Pneumonia is an infection of the lung tissue that fills the air sacs (alveoli) with fluid and pus, making it hard to breathe and get oxygen into the blood. WHO identifies pneumonia as the single largest infectious cause of death in children worldwide, and it is a leading cause of hospital admission and death in older adults. This care plan focuses on adults with community-acquired pneumonia.
Assessment
- Symptoms: cough (often productive of yellow, green or rusty sputum), fever, chills, breathlessness, pleuritic chest pain (sharp, worse on breathing in), tiredness. Older adults may present with confusion or falls rather than fever.
- Vital signs: raised respiratory rate (often the earliest sign), low SpOâ‚‚, fast heart rate, fever, low BP in severe cases. Calculate NEWS2.
- Chest: reduced breath sounds, crackles, bronchial breathing, dullness to percussion over the affected area.
- Hydration and nutrition, mobility, skin.
- Investigations as requested: chest X-ray, blood tests (FBC, CRP, urea and electrolytes), blood and sputum cultures, blood gas if SpOâ‚‚ low.
Severity: CURB-65
One point for each:
- Confusion (new).
- Urea above 7 mmol/L.
- Respiratory rate 30 or more.
- Blood pressure: systolic below 90 or diastolic 60 or below.
- Age 65 or older.
Score 0–1: low severity, often treated at home. Score 2: moderate, consider hospital. Score 3–5: high severity, hospital care, consider critical care. CRB-65 (without urea) is used where blood tests are not available. Clinical judgement always applies.
Nursing diagnoses
- Impaired gas exchange related to fluid-filled alveoli, as evidenced by SpOâ‚‚ 89% on air and RR 28.
- Ineffective airway clearance related to thick secretions and weak cough.
- Hyperthermia related to infection.
- Risk for deficient fluid volume related to fever, fast breathing and poor intake.
- Activity intolerance related to breathlessness and fatigue.
- Acute pain related to pleural inflammation.
Goals
- SpOâ‚‚ within target range and RR below 20 within 72 hours.
- Temperature normal within 48–72 hours.
- Patient able to clear secretions and mobilise to the toilet independently before discharge.
Interventions
Breathing and oxygen
- Sit upright (high Fowler’s position) to improve lung expansion.
- Oxygen as prescribed to target 94–98% (88–92% if at risk of hypercapnic respiratory failure). Humidify if high flow is used for long periods.
- Deep breathing and coughing exercises; incentive spirometry where available; early physiotherapy.
- Suction only if the patient cannot clear secretions.
Antibiotics
- Give the first dose promptly: NICE recommends within 4 hours of diagnosis, and within 1 hour if sepsis is suspected. See our sepsis guide.
- Take cultures before antibiotics where this doesn’t cause delay.
- Check allergies; watch for reactions.
- Switch from IV to oral when the patient improves and can swallow, as prescribed.
Fever, hydration and comfort
- Paracetamol for fever and pleuritic pain as prescribed.
- Encourage oral fluids; IV fluids as prescribed; fluid balance chart; watch for overload in older or cardiac patients.
- Mouth care; small frequent meals; nutritional support.
Preventing complications
- Watch for sepsis, respiratory failure (rising RR, falling SpOâ‚‚, drowsiness), pleural effusion or empyema (persistent fever, worsening pain).
- Early mobilisation to prevent clots and deconditioning; VTE prophylaxis as prescribed.
- Pressure area care for frail patients.
- Aspiration risk: in patients with stroke, reduced consciousness or swallowing problems, swallow screening and correct positioning for meals.
Evaluation and discharge
- Review observations and goals daily; adjust the plan.
- Explain that tiredness and cough may last several weeks; sputum should lessen; chest pain and fever should settle within about a week.
- Complete the antibiotic course.
- Return if breathlessness worsens, fever returns, or they cough blood.
- Prevention: stop smoking, reduce indoor smoke from cooking fires, and get pneumococcal and influenza vaccines where recommended.
Related: The nursing process · Normal vital signs · Acute asthma
Based on NICE guidance on pneumonia in adults (NG250/CG191), British Thoracic Society guidance and WHO pneumonia information. Educational content: follow your local guidelines.