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. BPD is fibrosis, or thickening, of the alveolar walls and the bronchiolar epithelium. Swelling of the tissues causes edema, and the respiratory cilia are paralyzed by the high oxygen concentrations and lose their ability to clear mucus from the airways.
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 three to four years of age.
The aim of the management of BPD is to support infants while lung growth occurs, limit further injury to the lungs, optimize lung function, and detect complications associated with BPD. BPD is a chronic illness that persists beyond discharge from the hospital. Infants have an increased risk of developing reactive airway disease, asthma, emphysema, and RSV bronchiolitis. They are also at high risk for cardiopulmonary sequelae like pulmonary hypertension, cor pulmonale, and systemic hypertension (Sahni, 2022).
Nursing Care Plans
The nursing care planning goals for a client diagnosed with bronchopulmonary dysplasia (BPD) center 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 nursing care plans and nursing diagnoses for bronchopulmonary dysplasia (BPD):
- Impaired Gas Exchange
- Imbalanced Nutrition: Less Than Body Requirements
- Compromised Family Coping
- Disorganized Infant Behavior
- Risk for Infection
- Ineffective Breathing Pattern
- Risk for Dysfunctional Ventilatory Weaning Response
Imbalanced Nutrition: Less Than Body Requirements
Infants diagnosed with BPD have increased energy requirements. Early parenteral nutrition is often used to ameliorate the catabolic state of the preterm infant, although excessive fluid administration (and failure to lose weight) in the first week of life may increase the risk for patent ductus arteriosus (PDA) and BPD. Postnatal growth failure is common and may have considerable effects on long-term developmental outcomes. Strategies to optimize postnatal weight gain are important to improve pulmonary, retinal, and neurologic development (Ambalavanan & Aslam, 2020).
- Imbalanced Nutrition: Less than Body Requirements
May be related to
- Hypoxia during feeding
- Poor feeder
- Decreased weight gain
- Increased energy/metabolic need for work of breathing
- Altered physical growth
- Sputum production
Possibly evidenced by
- Aversion to or lack of interest in eating
- Body weight 20% or more under ideal weight
- Inadequate food intake (less than recommended daily allowances)
- Perceived inability to ingest food
- Poor muscle tone
- The family members will demonstrate an understanding of nutritional principles and requirements, feeding techniques, and special needs.
- The infant will display progressive weight gain toward the goal as appropriate.
Nursing Assessment and Rationales
1. Assess the family member’s knowledge of the importance and advantages of attaining normal nutritional body requirements.
This determines the degree of the caregiver‘s knowledge of having a good nutritional status. The infant with respiratory distress often has decreased oral intake because of dyspnea and sputum production, despite being in a hypermetabolic state with increased caloric needs. As a result, the infant is often malnourished.
2. Obtain and record the child’s weight each morning before the first feeding.
Daily measurement of body weight, without clothes and with the same scales, is required in order to determine weight changes. BPD affects predominantly neonates whose birth weight is less than 1500 g. There is an inverse relationship between the prevalence of BPD and gestational age as well as birth weight (Karatza et al., 2022).
3. Auscultate the infant’s bowel sounds.
Diminished or hypoactive bowel sounds may reflect decreased gastric motility and constipation related to limited fluid intake, poor nutritional intake, and hypoxemia. Clients born extremely preterm may have difficulties with oral feeding and experience gastroesophageal reflux, vomiting, and other issues associated with discoordinated sucking, swallowing dysfunction, poor swallow breath coordination, and poor sucking endurance and performance (Karatza et al., 2022).
Nursing Interventions and Rationales
1. Encourage continuation of breastfeeding, as appropriate.
The provision of human milk exclusively, preferably using fresh maternal breast milk, is recommended in the treatment of neonates at the early stages of BPD. the results of a large study involving premature neonates born before 32 weeks showed that maternal breastmilk used exclusively resulted in a decreased incidence of BPD, necrotizing enterocolitis, and retinopathy of prematurity (Karatza et al., 2022).
2. Provide small, frequent feedings.
Early enteral feeding of small amounts followed by slow, steady increases in volume appears to optimize tolerance of feeds and nutritional support. Frequent interruptions in feedings because of intolerance or illness can complicate the care of the client (Ambalavanan & Aslam, 2020).
3. Provide a diet that fulfills the child’s daily caloric requirements.
Caloric requirements are raised due to increased work of breathing and to assist lung recovery and growth. Infants diagnosed with BPD need an increased amount of energy to promote lung growth and repair. Their nutritional need may be up to 140 to 150 kcal/kg/day and protein intake from 3.5 to 4 g/kg/day (Sahni, 2022).
4. Provide adequate amounts of protein and fat.
Protein and fat supplementation are progressively increased to provide approximately 3 to 3.5g/kg/day. A limited number of studies have investigated the needs of neonates with BPD in proteins, therefore it may be suggested that these are similar to the requirements of premature neonates that do not have BPD. These subjects have altered body composition, suggesting that the usual provision of protein may not be adequate Karatza et al., 2022).
