infection that can develop in anybody. It most commonly occurs in the very young, old, or infirm and usually requires hospitalization and aggressive treatment to prevent complications.
It is a condition in which the lungs fill with fluid, and air sacs become inflamed. It’s caused by bacteria, viruses, or fungi and can be transmitted through droplets from coughing or sneezing.
The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for pneumonia is 480. The ICD-9 codes are based on the features of presentation, course, and outcome that characterize a particular disease or infection.
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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
What is Pneumonia?
Pneumonia is an infection in which the air sacs (alveoli) within the lungs have become inflamed and filled with fluid. Bacteria, viruses, or fungi can all cause pneumonia. The condition often occurs in young, old, or already sick people and may result in death if not treated promptly.
Therefore, a nursing care plan for pneumonia should prioritize patient safety and health outcome and reduce hospitalization time.
What is a Nursing Care Plan?
A nursing care plan is a structured list of actions and interventions designed to achieve clearly stated goals.
Pneumonia may be preventable in many individuals if appropriate precautions are taken.
A good nursing care plan for pneumonia will address possible transmission pathways, prevention principles, assessment measures appropriate to the patient’s age and health status, treatment options and interventions, and monitoring of outcomes
How Do You Write a Nursing Care Plan?
A nursing care plan for pneumonia should include, at a minimum:
1.Definition of the problem in terms of nursing process and medical outcomes criteria, including the patient’s diagnosis, prescribed interventions and associated expected outcomes, and measurement tools;
2.Risk factors that may have contributed to the development or progression of pneumonia;
3.Estimated time frames for implementing interventions; and
4.Identification of expected outcomes of the described interventions.
Why is a Nursing Care Plan Important?
A nursing care plan for pneumonia is important because it:
1. Helps ensure the patient’s safety and comfort;
2. Promotes continuity of care and improvement in the quality of life; and
3. Enhances communication among all members of the patient’s health care team.
What is the Difference Between a Nursing Care Plan and a Treatment Plan?
A nursing care plan outlines the process by which patients with pneumonia are cared for. It describes tasks performed to achieve defined goals, whereas treatment plans outline what treatments have been prescribed by physicians to effectively manage disease processes. A treatment plan should never be confused with a nursing care plan.
How to Prevent Pneumonia
To help prevent pneumonia, make sure you always wash your hands with soap before eating or touching anyone else who might have already touched something contaminated, like a door handle. Also, try to avoid crowds and people who have respiratory infections such as the flu. A common misconception is you can catch pneumonia through a sneeze or cough from someone who has it, but this is not true; it can only be spread by touching something contaminated with bacteria then touching your mouth or nose. Regardless of how you contract pneumonia, make sure to always take any medications as prescribed!
How to Provide Your Patients with Quality Nursing Care
Before you begin providing care for a patient who has pneumonia, make sure that you have gathered the following:
1. Any medical history or previous laboratory results that may be related to the patient’s illness
2. A list of medications including dosage and frequency;
3. The name, phone number, and contact information for emergency contacts such as a family member or primary physician;
4. A list of any vitamins, over-the-counter medications, herbal remedies, or other supplements they may be taking;
5. A list of previous surgeries or hospitalizations;
6. The location of the patient’s medical history on file in your facility; and
7. Confirmation that a health care proxy has been filed with your facility if the patient cannot communicate for themselves.
What Steps Do You Take When Caring for a Pneumonia Patient?
The following steps should be taken when caring for someone with pneumonia:
1) Check breathing rate, the color of skin, level of consciousness
2) Administer oxygen if needed
3) Treat fever with acetaminophen
4) Monitor for signs of worsening
5) Provide pain relief
6) Encourage fluids as tolerated
7) Observe for changes in mental status
8) Chest x-ray may be warranted
9) Consider referral to specialist
10) Reassess at least every 4 hours
What Are Types of Pneumonia?
The different types of pneumonia include;
Acute community-acquired pneumonia (CAP) occurs most often in adults and children older than five years. It usually spreads from one person to another and is caused by viruses or bacteria.
Common bacterial causes for community-acquired pneumonia include Strep Pneumonia, Mycoplasma, Chlamydia, Legionellosis.
Community-Acquired Pneumonia (CAP) is an acute illness, which means that your symptoms begin suddenly and may worsen quickly. You might have a fever or cough, feel short of breath, be tired, or have other respiratory problems associated with pneumonia.
