NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
Diagnosis at a glance
| Code | 00031 |
|---|---|
| Label | Ineffective airway clearance |
| Spanish label | Limpieza ineficaz de las vías aéreas |
| Domain | 11. Safety / protection |
| Class | 2. Physical injury |
| Type | Problem-focused |
| Status | Current |
What it means
The patient can't keep the airway open because they can't expel secretions or whatever is blocking it. The cough is too weak or absent, mucus builds up and air moves with difficulty.
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.
- Pneumonia, bronchitis and COPD with excess mucus.
- Postoperative pain that keeps the patient from coughing well.
- Patients with a tracheostomy or who are intubated.
- Weakness, sedation or altered level of consciousness.
- Dehydration that thickens secretions.
- Infants with bronchiolitis and heavy nasal congestion.
What to assess
- Cough: whether it is productive, whether it clears secretions, and its strength.
- Secretions: amount, color, consistency and odor.
- Breath sounds: crackles, rhonchi, wheezes, areas of diminished breath sounds.
- Respiratory rate, saturation and work of breathing.
- Hydration and level of consciousness.
- Pain with coughing on a numeric scale.
- Ability to swallow and protect the airway.
- Temperature: fever and a change in sputum color may point to infection.
Defining characteristics
Assessment findings that support the diagnosis. They go in the "as evidenced by" part of the statement.
- Weak or absent cough, or a cough that doesn't bring up secretions.
- Copious or thick secretions, or secretions you can hear in the throat.
- Rhonchi, crackles or wheezes on auscultation.
- Diminished breath sounds in one area.
- Increased respiratory rate or irregular rhythm.
- Dyspnea or a choking sensation that improves after coughing or suctioning.
- Saturation that drops and then improves after secretions are cleared or suctioned.
- Difficulty speaking because of mucus.
- Restlessness or anxiety from not being able to breathe well.
- In patients with an artificial airway, rising pressures or ventilator alarms from secretions.
Related factors
The causes nursing can act on. They go in the "related to" part of the statement.
- Thick secretions from low fluid intake or very dry air.
- Incisional or chest pain that prevents a forceful cough.
- Incorrect or unknown coughing technique.
- Fatigue or respiratory muscle weakness.
- Immobility and staying in the same position.
- Exposure to tobacco smoke.
- Fear that the incision will open when coughing.
At-risk populations
- Older adults and debilitated patients.
- Patients recovering from thoracic or upper abdominal surgery.
- Current smokers.
- Infants with respiratory infections.
- People with altered level of consciousness or impaired swallowing.
- Patients with a tracheostomy or endotracheal tube.
Associated conditions
- Pneumonia and bronchitis.
- COPD, bronchiectasis and cystic fibrosis.
- Asthma.
- Neuromuscular diseases such as ALS or muscular dystrophy.
- Stroke with weak cough or dysphagia.
- Artificial airway: endotracheal tube or tracheostomy tube.
How to write it (PES)
Ineffective airway clearance related to thick secretions and incisional pain with coughing as evidenced by a weak cough that does not clear secretions, bilateral basilar rhonchi and SpO2 of 91%.
Ineffective airway clearance (00031).
What keeps the airway from clearing that nursing can modify: thick secretions, pain, weakness, poor coughing technique.
Characteristics of the cough and secretions, breath sounds and oxygenation values.
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.
- Patient clears secretions with an effective cough within 24 hours.
- Rhonchi decrease on auscultation by day 2.
- Patient maintains oxygen saturation at target.
- Patient reports pain of 3/10 or less when coughing after analgesia.
- Patient demonstrates assisted coughing while splinting the incision with a pillow.
