Nursing care
Nursing care plan for pneumonia: ranked problems, goals, interventions and rationales
Written and reviewed by Rachel Goldberg, MSN, RN, CEN · 5 min read · Updated November 2026
Short answer
A nursing care plan for pneumonia ranks impaired gas exchange first, then ineffective airway clearance, then the risk of sepsis, then fluid and activity problems. That order follows airway, breathing and circulation. Goals use numbers you can check, such as oxygen saturation on the prescribed target, clearer breath sounds and a safe walk to the bathroom.
Pneumonia care plan table: five problems in priority order
Use this table as the core of a pneumonia assignment. NANDA-I is the source taxonomy for the labels, and exact wording varies by edition, so adjust to your program. Interventions are nursing actions; antibiotic choice and oxygen orders come from the prescriber.
| Nursing diagnosis or problem | Goal or outcome | Nursing interventions | Rationale |
|---|---|---|---|
| 1. Impaired gas exchange related to fluid-filled alveoli | Oxygen saturation stays within the prescribed target range and respiratory rate eases toward baseline within 24 hours | Monitor saturation, rate and work of breathing, raise head of bed, apply oxygen as ordered, report rising rate or new confusion | Consolidated alveoli cannot exchange gas, so hypoxemia shows first in rate, effort and mental status |
| 2. Ineffective airway clearance related to thick secretions and weak cough | Client coughs up secretions and breath sounds over the affected area improve by day 2 | Coach deep breaths 2 to 3 times an hour, encourage coughing, sit client upright, assist with chest tapping if ordered | Moving mucus out opens airways and gives the lungs more surface for gas exchange |
| 3. Risk for shock related to infection that may progress to sepsis | Blood pressure, heart rate and mental status stay at baseline; changes reported within the shift | Trend vital signs, watch for falling systolic pressure, new confusion, low urine output; collect ordered cultures | Severe pneumonia can progress to sepsis, and confusion and low systolic pressure are also severity markers |
| 4. Risk for deficient fluid volume related to fever, fast breathing and poor intake | Intake meets the target set with the prescriber and urine output stays adequate | Track intake and output, offer fluids the client will drink, report dark scant urine | Fever and rapid breathing raise fluid loss, and dry secretions are harder to cough up |
| 5. Activity intolerance related to hypoxemia and fatigue | Client walks to the bathroom with saturation staying in range by discharge | Cluster care, plan rest, mobilize early in short walks, check saturation during activity | Early mobilization is part of supportive care and lowers clot and deconditioning risk |
If your school requires three problems only, keep the top three. They cover breathing, the airway and circulation, which is the reasoning examiners look for.
Why gas exchange outranks airway clearance
Students often put airway clearance first because "airway" comes first in ABC. In most pneumonia clients the airway itself is open; the problem is oxygen crossing filled alveoli. Low saturation, a fast rate and new confusion are the gas exchange cues, and they threaten the brain sooner than retained sputum does. If a client truly cannot clear secretions and is obstructing, airway clearance moves to the top.
Sepsis risk ranks third rather than last because it can turn a stable ward client into an unstable one within hours. MSD Manuals lists sepsis among the severe complications, along with pleural effusion and empyema. A temperature that settles and then returns, or pleuritic pain that worsens, should prompt a report rather than another antipyretic.
Assessment cues and CURB-65 as a nursing early warning
MSD Manuals lists fever, cough, sputum, pleuritic chest pain, dyspnea, a fast respiratory rate and a fast heart rate as the usual picture, with crackles, bronchial breath sounds and dullness to percussion on exam. It also notes that older adults may have only a dry cough or few signs, so new confusion can be the first clue.
CURB-65 is a physician tool for deciding where a client is treated, but every item except the BUN is something a nurse measures. One point each goes to confusion, a BUN of 19 mg/dL or more, a respiratory rate over 30, a systolic pressure under 90 (or a diastolic of 60 or less) and age 65 or older. A score of 3 or more points toward hospital care and ICU review. When a ward client newly develops confusion and a rate over 30, the nurse is watching that score climb in real time.
Worked example: a diagnostic statement and SMART goals
Hypothetical client for practice: a 72-year-old woman on day 1 of admission with right lower lobe pneumonia, saturation just below her target on oxygen, respiratory rate 28, crackles at the right base and new difficulty following directions.
Diagnostic statement: Impaired gas exchange related to consolidation of the right lower lobe, as evidenced by saturation below target, respiratory rate of 28 and new confusion. SMART goal: by the end of the shift, saturation stays within the prescribed range at rest and the client is oriented to person, place and time. A second goal for airway clearance: by day 2, the client coughs up secretions after deep breathing and crackles at the right base decrease.
A common wrong answer to "what first?" for this client is to teach the incentive spirometer. Teaching can wait; a confused, hypoxemic client needs positioning, oxygen as ordered and a report to the provider first.
Evaluation and discharge teaching tied to the plan
Evaluate each goal against the client's numbers and behavior. If saturation drops every time she walks, activity intolerance is not resolved, even if resting values look fine. Write "goal partially met" with the data, and revise rather than restating the same goal.
MedlinePlus discharge guidance gives clients clear reasons to call for help: breathing that is harder, faster or shallower, chest pain with deep breaths, new sleepiness or confusion, fever that returns, coughing up dark mucus or blood, and blue fingertips. Ask the client to repeat these back. It also advises plenty of fluids, rest and deep breathing several times an hour at home.
Sources and further reading
MSD Manual Professional Version: Community-Acquired Pneumonia. Signs and symptoms, atypical presentation in older adults, CURB-65 items and score bands, supportive care including early mobilization, cultures, sepsis, effusion and empyema.
MedlinePlus: Pneumonia in adults, discharge. Deep breathing 2 to 3 times an hour, coughing and chest tapping, fluids, rest, and warning signs that need a call to the provider or 911.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our respiratory practice questions are the closest set to what this page covers.
Common questions
What is the priority nursing diagnosis for pneumonia?
Impaired gas exchange is usually the priority, because fluid in the alveoli lowers oxygen reaching the blood. Ineffective airway clearance moves to the top when thick secretions are blocking the airway and the client cannot cough them out.
What are SMART goals for a patient with pneumonia?
Measurable, timed outcomes such as: saturation within the prescribed range at rest by end of shift; coughs up secretions and crackles decrease by day 2; walks to the bathroom with saturation in range before discharge; repeats four warning signs that mean call for help.
What are nursing interventions for pneumonia?
Monitor saturation, rate and mental status, position upright, give oxygen and antibiotics as ordered, coach deep breathing and coughing, collect ordered cultures, track fluids, mobilize early and teach discharge warning signs.