{
  "name": "Pneumonia",
  "slug": "pneumonia",
  "url": "https://nursingplex.com/care-plans/pneumonia",
  "category": "Respiratory",
  "summary": "Lung infection; antibiotics, airway clearance, hydration and oxygenation.",
  "nursing_diagnoses": [
    "Ineffective airway clearance",
    "Impaired gas exchange",
    "Hyperthermia"
  ],
  "overview": [
    "Pneumonia is inflammation of the lung parenchyma from bacteria, viruses, fungi or aspiration of gastric contents. Inflammatory exudate fills the alveoli, so the affected area is perfused but not ventilated — a shunt — and hypoxemia results even with supplemental oxygen. Consolidation is what produces the classic findings of bronchial breath sounds over the periphery, dullness to percussion, increased fremitus and crackles.",
    "Classification matters clinically because it predicts the organism and the drug. Community-acquired pneumonia most often involves Streptococcus pneumoniae; hospital-acquired and ventilator-associated pneumonia begin 48 hours or more after admission or intubation and involve more resistant organisms; aspiration pneumonia follows entry of oropharyngeal or gastric material in patients with impaired swallow, decreased consciousness or tube feeding.",
    "Presentation shifts with age. A young adult shows fever, chills, pleuritic chest pain, productive cough and tachypnea. An older adult may show none of that — the first and sometimes only sign is new confusion, falling, weakness or a low temperature. Any acute mental status change in an older adult should trigger an infection workup that includes the chest."
  ],
  "key_facts": [
    {
      "label": "Diagnostic anchor",
      "text": "Chest x-ray showing infiltrate or consolidation, with sputum and blood cultures obtained before antibiotics whenever possible."
    },
    {
      "label": "Timing rule",
      "text": "Obtain cultures first, then start antibiotics promptly — do not delay the first dose waiting on results."
    },
    {
      "label": "Highest-yield prevention",
      "text": "Pneumococcal and influenza vaccination, hand hygiene, smoking cessation, early mobility, oral care and elevating the head of bed for tube-fed patients."
    },
    {
      "label": "Older adult red flag",
      "text": "New confusion, falls or hypothermia may be the only presentation."
    },
    {
      "label": "Aspiration prevention",
      "text": "Head of bed 30–45 degrees, swallow screening before oral intake, small bites, chin-tuck, upright for 30–60 minutes after meals."
    }
  ],
  "nursing_priorities": [
    "Improve oxygenation and gas exchange.",
    "Mobilize and clear secretions to reopen alveoli.",
    "Eradicate infection and prevent spread and sepsis.",
    "Restore hydration and nutrition.",
    "Manage fever, pleuritic pain and fatigue.",
    "Prevent recurrence, especially aspiration in at-risk patients."
  ],
  "assessment": {
    "subjective": [
      "Cough, productive or dry, and chest pain that worsens with deep breath or cough",
      "Shortness of breath, fatigue, chills, sweats, muscle aches",
      "Loss of appetite, nausea, headache",
      "In older adults, family reports of new confusion, weakness or a fall rather than respiratory complaints"
    ],
    "objective": [
      "Fever or, in older adults, hypothermia; tachycardia; tachypnea; hypotension if septic",
      "Crackles, bronchial breath sounds over lung fields, dullness to percussion, increased tactile fremitus, pleural friction rub",
      "Rust-colored, purulent, green or blood-streaked sputum",
      "Falling oxygen saturation, use of accessory muscles, nasal flaring, cyanosis",
      "Chest x-ray infiltrate; leukocytosis with a left shift; positive sputum or blood culture",
      "Restlessness or confusion from hypoxemia; poor skin turgor and dry mucous membranes from fever and tachypnea"
    ],
    "related_factors": [
      "Alveolar-capillary membrane changes and inflammatory exudate causing shunt",
      "Retained thick secretions and ineffective cough",
      "Impaired swallow, decreased level of consciousness, or enteral feeding permitting aspiration",
      "Immunosuppression, chronic lung disease, smoking, immobility, advanced age",
      "Recent intubation, surgery, or prolonged hospitalization"
    ]
  },
  "goals": [
    "The client will achieve and maintain oxygen saturation at or above the ordered target with a respiratory rate within normal limits and no dyspnea at rest.",
    "The client will demonstrate an effective cough and clearing breath sounds with the ability to expectorate secretions.",
    "The client will remain afebrile with a decreasing white blood cell count and no evidence of sepsis.",
    "The client will maintain adequate hydration with moist mucous membranes and urine output above 30 mL/hr.",
    "The client will report pain controlled well enough to breathe deeply and cough effectively.",
    "The client will describe vaccination, hand hygiene and aspiration precautions before discharge."