Hospital-acquired pneumonia (HAP) – is a severe form of acute bacterial pneumonia. It occurs more often in hospitalized people, particularly those over age 65 and in intensive care units( ICU).
The exact causes of Hospital Acquired Pneumonia (HAP) are not known. Risk factors include:
1) Prior upper respiratory infection
2) Prolonged hospitalization
3) Certain medical conditions such as diabetes, high blood pressure, or obesity
4) Use of certain drugs
5) Diseases that cause problems with the immune system
6) Having a respiratory device in your lungs
7) Recent surgery.
Hospital-Acquired Pneumonia (HAP) is an acute illness which means that symptoms appear suddenly and get worse quickly. It occurs most commonly in hospital patients with chronic illnesses.
Chronic Pneumonia -This is a long-term (or persistent) lung infection in which you have symptoms such as cough, fever, night sweats, weight loss for three months or more, or coughing up blood. A diagnosis of Chronic pneumonia must be made by your doctor and cannot be self-diagnosed.
This type is often caused by a virus or as a complication of COPD (chronic obstructive pulmonary disease). Some people are more susceptible to chronic pneumonia because they have: HIV/AIDS, Heart Disease, Kidney disease, Cancer, etc.
Parasitic Pneumonia occurs most often in the tropics and subtropics but can occur anywhere. It’s caused by a variety of organisms, including:
Fungal Pneumonia occurs in people with weakened immune systems, especially those with AIDS. Fungus grows on mucous membranes and the lungs’ delicate alveoli (air sacs). Aspergillus is one of the most common fungi that cause fungal pneumonia, but other species can also cause infections.
Common bacterial causes for community-acquired pneumonia include Strep Pneumonia, Mycoplasma, Chlamydia, Legionellosis.
What Are the Symptoms of Pneumonia?
The signs and symptoms of pneumonia result from inflammation, infection, and other complications within the affected lung tissue. The following are some of the most common manifestations of pneumonia:
1.Fever
2. Cough with or without sputum production
3. Fatigue
4. Chest pain that worsens with increased activity
5. Difficulty breathing, especially when lying flat
6. Confusion or disorientation
7. Acidosis (low pH level resulting from too much acid in the blood)
8. Hypoxemia (decreased level of oxygen in the blood)
9. Bradycardia (slow heart rate, less than 60 beats per minute)
10. Tachycardia (fast heart rate, more than 100 beats per minute).
What Are the Causes of Pneumonia?
Pneumonia is an infection that affects the lungs. However, there are three basic types of pneumonia with varying causes:
Sputum-Producing: also referred to as bacterial pneumonia. This type of pneumonia is caused by microorganisms that are present in the upper respiratory tract and become lodged in the lungs
Non-Sputum-Producing: Also known as viral or atypical pneumonia. This form occurs when a virus enters your body through your nose or mouth and travels to your lungs.
The third type of pneumonia combines the above two types and is referred to as atypical bacterial pneumonia.
In addition, some bacterial infections are more likely than others to progress into pneumonia, such as Streptococcus pneumonia. This specific bacteria is responsible for 50% of all cases of pneumonia in adults and most cases of pneumonia in children.
Other bacteria that can lead to bacterial pneumonia include Chlamydia, Legionella pneumophila, Mycoplasma pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus. These particular infections are spread through the air by coughs and sneezes.
Viral types of pneumonia are the most common form of pneumonia and occur when viruses invade your body through your nose or mouth – often from contaminated water, food, or touching the surface of another person’s respiratory secretions (“hand to mouth” contact). This type of pneumonia is spread directly between people who share living quarters or close contact with each other for a long period.
In addition, some viruses are spread by insects such as mosquitoes such as the West Nile Virus or in food that has not been properly cooked (e.g., raw oysters).
The third type of pneumonia – atypical bacterial – is both caused and spread through the same mechanisms as bacterial pneumonia; however, the particular microorganisms that cause it are different.
These three types of pneumonia can overlap with each other, and often symptoms overlap as well. Misdiagnosis is extremely common, which increases the risk of severe complications such as respiratory failure, sepsis (blood infection), congestive heart failure, ventilator-associated pneumonia (VAP), and death.
Nursing Diagnosis of Pneumonia:
Many of these nursing diagnoses are to help patients under your care. Some may also apply to you or other health professionals.
