Bronchopulmonary dysplasia (BPD) is the most common chronic pulmonary disease that affects low birth weight and premature infants who received assistive ventilation due to respiratory distress syndrome. This condition occurs from a deficiency in lung surfactant, damage to the lungs caused by ventilator pressure, and exposure to high oxygen concentrations. Infants experiencing BPD may develop labored breathing, tachypnea, wheezes, oxygen dependence, cyanosis, abnormal ABGs and chest findings, poor weight, and repeated lung infections that may require frequent and prolonged hospitalizations. BPD may resolve by the time the child reaches 3 to 4 years of age.
Nursing Care Plans
The nursing care planning goals for a patient with Bronchopulmonary Dysplasia (BPD) centers on decreasing further lung injury, maintaining adequate ventilation, providing nutritional needs to promote lung maturity and development, preventing infections and enabling the family to cope up with the condition.
Here are five (5) nursing care plans (NCP) for Bronchopulmonary Dysplasia (BPD):
- Impaired Gas Exchange
- Imbalanced Nutrition: Less Than Body Requirements
- Compromised Family Coping
- Disorganized Infant Behavior
- Risk for Infection
Impaired Gas Exchange: Excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane.
May be related to
- Tissue damage
Possibly evidenced by
- Abnormal breathing (rate, depth, rhythm)
- Hypoxemia
- Hypercapnia
- Restlessness
- Confusion
- Irritability
- Somnolence
Desired Outcomes
- Infant/Child will maintain clear lung fields and remains free of signs of respiratory distress.
| Nursing Interventions | Rationale |
|---|---|
| Assess respiratory rate, depth, and effort, including rapid breathing, use of accessory muscles, grunting sounds and flaring of the nostrils. | An infant with bronchopulmonary dysplasia display signs and symptoms of respiratory distress syndrome such as tachypnea, labored breathing, nasal flaring, grunting sounds, and chest retractions. |
| Assess for any alterations in the behavior. | Restlessness is an early sign of hypoxia. Chronic hypoxemia may result in cognitive changes, such as memory changes. |
| Observe for nail beds, cyanosis in the skin; especially note color of the lips, tongue, and oral mucous membranes. | Bluish discoloration of the skin around the lips and nails occurs when there is a low oxygen concentration in the blood. |
| Monitor arterial blood gases (ABGs) and note changes. | Reveals the occurrence of hypoxia, acidosis, and hypercarbia as the requirement for oxygen increases. |
| Assess the lungs for areas of decreased ventilation and auscultate presence of adventitious sounds. | A soft, tight whistling sound (wheezing) may be heard with each breath that may indicate narrowed airways or inflammation. |
| Assess oxygen saturation using pulse oximetry during feeding, sleeping, and crying. | Pulse oximetry is a useful tool to detect changes in oxygenation. O2 saturation should be maintained at 90% or greater. |
| Encourage frequent positional changes. | Promotes expansion of the lungs and helps mobilization of secretions out of the airways. |
| Suction the nose and mouth with a bulb syringe as needed. | Suctioning clears out secretions. |
| Administer medications as prescribed: | |
| Decreases airway resistance by relaxing the bronchial smooth muscle. |
| Reduces inflammation within the lungs and lessen the mucus production. |
| Decreases the development of alveolar and pulmonary interstitial edema. |
| Inform parents that the infant may be prescribed with a surfactant-replacement therapy. | Surfactant if administered in the early course of treatment, decreases the development of BPD. |
| Educate parents that a breathing support or oxygen inhalation either through nasal continuous positive airway pressure (NCPAP) or a ventilator may be required for the infant. | Maintains adequate ventilation and ensures the delivery of concentrated amount of oxygen. |
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