Nursing Care Plan Pneumonia

CARE SETTING

Most patients are treated as outpatients; however, persons at higher risk (e.g., with ongoing/chronic health problems) are treated in the hospital, as are those already hospitalized for other reasons.

RELATED CONCERNS

1. AIDS
2. Chronic obstructive pulmonary disease (COPD) and asthma
3. Psychosocial aspects of care
4. Sepsis/septicemia
5. Surgical intervention
6. Patient Assessment Database

ACTIVITY/REST

May report: 

1. Fatigue, weakness
2. Insomnia

May exhibit: 

1. Lethargy
2. Decreased tolerance to activity

CIRCULATION

May report: 
History of recent/chronic heart failure (HF)

May exhibit: 
Tachycardia

Flushed appearance or pallor

EGO INTEGRITY

May report: 
Multiple stressors, financial concerns

FOOD/FLUID

May report: 
Loss of appetite, nausea/vomiting

May exhibit: 

1. Distended abdomen
2. Hyperactive bowel sounds
3. Dry skin with poor turgor
4. Cachectic appearance (malnutrition)

NEUROSENSORY

May report: 
Frontal headache (influenza)

May exhibit: 
Changes in mentation (confusion, somnolence)

PAIN/DISCOMFORT

May report: 

1. Headache
2. Chest pain (pleuritic), aggravated by cough; substernal chest pain (influenza)
3. Myalgia, arthralgia

May exhibit: 
Splinting/guarding over affected area (patient commonly lies on affected side to restrict movement)

RESPIRATION

May report: 

1. History of recurrent/chronic URIs, tuberculosis or COPD, cigarette smoking
2. Progressive dyspnea
3. Cough: Dry hacking (initially) progressing to productive cough

May exhibit: 

1. Tachypnea; shallow grunting respirations, use of accessory muscles, nasal flaring
2. Sputum: Scanty or copious; pink, rusty, or purulent (green, yellow, or white)
3. Percussion: Dull over consolidated areas
4. Fremitus: Tactile and vocal, gradually increases with consolidation
5. Pleural friction rub
6. Breath sounds: Diminished or absent over involved area, or bronchial breath sounds over area(s) of consolidation; coarse inspiratory crackles
7. Color: Pallor or cyanosis of lips/nailbeds

SAFETY

May report: 

1. Recurrent chills
2. History of altered immune system: i.e., systemic lupus erythematosus (SLE), AIDS, steroid or chemotherapy use, institutionalization, general debilitation
3. Fever (e.g., 1028F–1048F/398C–408C)
4. May exhibit: Diaphoresis
5. Shaking
6. Rash may be noted in cases of rubeola or varicella

TEACHING/LEARNING

May report: 

1. History of recent surgery; chronic alcohol use; intravenous (IV) drug therapy or abuse; immunosuppressive therapy
2. Discharge plan
3. DRG projected mean length of inpatient stay: 4.3–8.3 days
4. Assistance with self-care, homemaker tasks.
5. Oxygen may be needed, especially if recovery is prolonged or other predisposing condition exists.
6. Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES

1. Chest x-ray: Identifies structural distribution (e.g., lobar, bronchial); may also reveal multiple abscesses/infiltrates, empyema (staphylococcus); scattered or localized infiltration (bacterial); or diffuse/extensive nodular infiltrates (more often viral). In mycoplasmal pneumonia, chest x-ray may be clear.
2. Fiberoptic bronchoscopy: May be both diagnostic (qualitative cultures) and therapeutic (re-expansion of lung segment).
3. ABGs/pulse oximetry: Abnormalities may be present, depending on extent of lung involvement and underlying lung disease.
4. Gram stain/cultures: Sputum collection; needle aspiration of empyema, pleural, and transtracheal or transthoracic fluids; lung biopsies and blood cultures may be done to recover causative organism. More than one type of organism may be present; common bacteria include Diplococcus pneumoniae, Staphylococcus aureus, ahemolytic streptococcus, Haemophilus influenzae; cytomegalovirus (CMV). Note: Sputum cultures may not identify all offending organisms. Blood cultures may show transient bacteremia.
5. CBC: Leukocytosis usually present, although a low white blood cell (WBC) count may be present in viral infection, immunosuppressed conditions such as AIDS, and overwhelming bacterial pneumonia. Erythrocyte sedimentation rate (ESR) is elevated.
6. Serologic studies, e.g., viral or Legionella titers, cold agglutinins: Assist in differential diagnosis of specific organism.
7. Pulmonary function studies: Volumes may be decreased (congestion and alveolar collapse); airway pressure may be increased and compliance decreased. Shunting is present (hypoxemia).
8. Electrolytes: Sodium and chloride levels may be low.
9. Bilirubin: May be increased.
10. Percutaneous aspiration/open biopsy of lung tissues: May reveal typical intranuclear and cytoplasmic inclusions
11. (CMV), characteristic giant cells (rubeola).

NURSING PRIORITIES

1. Maintain/improve respiratory function.
2. Prevent complications.
3. Support recuperative process.
4. Provide information about disease process/prognosis and treatment.

DISCHARGE GOALS

1. Ventilation and oxygenation adequate for individual needs.
2. Complications prevented/minimized.
3. Disease process/prognosis and therapeutic regimen understood.
4. Lifestyle changes identified/initiated to prevent recurrence.
5. Plan in place to meet needs after discharge.