Physical Diagnosis of Pneumonia:
A physical examination takes place before a diagnosis of pneumonia. It is performed by a medical professional and involves checking for temperature, pulse, and blood pressure – essential in determining the risk of infection.
During the physical examination, your medical professional will look closely at your respiratory system via the nasal or oral cavity (depending on the individual’s age).
They will check your lymph nodes, lungs, and heart for signs of infection.
In addition to these examinations, your medical professional may order lab tests or other imaging procedures (i.e., x-ray) to confirm a final diagnosis.
Diagnostic Lab Tests
Routine blood test to determine if there is an infection. Typically, these results are received the same day, and if your medical professional has any concerns, they will order other tests such as a chest x-ray or sputum culture.
Sputum Culture
This test is performed to identify bacteria in your lungs (pneumonia). A sputum sample is collected by asking you to cough into a sterile container. The sample is then sent to the lab for analysis.
Chest X-Ray
This test is performed to view your lungs from the inside and confirm a pneumonia diagnosis.
Complete Blood Count (CBC)
This blood test checks the number of red blood cells, white blood cells, and platelets. It is often performed along with a complete metabolic panel (CMP) to measure your blood’s protein content, which can indicate sepsis or other systemic infections.
Complete Metabolic Panel
This medical exam checks for possible nutrient deficiencies in patients who cannot eat due to nausea and vomiting. It includes glucose, sodium, potassium, chloride, calcium, and magnesium.
Arterial Blood Gas (ABG)
This blood test evaluates how well oxygen is being absorbed into your bloodstream. This test will be ordered if pneumonia symptoms include difficulty breathing or a fast heart rate.
You may also check Comprehensive Nursing Diagnosis for Pneumonia
Nursing Interventions for Treating Pneumonia in Children and Adults
The following interventions are generally appropriate for most patients being cared for in the hospital setting:
- Check vital signs, including temperature;
- Monitor respiratory status using a pulmonary artery catheter if needed;
- Administer oxygen if indicated; and assess for signs and symptoms of dehydration, including a dry mouth with cracked lips, excessive thirst, passing little urine, and dark yellow or strong-smelling urine.
The nurse must also teach the patient and family/friends about how to recognize early pneumonia symptoms so that prompt treatment can be initiated if the disease progresses. Furthermore, nurses need to teach family/friends the proper dosage and administration of medications to be self-administered at home.
What Should You Monitor for Pneumonia?
Monitor for fever, chest pain, shortness of breath, or difficulty breathing. These symptoms can indicate pneumonia in adults and children. Pneumonia itself is not fatal, but the complications that occur as a result of it are. If you observe these symptoms, seek medical attention immediately.
Review & Evaluate – As with most cases, when the child recovers from pneumonia, there is a need to assess the child’s overall condition and identify whether or not there are any complications that resulted during treatment. In addition, review how well each of your assessments and interventions worked in treating this disease. If you found anything ineffective, then make sure to revise as needed.
What Kinds of Complications Can Develop from Pneumonia?
Pneumonia can cause serious complications that may threaten your life and require emergency care. Some of the most common complications that can arise from pneumonia include:
1. Acute respiratory distress syndrome (ARDS) which is a condition that occurs when fluid leaks into the lungs due to damage to lung tissue;
2. Severe dehydration or electrolyte abnormalities such as low blood pressure, confusion, and muscle spasms; and
3. The development of a lung abscess is when pus builds up in the lung and causes swelling, pain, high fever, shortness of breath, and chills. Lung abscesses can be very dangerous if they are not treated quickly. See your doctor as soon as possible to minimize complications.
What Should I Do If I Think My Patient May Have Been Exposed to Pneumonia?
Pneumonia can be passed from person to person, so it is important if you think a loved one has pneumonia that you take some extra precautions to prevent the spread of germs. Some steps you can take include:
1. Reposition the patient to help reduce coughing, which may spread infectious particles;
2. Check mucus from their nose and mouth for blood that could indicate bleeding in the lung;
3. Ask them to cough into a tissue instead of directly onto you if they have bloody or watery mucus; 4. Make sure they are up to date on their flu shot and other vaccines;
5. Stay home yourself and avoid crowds if you have been exposed and should develop symptoms over the next three days;
6. Practice good hand hygiene at all times, such as washing your hands frequently, especially after touching body fluids;
7. If you develop symptoms such as a cough, fever, difficulty breathing, and muscle pain, see your doctor immediately.
What is the Nursing Care Plan for Pneumonia?
