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This Concept Map, created with IHMC CmapTools, has information related to: Main Map, Community Aquired Pneumonia ???? Nursing Goals: -Patient will have adequate oxygenation at discharge -Patient will be able to return demonstrate effective coughing and deep breathing exercises at discharge, Community Aquired Pneumonia ???? Risk Factors: Emphysema Smoking Over 65 Diabetes Hypertension, Community Aquired Pneumonia ???? Nursing Interventions: -Provide oxygen therapy to increase O2 levels -Provide at home education for breathing activities such as an incentive spirometer -continue to monitor vitals every 2 hours until regulated -Monitor lab values -Teach effective coughing and body positioning to promote airway clearance, Community Aquired Pneumonia ???? Pathophysiology: Lung infection caused by bacteria, a virus or fungi that causes alveoli to become inflamed and fill up with fluid or pus. This can negatively affect proper gas exchange and can make it hard to promote effective oxygen exchange in blood., Community Aquired Pneumonia ???? Nursing Assessment Findings: Pt. presents with confusion upon assessment 90/50 BP with hypertension 101.5 F Pulse Ox. 85% 28 RPM Diminished breath sounds in right lower lobe Diaphoretic Cyanotic with O2 decrease Using accessory muscles with SOB Weak cough, Community Aquired Pneumonia ???? Nursing Diagnosis: -Ineffective airway clearance related to pneumonia as evidence by weak cough with no sputum production -Ineffective gas exchange related to pneumonia as evidence by low pH, low spo2, and decreased oxygenation.