NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
Diagnosis at a glance
| Code | 00103 |
|---|---|
| Label | Impaired swallowing |
| Spanish label | Deterioro de la deglución |
| Domain | 2. Nutrition |
| Class | 1. Ingestion |
| Type | Problem-focused |
| Status | Current |
What it means
The person has difficulty swallowing. The problem can be in the mouth (forming and pushing the bolus), in the throat (closing off the airway while the bolus passes) or in the esophagus. The main concerns are food going into the lungs and the person not eating enough.
Explanation written by our team. The official definition is in the NANDA-I 2024-2026 book.
When to use it
Clinical situations where it commonly shows up. The diagnosis is confirmed by your assessment, not by the medical diagnosis.
- Every stroke patient before giving anything by mouth, until a swallow screen is completed.
- After extubation, especially after more than 48 hours of intubation.
- Progressive neurological diseases: Parkinson's, ALS, multiple sclerosis, advanced dementia.
- Frail older adults who cough or clear their throat while eating, or who lose weight for no clear reason.
- Head and neck surgery or radiation therapy.
- Patients with a decreased level of consciousness after a seizure or sedation.
What to assess
- Level of consciousness and ability to sit up with the head upright; without this, swallowing is not tested.
- Swallow screen using a validated protocol on your unit (for example, the volume-viscosity swallow test or GUSS) before starting oral intake.
- Signs during and after swallowing: coughing, throat clearing, a wet or “gurgly” voice, watery eyes, color change.
- SpO2 before and during the test: a drop of 3 points or more suggests aspiration.
- Lip closure, tongue movement, drooling, food left in the mouth after swallowing.
- Voluntary cough and cough reflex: if they are weak, aspiration can be silent.
- How long the patient takes to eat, how much is left on the tray, and weight.
- Oral hygiene and the condition of teeth or dentures.
Defining characteristics
Assessment findings that support the diagnosis. They go in the "as evidenced by" part of the statement.
- Coughs or clears the throat during or right after swallowing.
- Voice sounds wet or gurgly after drinking.
- Drools or leaks liquid from the corner of the mouth.
- Pockets food in the mouth or in the cheek on the paralyzed side.
- Needs to swallow several times for the same bite.
- SpO2 drops during meals.
- Takes more than 30 to 40 minutes to eat a normal portion.
- Reports food “getting stuck” in the throat or chest.
- Refuses certain foods or liquids for fear of choking.
- New fever or crackles with no other cause, suggesting previous aspiration.
Related factors
The causes nursing can act on. They go in the "related to" part of the statement.
- Improper position for eating: reclined, head tilted back or no trunk support.
- Food and liquid textures that don't match the patient's ability.
- Large bites or a fast feeding pace.
- Fatigue toward the end of the meal.
- Distraction or talking while eating.
- Poor oral hygiene or ill-fitting dentures.
- Caregiver unfamiliar with safe feeding techniques.
At-risk populations
- People in the acute phase of a stroke.
- Frail or institutionalized older adults.
- Recently extubated patients.
- People with advanced dementia.
- Patients undergoing treatment for head and neck cancer.
Associated conditions
- Stroke.
- Neurodegenerative and neuromuscular diseases.
- Prolonged intubation and tracheostomy.
- Head and neck surgery or radiation therapy.
- Decreased level of consciousness from sedation or a postictal state.
- Esophageal disorders (stricture, achalasia).
How to write it (PES)
Impaired swallowing related to improper positioning during meals and unmodified liquid consistency as evidenced by coughing and wet voice with 10 mL of water, SpO2 drop from 96% to 92%, food pocketed on the paralyzed side of the mouth, and drooling.
Impaired swallowing (00103).
The factors nursing can correct: positioning, texture, pace of feeding, fatigue. The neurological or muscular injury is the associated condition.
The signs you saw during the screen or the meal: coughing, wet voice, SpO2 drop, food left in the mouth, time to eat.
Example written by our team for a fictional patient. Adapt it to your own patient's data. Build your statement with the PES generator.
Goals / expected outcomes
Written in measurable terms: what, how much and by when.
- The patient has no coughing, wet voice or SpO2 drop of 3 points or more during meals with the ordered texture, starting at 48 hours.
- Eats at least 75% of each meal on the modified diet throughout the hospital stay.
- Maintains a temperature below 38 °C (100.4 °F) and lung fields without new crackles during the stay.
- The caregiver demonstrates correct positioning, bite size and texture before discharge.
