Quick Answer
Priority CAP diagnoses: impaired gas exchange → ineffective airway clearance → hyperthermia → activity intolerance → risk for deficient fluid volume. Empiric antibiotics within 4 h (beta-lactam + macrolide, or fluoroquinolone), O₂ to SpO₂ 92–96%, 'good lung down' positioning, incentive spirometry q1h, early ambulation. Minimum 5-day antibiotic course; afebrile 48 h before stopping.
Assessment
Subjective: productive cough, purulent sputum, pleuritic chest pain, dyspnea, chills.
Objective: temp > 38 °C, HR > 100, RR > 22, SpO₂ ↓, crackles/bronchial breath sounds, dullness to percussion, CXR infiltrate, WBC ↑, CURB-65 ≥ 2.
Priority NANDA-I diagnoses
- Impaired gas exchange AEB SpO₂ 89%, PaO₂ 62.
- Ineffective airway clearance AEB weak cough, coarse crackles.
- Hyperthermia.
- Activity intolerance.
- Risk for deficient fluid volume.
NOC outcomes
- SpO₂ ≥ 92% on ≤ 2 L NC within 24 h.
- Afebrile within 72 h of antibiotic initiation.
- Patient mobilizes secretions and demonstrates incentive-spirometer use.
- Ambulates ≥ 100 ft before discharge.
NIC interventions and rationale (IDSA/ATS 2019)
- Empiric antibiotics within 4 h — beta-lactam + macrolide (or respiratory fluoroquinolone) for inpatient CAP; add MRSA/Pseudomonas coverage if risk factors.
- O₂ to SpO₂ 92–96% — avoid hyperoxia in COPD overlap.
- "Good lung down" positioning — improves V/Q matching.
- Incentive spirometry q1h; cough and deep breathe — reduces atelectasis.
- Adequate hydration + mucolytics.
- Early ambulation — reduces LOS and VTE risk.
- Antipyretics as needed.
- Discharge vaccinations: pneumococcal, influenza, COVID-19.
Evaluation
Day 3: afebrile, SpO₂ 96% RA, WBC normalized, clear cough. Discharge on 5–7 day oral antibiotic course.