The nursing care plan below has been compiled to ensure your patients’ health is maintained while they recover.
1. Check the patient for a fever – if there is one, call a doctor immediately. If not, continue with treatment plan
2. Administer antibiotics prescribed by physician
3. For mild cases, a cool-mist vaporizer can be used to provide comfort
4. Encourage fluids – liquids such as juices and jellies are preferred over milk products
5. For adults: Follow up every 2 hours until temperature returns to normal range; then follow up every 4 hours
6. Rest is important – encourage them to stay in bed
7. For severe cases, intensive care may be needed
8. Complications: Monitor for signs of dehydration, infection (including in blood), and respiratory distress (increasing difficulty breathing). If a patient has these symptoms, call the physician immediately.
What Are the Health Risks of Pneumonia?
Pneumonia can be a life-threatening condition. It causes an infection in your lungs that makes it difficult to breathe. In adults, pneumonia is the leading cause of death from infection and the eighth the leading cause of death overall. In children, pneumonia is one of the top causes of death worldwide and in developed countries.
The symptoms of pneumonia are similar to other respiratory infections such as a cold or bronchitis: fever, cough, mucus production, body aches and pains, chills, and fatigue. The symptoms differ from the flu, which has more fever and aches as well as muscle pain.
The most important part of pneumonia treatment is to take antibiotics prescribed by a doctor within 24 hours of symptom onset. Without it, your likelihood of recovery declines rapidly. Early antibiotic treatment usually improves the outcome for patients with pneumonia.
In addition to antibiotics, people with pneumonia should take over-the-counter pain relievers for their aches and pains and stay hydrated by drinking plenty of fluids such as water or chicken broth. Drinking juice or soft drinks is OK. Patients are encouraged to get plenty of rest to help the body fight the infection. Patients with more severe infections are likely to need specialized treatment at a hospital.
Complications of pneumonia can include difficulty breathing, dehydration (if fluids are not taken in), and lung damage, including the formation of liquid in the lungs. If these complications occur, your doctor may decide to provide intensive care or may prescribe other medications such as steroids to help control inflammation in the body. In severe cases, people with pneumonia may need to stay in the intensive care unit (ICU) for a short time.
Sample Nursing Care Plan for Pneumonia; Impaired Gas Exchange (Complicated)
A sample nursing care plan for pneumonia is provided in the following section. This nursing care plan is for adults with pneumonia who have symptoms of difficulty breathing or other complications and received prescription antibiotic treatment within 24 hours of symptom onset.
As noted, the main treatment goal for this type of pneumonia is to make sure that patients are getting enough oxygen (called a gas exchange) to the rest of their bodies. This is usually done by providing oxygen through a tube inserted in the nostrils or mouth (called a nasal cannula) if there are no other complications such as respiratory failure.
Other goals for nursing care revolve around preventing and managing complications that occur in most pneumonia patients, such as chest pain, increased heart rate, and difficulty breathing.
Nursing interventions will also include careful monitoring of oxygenation levels in the blood (called arterial blood gases or ABGs) to ensure the patient is getting enough oxygen through their lungs. In addition, nurses may need to monitor the heartbeats per minute (called heart rate), temperature, respiratory status, and urine output to make sure the patient is stable.
Key Nursing Interventions for Complicated Pneumonia
The following list summarizes key intervention points for the care of patients with pneumonia, including those who have received antibiotic treatment within 24 hours of symptom onset.
If the patient has a tracheostomy, check the tracheostomy tube and suction it as needed to keep it clear. If there is purulent drainage (a greenish mucus), suctioning may be done through a catheter inserted in one of the nostrils instead of the tracheostomy tube.
A patient having respiratory failure will be intubated and connected to a mechanical ventilator (breathing machine). If a patient has had surgery for suspected lung abscesses, check that the endotracheal tube is in place every hour or two by asking the health care provider or nurse to listen through a stethoscope for breath sounds and chest wall movement.
For a patient showing signs of increased respiratory effort (tachypnea) where they are breathing faster than normal, check to see if oxygen levels are adequate by measuring arterial blood gases. If not, administer oxygen as ordered by the health care provider or nurse.