Nursing interventions and rationales
| Intervention | Rationale |
|---|---|
| Keep the stroke patient NPO until the swallow screen is completed, including oral medications. | Aspiration in the first hours is common and can be silent; the screen identifies who can eat safely. |
| Sit the patient at 90° (or as upright as possible) for meals and keep them upright for 30 minutes afterward. | Gravity helps the bolus move and reduces reflux toward the airway. |
| Provide the food and liquid texture ordered after the evaluation (for example, IDDSI levels) and check it on every tray. | Thin liquids are the hardest to control; thickening them gives the patient time to close the airway. |
| Give small bites (one teaspoon), wait for a complete swallow and check the mouth before the next one. | Keeps food from building up and entering the airway. |
| Cue the patient to tuck the chin toward the chest when swallowing, if speech-language pathology recommended it. | This posture protects the airway in many patients, but not all; that is why it depends on the evaluation. |
| Place food on the unaffected side of the mouth in patients with hemiparesis. | Takes advantage of the preserved sensation and strength. |
| Monitor SpO2, coughing and voice during meals, and stop the meal if signs of aspiration appear. | Catching it early prevents pneumonia. |
| Provide oral care after every meal and at least twice a day for patients who are NPO. | Lowers the bacterial load that reaches the lungs if aspiration occurs. |
| Request an evaluation by speech-language pathology or your unit's swallowing specialist, and by the dietitian if intake is low. | They determine the safe texture, the exercises and whether an alternative feeding route is needed. |
NOC outcomes and NIC interventions
Outcomes (NOC) and interventions (NIC) that published sources link to this diagnosis. Pick the ones that fit your patient.
NOC outcomes
- 1010Swallowing Status
- 0303Self-Care: Eating
- 1918Aspiration Prevention
NIC interventions
- 1860Swallowing Therapy
- 1803Self-Care Assistance: Feeding
- 3200Aspiration Precautions
Linkages drawn from care plans published by health services, universities and nursing journals. Labels may vary depending on the NIC and NOC edition your facility uses.
Case study: Dysphagia in the first hours after a stroke
Patient. A 74-year-old woman with atrial fibrillation comes to the ED with left-sided hemiparesis and slurred speech that started 6 hours earlier; she is diagnosed with an ischemic stroke.
Assessment
- GCS 15; sits upright with support.
- Screen with 5 mL of water: swallows without coughing. With 10 mL: immediate cough and wet voice.
- Baseline SpO2 96%; drops to 92% after the 10 mL sip.
- Drooling from the left corner of the mouth and liquid pocketed in the left cheek.
- Weak voluntary cough.
- Temperature 36.8 °C (98.2 °F); lungs clear.
- Her son wanted to give her juice because “she's thirsty.”
Nursing diagnosis
Impaired swallowing related to unmodified liquid consistency and improper positioning for oral intake as evidenced by coughing and wet voice with 10 mL of water, SpO2 drop from 96% to 92%, and liquid pocketed in the left cheek, in a patient with ischemic stroke (associated condition).
Goal
The patient will tolerate the diet at the ordered texture without coughing, wet voice or an SpO2 drop of 3 points or more by 48 hours.
Interventions
- Keep her NPO and notify the provider of the screen result.
- Post an “NPO” sign and explain the reason to her son.
- Request a swallowing evaluation by speech-language pathology.
- When the diet starts, sit her at 90° and give thickened liquids by teaspoon on the right side.
- Oral care every 8 hours and after every meal.
- Monitor temperature, SpO2 and breath sounds every shift.
Evaluation
At 48 hours she eats pureed food and drinks thickened liquids without coughing or SpO2 drops, and finishes 80% of her tray. She still coughs with thin water. The diagnosis remains active; she will be reevaluated by speech-language pathology before discharge.
How it differs from similar diagnoses
- Risk for aspiration (00039): Use it when there is a risk of secretions or food entering the airway, with or without a swallowing problem. The two often coexist: impaired swallowing is one of its risk factors.
- Inadequate nutritional intake (00343): Focuses on intake that does not meet the person's needs. It can result from dysphagia, but also from poor appetite or lack of access to food.
- Ineffective infant suck-swallow response (00295): Specific to infants who cannot coordinate sucking, swallowing and breathing during feeding.
Common mistakes
- Giving water “just to see” without a screening protocol and without measuring SpO2.
- Assuming that a patient with a gag reflex swallows safely: its presence does not rule out aspiration.
- Thickening only the meals and forgetting the water used for medications.
- Feeding the patient lying down or in a hurry because of workload.
- Writing “related to stroke” without a factor nursing can modify.
Used in these conditions
Other diagnoses in the Ingestion class
Domain 2, Nutrition. See every diagnosis in this domain.
Frequently asked questions
What is the NANDA code for impaired swallowing?
00103. It belongs to Domain 2 (Nutrition), Class 1 (Ingestion), and is still current in the 2024-2026 edition.
Is impaired swallowing the same as dysphagia?
In practice, yes: dysphagia is the medical term, and impaired swallowing is the nursing diagnosis that describes the person's response.
Can I use impaired swallowing and risk for aspiration together?
You can, if you justify both. Many instructors prefer impaired swallowing as the priority diagnosis, with preventing aspiration as a goal within its plan.
What is silent aspiration?
Food entering the airway without triggering a cough. It is common after a stroke, which is why you monitor SpO2, voice and temperature, not just coughing.
Who decides the diet texture?
The team, based on the swallowing evaluation. Nursing performs the screen according to protocol, monitors tolerance and reports any signs of aspiration.
Study material: the explanation, characteristics, factors, examples and case study on this page were written by our editorial team. The official text for Impaired swallowing (00103) is in NANDA International Nursing Diagnoses: Definitions and Classification 2024-2026. This page does not replace clinical judgment or your facility's protocols.
Classification sources: NANDA-I 2024-2026, Thieme supplement · Elsevier summary of changes · Spanish edition table of contents · NOC/NIC: source 1, source 2. Reviewed November 2, 2026.