Reduced ability to clear secretions or obstructions from the respiratory tract to maintain airflow

• Excessive mucus
• Exposure to harmful substance
• Fear of pain
• Foreign body in airway
• Inadequate fluid volume
• Inattentive to second-hand smoke
• Mucus plug
• Retained secretions
• Thick sputum
• Tobacco use

• Congenital heart diseases
• Critical illness
• Exudate in the alveoli
• General anesthesia
• Neuromuscular diseases
• Respiratory tract diseases
• Stroke
• Swallowing disorders

• History of present illness
• Patient's ability to clear airway
• Knowledge of physical condition
• Neurologic status, including level of consciousness, orientation, and sensory and motor status
• Respiratory status, including symmetry of chest expansion; use of accessory muscles; cough (productive or nonproductive); respiratory rate, depth, and pattern; sputum characteristics; palpation for fremitus; percussion of lung fields; auscultation for breath sounds; pulse oximetry; chest x-ray; arterial blood gas (ABG) values; and hemoglobin level and hematocrit; pulmonary function studies
• Psychosocial status, including interest, motivation, and knowledge

• Adventitious respiratory sounds
• Altered respiratory rhythm
• Altered thoracic percussion
• Altered thoraco-vocal fremitus
• Bradypnea
• Cyanosis
• Difficulty verbalizing
• Diminished respiratory sounds
• Excessive sputum
• Excessive use of accessory respiratory muscles
• Hypoxemia
• Inability to clear nasal passages
• Inability to cough
• Ineffective cough
• Nasal flaring
• Orthopnea
• Psychomotor agitation
• Subcostal retraction
• Tachypnea

• Airway will remain patent.
• Adventitious breath sounds (crackles, rhonchi, wheezes, or stridor) will be absent.
• Chest x-ray will show no abnormality.
• Oxygen level will be in normal range.
• Patient will breathe deeply and cough to remove secretions.
• Patient will expectorate sputum.
• Patient will demonstrate controlled coughing techniques.
• Ventilation will be adequate.
• Patient will demonstrate skill in conserving energy while attempting to clear airway.
• Patient will state understanding of changes needed to diminish oxygen demands.

Suggested NOC Outcomes

• Assess respiratory status at least every 4 hours or according to established standards. Obstruction in the airway leads to atelectasis, pneumonia, or respiratory failure.
• Turn patient every 2 hours. Always position for maximal aeration of lung fields and mobilization of secretions. This prevents pooling and stasis of respiratory secretions.
• Mobilize patient to full capabilities to facilitate chest expansion and ventilation.
• Avoid placing patient in supine position for extended periods. Encourage lateral, sitting, prone, and upright positions as much as possible to enhance lung expansion and ventilation.
• When helping patient cough and deep breathe, use whatever position best ensures cooperation and minimizes energy expenditure, such as raising the head of the bed or sitting on side of bed. Such positions promote chest expansion and ventilation of basilar lung fields.
• Suction, as ordered, to stimulate cough and clear airways. Be alert for progression of airway compromise. Maintaining a patent airway will prevent respiratory distress.
• Perform postural drainage, percussion, and vibration to facilitate secretion movement. Monitor sputum, noting amount, odor, and consistency. Sputum amount and consistency are indicators of hydration status and effectiveness of therapy. Foul-smelling sputum may indicate respiratory infection.
• Teach patient an easily performed cough technique to clear airway without fatigue.
• Provide adequate humidification to loosen secretions.
• Encourage adequate water intake (3 to 4 L/day) to ensure optimal hydration and loosening of secretions, unless contraindicated.
• Encourage sputum expectoration to remove pathogens and prevent spread of infection. Provide tissues and paper bags for hygienic disposal to prevent spread of infection.
• Give expectorants, bronchodilators, and other drugs, as ordered, and monitor effectiveness. These measures enhance clearance of secretions from airways.
• Provide bronchodilator treatments before chest physical therapy to optimize results of the treatment.
• Administer oxygen, as ordered, to promote oxygenation of cells throughout the body.
• Monitor ABG values and hemoglobin levels to assess oxygenation and ventilatory status. Report deviations from baseline levels; oxygen saturation should be higher than 90%.
• If conservative measures fail to maintain partial pressure of arterial oxygen (Pao₂) within an acceptable range, prepare for endotracheal intubation, as ordered, to maintain artificial airway and optimize Pao₂ level.
• Assess patient's learning needs and provide appropriate information to help prevent recurrence of obstruction and promote change in daily activities to reduce oxygen demands.

Suggested NIC Interventions

• Patient's airway remains clear and allows for adequate ventilation.
• Auscultation of patient's lung fields reveals no adventitious breath sounds.
• Patient's chest x-ray is normal.
• Patient's oxygen level remains within normal range.
• Patient coughs and deep breathes to expectorate secretions.
• Patient expectorates sputum.
• Patient performs controlled coughing techniques.
• Patient doesn't experience dyspnea or change in respiratory pattern.
• Patient performs energy conservation techniques.
• Patient demonstrates understanding of changes needed to diminish oxygen demands.

• Patient's perceptions of ability to cough
• Observations of physical findings
• Effectiveness of medications
• Patient's attempts to clear airway
• Maneuvers performed to clear airway
• Evaluations for expected outcomes

• Dilektas¸lı, A. G., & Önen, Z. P. (2018). Essentials in the comprehensive management of chronic respiratory diseases: Airway clearance and vaccination. Turkish Thoracic Journal, 19(3), 101-102.
• Lee, L., Hill, A., & Patman, S. (2017). A survey of clinicians regarding respiratory physiotherapy intervention for intubated and mechanically ventilated patients with community-acquired pneumonia. What is current practice in Australian ICUs? Journal of Evaluation in Clinical Practice, 23(4), 812-820.
• Reychler, G., Debier, E., Contal, O., & Audag, N. (2018). Intrapulmonary percussive ventilation as an airway clearance technique in subjects with chronic obstructive airway diseases. Respiratory Care, 63(5), 620-631.
• Spors, D., & Sawyer, C. (2018). Connected solutions for pediatric airway clearance: Airway clearance therapy adherence for adults can be complicated by a variety of factors, but pediatric patients face additional barriers to proper management simply due to their age. RT: The Journal for Respiratory Care Practitioners, 31(1), 22-24.