If the patient is having chest pain and is doing your initial assessment of lung sounds, listen for crackles in the lungs (called rales), which may be due to fluid around the lungs or pleural effusion. If suspected, consult with the health care provider or nurse before attempting to suction secretions from the chest. If the patient has a productive cough with mucus, also check for possible empyema (large fluid-filled pocket next to lung due to infection) or abscess and consult with the health care provider about draining the area if it is needed.
In case there is evidence of respiratory failure from tachypnea or worsening oxygenation levels, consult with the health care provider or nurse to assess if the patient needs respiratory therapy, such as nebulizer treatment (an aerosol drug delivery system), further oxygen supplementation through either nasal cannula or endotracheal tube (if intubated), chest physiotherapy, or other treatments.
Instruct and assist the patient in deep breathing exercises if respiratory distress is evident.
If the patient has a pleural effusion, they will have an X-ray to assess adequate drainage of fluid from the chest cavity (called thoracentesis). If this is not done immediately but instead ordered for later in the hospital course, you may be asked by a nurse or health care provider to ask the patient questions about their breathing comfort and whether or not they feel like they can take a deep breath.
A patient who develops a fever, along with coughing up mucus, may be due to developing pneumonia. Keep monitoring them for signs of respiratory distress while getting your health care provider’s permission/request to start treatment if needed.
If the patient has a pathological fracture of one of their ribs, and if experiencing shortness of breath or pain on breathing due to this, consult with a health care provider for X-ray imaging to assess whether fusing of the fractured bones is needed.
Monitor oxygen saturation levels and measure pulse oximetry every hour or two to assess if oxygen supplementation is needed.
Contact the hospitalist if the patient does not appear to be improving or has any concerns about their condition.
If suctioning of secretions becomes necessary, follow specific instructions for this procedure from the health care provider, nurse, or respiratory therapist.
Monitor the patient’s fluid intake and output (urine output is measured from a catheter drained every hour or two) to ensure they are adequately hydrated (have enough water in their body), as this may be low due to fluid loss through pulmonary secretions. If deficient, consult the health care provider or nurse about fluid intake orders.
Notify your health care provider or the hospitalist if the patient becomes tachycardic, hypotensive, or if there are urgent changes in heart rate during the day that make you suspect there is a problem with their cardiac status.
If a change in mental status makes you suspect an alteration in hypoxia (oxygen deficiency), consult with a health care provider or nurse about possible seizure activity and what to do if it occurs. Also, check for parkinsonian symptoms and get neurology to consult as needed.
Avoid giving the patient suction medications unless specifically ordered to do so by your health care provider or nurse until you have some experience performing this procedure. Until then, ask your health care provider or nurse if they want you to perform this task. If not explicitly instructed otherwise, use only one nostril for nasal suctioning.
Check with the health care provider or nurse before suctioning the oropharynx if the patient is a trauma victim. This is to avoid dislodging any foreign bodies in there (this can be done by asking the patient to keep their mouth open and using an endoscope if available).
The only suctioning of the trachea is done if there are airway secretions or blood present in the mucus. If this occurs, consult with your health care provider or nurse about obtaining suction equipment and how to use it appropriately. Never attempt to clear blood clots from their airway with a catheter; this must be done by health care personnel.
If a patient has a history of allergic reactions, find out if they have any allergies to medications or anything else that may worsen their condition (e.g., latex products). If so, avoid giving them any medication unless specifically ordered by your health care provider.
How is Pneumonia Treated?
Treatment of pneumonia depends on the severity of symptoms and how quickly treatment is received after symptoms appear. Milder infections usually get better without the need for treatment (and they’re usually easily treated with self-care measures).
In more severe cases, it is important to get medical treatment quickly. Antibiotics are the main treatment for pneumonia. These medications can improve chances of recovery and prevent complications such as infections in other areas of the body (called sepsis) or respiratory failure where breathing becomes difficult.
Most cases of pneumonia can be treated on an outpatient basis, though medical attention may be required if the patient is experiencing severe symptoms or complications. Hospitalization and monitoring are usually necessary for more severe infections such as those caused by a bacterial infection rather than a virus. In rare cases, surgery may be needed to drain fluid from the lungs or remove infected tissue.
In addition to antibiotics, people with pneumonia should take over-the-counter pain relievers for their aches and pains and stay hydrated by drinking plenty of fluids such as water or chicken broth. Drinking juice or soft drinks is OK. Patients are encouraged to get plenty of rest to help the body fight the infection. Patients with more severe infections are likely to need specialized treatment at a hospital.
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