  ],
  "interventions": [
    {
      "title": "1. Improving oxygenation",
      "points": [
        "Assess respiratory rate, depth, effort, breath sounds and saturation at least every 4 hours and with any change; increasing rate and restlessness precede a fall in saturation.",
        "Give oxygen as ordered and titrate to the target range, checking for improvement after any position change or airway clearance.",
        "Position upright in semi- or high-Fowler's; if one lung is affected, position with the good lung down to improve perfusion to the better-ventilated side.",
        "Encourage frequent position changes and early ambulation, which reopen dependent alveoli better than any respiratory treatment.",
        "Monitor for confusion, lethargy or agitation as signs of worsening hypoxemia, and monitor for hypotension and rising lactate as signs of progression to sepsis."
      ]
    },
    {
      "title": "2. Clearing the airway",
      "points": [
        "Teach and reinforce deep breathing and incentive spirometry every hour while awake with splinting of the chest for comfort.",
        "Encourage 2–3 liters of fluid daily unless contraindicated to thin secretions and replace fever losses.",
        "Coach controlled coughing after bronchodilator or nebulizer therapy, and use humidification as ordered.",
        "Suction only when the patient cannot clear secretions themselves, preoxygenating and limiting suction passes.",
        "Assess and document sputum color, amount and consistency each shift; collect the specimen before antibiotics when possible and ideally in the morning."
      ]
    },
    {
      "title": "3. Treating and containing infection",
      "points": [
        "Obtain cultures as ordered, then give antibiotics on time; delayed and missed doses drive treatment failure and resistance.",
        "Monitor temperature trends, white blood cell count, and clinical response over 48–72 hours; report a lack of improvement, which may mean a resistant organism or an empyema.",
        "Apply the appropriate isolation precautions and enforce strict hand hygiene among staff and visitors.",
        "Provide oral care at least twice daily — reducing oral bacterial load lowers hospital-acquired pneumonia rates measurably.",
        "Treat fever with antipyretics and light coverings, and monitor fluid status because fever increases insensible loss."
      ]
    },
    {
      "title": "4. Preventing aspiration",
      "points": [
        "Keep the head of the bed elevated 30–45 degrees for anyone receiving enteral feeding or with impaired consciousness.",
        "Screen swallowing before the first oral intake in stroke, dementia and post-extubation patients, and refer to speech therapy when indicated.",
        "Seat the patient fully upright for meals, use small bites and a chin-tuck, avoid straws when ordered, and keep them upright 30–60 minutes afterward.",
        "Check enteral tube placement and residuals per policy and hold feeding as indicated."
      ]
    },
    {
      "title": "5. Comfort, nutrition and energy",
      "points": [
        "Assess pleuritic pain and treat it — a patient who splints out of pain will not deep breathe, and atelectasis follows.",
        "Teach splinting the chest with a pillow when coughing.",
        "Offer small, frequent, high-calorie and high-protein meals with rest before eating; illness and the work of breathing raise metabolic demand.",
        "Cluster care to allow rest, and progress activity gradually as oxygenation improves."
      ]
    }
  ],
  "patient_teaching": [
    "Finish the entire antibiotic course even after you feel better.",
    "Keep doing deep breathing and incentive spirometry at home several times a day for at least the first couple of weeks.",
    "Drink plenty of fluids and rest; full energy often takes several weeks to return.",
    "Call for returning fever, worsening shortness of breath, chest pain, coughing up blood, or confusion.",
    "Get the influenza vaccine every year and the recommended pneumococcal vaccines.",
    "Stop smoking, which paralyzes the cilia that clear your lungs.",
    "Wash hands often, and stay upright during and after meals if you have swallowing problems.",
    "Keep the follow-up appointment and any repeat chest x-ray that is ordered."
  ]
}