Nursing interventions and rationales
| Intervention | Rationale |
|---|---|
| Auscultate lung fields every shift and before and after airway clearance techniques. | Shows whether secretions are moving. |
| Teach effective coughing: deep breath, hold, then two or three coughs. | Increases the force available to expel secretions. |
| Encourage fluid intake unless restricted. | Secretions thin out and come up more easily. |
| Position the patient sitting or semi-sitting and reposition frequently. | Promotes drainage and lung expansion. |
| Manage pain before coughing exercises and chest physiotherapy. | Coughing is more effective without pain. |
| Teach the patient to splint the incision with a pillow when coughing. | Reduces pain and the fear that the incision will open. |
| Suction only when needed, using sterile technique for artificial airways. | Prevents mucosal injury, hypoxia and infection. |
| Give prescribed nebulizer treatments or mucolytics. | Help loosen and thin secretions. |
| Document the amount and appearance of secretions every shift. | A change in color or amount may be the first sign of infection. |
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
- 0410Respiratory Status: Airway Patency
- 0802Vital Signs
- 0703Infection Severity
NIC interventions
- 3140Airway Management
- 3316Nasal Irrigation
- 3350Respiratory Monitoring
- 6680Vital Signs Monitoring
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: Post-laparotomy patient
Patient. Laura, 58, a smoker, is on postoperative day 1 after a laparotomy for bowel obstruction. She barely coughs because her incision hurts, and she has had little to drink.
Assessment
- Weak, shallow cough; she does not bring up secretions.
- Bilateral basilar rhonchi.
- SpO2 91% on room air and RR 24 breaths/min.
- Incisional pain of 7/10 when she tries to cough.
- Thick, whitish secretions.
- Fluid intake of 400 mL in 12 hours.
- Temperature 37.6 °C (99.7 °F).
Nursing diagnosis
Ineffective airway clearance related to thick secretions from low fluid intake and incisional pain with coughing as evidenced by a weak cough that does not clear secretions, bilateral basilar rhonchi, RR of 24 breaths/min and SpO2 of 91%.
Goal
Within 24 hours, Laura clears her secretions with an effective cough and maintains an SpO2 of 94% or higher.
Interventions
- Give prescribed analgesia 30 minutes before breathing exercises.
- Teach effective coughing while splinting the incision with a pillow.
- Offer oral fluids or adjust IV fluids with the provider.
- Get her up to the chair and reposition every 2 hours.
- Auscultate before and after coughing and document secretions.
Evaluation
At 24 hours she is bringing up thinner whitish secretions, the rhonchi have decreased and SpO2 is 95%. The diagnosis stays active one more day to confirm she keeps coughing effectively without help.
How it differs from similar diagnoses
- Ineffective breathing pattern (00032): Ineffective breathing pattern: the mechanics are the problem, with no secretions required.
- Impaired gas exchange (00030): Impaired gas exchange: the problem is oxygenation at the alveolus.
- Risk for aspiration (00039): Risk for aspiration: the concern is secretions, food or fluids entering the airway.
Common mistakes
- Confusing it with ineffective breathing pattern when the problem is secretions.
- Writing the evidence without describing the cough or the breath sounds.
- Suctioning on a routine schedule instead of as needed.
- Writing "related to pneumonia": pneumonia is the condition; the related factor is, for example, thick secretions or pain with coughing.
Assessment scales
Used in these conditions
Other diagnoses in the Physical injury class
Domain 11, Safety / protection. See every diagnosis in this domain.
Frequently asked questions
What is the NANDA code for ineffective airway clearance?
00031, in Domain 11 (Safety/protection), Class 2 (Physical injury). It is still current in the 2024-2026 edition.
Why is ineffective airway clearance under Safety/protection and not a respiratory domain?
The taxonomy classifies it as an airway protection problem, alongside risk for aspiration.
Can I use it for a patient with a tracheostomy?
Yes, when the patient can't keep the airway clear of secretions on their own.
How long should each suction pass last?
Each pass of the catheter should be short, generally no more than 10 to 15 seconds, with oxygenation before and after per protocol.
When do I resolve this diagnosis?
When the patient clears secretions independently, breath sounds improve and saturation stays at target.
Study material: the explanation, characteristics, factors, examples and case study on this page were written by our editorial team. The official text for Ineffective airway clearance (00031) 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. Reviewed November 2, 2026.