5. Increase the supplementation of calcium and phosphorus, as indicated.
Calcium and phosphorus requirements are greatly increased in preterm infants. Most mineral stores in the fetus are collected during the third trimester, leaving the extremely preterm infant deficient in calcium and phosphorus and at increased risk of rickets (Ambalavanan & Aslam, 2020). Enteral calcium and phosphorus intake should be optimized at 120 to 140 mg/kg/day of calcium or 150 to 220 mg/kg/day with 90 mg/kg/day or 75 to 140 mg/kg/day of phosphorus and calcium/phosphorus ratio of two.
6. For infants older than age 6 months, offer solid foods before formula or breast milk.
Place solid foods in the center of the tongue, using a small spoon to press downward slightly to facilitate swallowing. Older infants and young toddlers may resist solid foods, preferring milk or formula. The initiation of solid food should not be based on chronological age as children with BPD may be able to swallow solid foods at a later age as a result of prematurity and feeding difficulties. Thicker foods may be easier to swallow (Karatza et al., 2022).
7. Promote the use of nutrient-rich formulas, especially for discharged infants.
A nutrient-enriched formula containing high energy and micronutrients used on neonates with BPD up to three months after birth resulted in improved growth in comparison to neonates consuming an isoenergetic standard preterm formula. This implies that infants with BPD have increased growth rates when formulas richer in nutrients compared to standard ones are used. The commercially available preterm formulas which are used in the NICU contain increased amounts of energy, protein, calcium, and phosphorus, and the type of fat added in the formula is a blend of vegetable oils including long-chain triglycerides and MCT (Karatza et al., 2022).
8. Administer vitamin supplementation as indicated.
Vitamin a supplementation decreases the incidence of BPD. supplementation of trace minerals such as copper, zinc, and manganese is needed because they are essential cofactors in antioxidant enzymes (Ambalavanan & Aslam, 2020). A meta-analysis concluded that supplementation with vitamin A to attain normal serum levels of retinol reduces the dependence on supplemental oxygen at 36 weeks of gestational age, but does not have any effect on long-term outcomes (Pasha et al., 2018). Intramuscular supplementation of vitamin A started within a few days of birth and administered three times a week for four weeks has been shown to decrease the risk of BPD by 7% (Sahni, 2022).
9. Administer tube feedings for those clients who continue to rely on mechanical ventilators.
Infants with severe BPD often experience feeding difficulty that may require the placement of a permanent feeding tube to provide nutritional support. Studies concerning feeding strategies have demonstrated that the use of nasogastric tube (NGT) feeding is preferable to gastrostomy. NGT use in the population with established BPD seems to be a practical approach with lower numbers of infants needing the insertion of a gastrostomy tube (Karatza et al., 2022).
10. Provide parenteral fluids, as ordered.
With increased energy requirements, parenteral fluids ensure adequate fluid and electrolyte levels. The oral provision of energy should be optimized at 120 to 150 mL/kg/day (Karatza et al., 2022).
11. Refer the client and parents to a registered dietitian for the creation of a diet plan.
The diet plan of the child should be established according to the advice of a dietitian, who should be informed on whether the child requires a high-calorie diet (Sahni, 2022).
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans related to respiratory system disorders:
- Asthma | 9 Care Plans UPDATED!
- Bronchiolitis | 7 Care Plans UPDATED!
- Bronchopulmonary Dysplasia (BPD) | 7 Care Plans UPDATED!
- Chronic Obstructive Pulmonary Disease (COPD) | 7 Care Plans UPDATED!
- Cystic Fibrosis | 6 Care Plans UPDATED!
- Hemothorax, Pneumothorax, and Pleural Effusion | 5 Care Plans UPDATED!
- Influenza (Flu) | 6 Care Plans UPDATED!
- Lung Cancer | 7 Care Plans UPDATED!
- Mechanical Ventilation & Endotracheal Intubation | 10 Care Plans UPDATED!
- Drowning (Submersion Injury) | 7 Care Plans UPDATED!
- Pneumonia | 11 Care Plans
- Pulmonary Embolism | 4 Care Plans
- Pulmonary Tuberculosis | 5 Care Plans
- Tracheostomy | 5 Care Plans
References and Sources
With updates and contributions by M. Belleza, RN.
- Ackley, B. J., Ladwig, G. B., Msn, R. N., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care. Mosby. [Link]
- Carpenito-Moyet, L. J. (2006). Handbook of nursing diagnosis. Lippincott Williams & Wilkins. [Link]
- Chiafery, M. C., & D’Angio, C. T. (2020). Burden of Chronic Lung Disease on the Caregivers: Families, Nurses, and Physicians. Updates on Neonatal Chronic Lung Disease, 317-333. https://doi.org/10.1016/B978-0-323-68353-1.00022-1
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span. F.A. Davis Company.
- Hübl, N., da Costa, S. P., Kaufmann, N., Oh, J., & Willmes, K. (2020, February). Sucking patterns are not predictive of further feeding development in healthy preterm infants. Infant Behavior and Development, 58. https://doi.org/10.1016/j.infbeh.2019.101412
- Joyce, B. M., & Jane, H. H. (2008). Medical surgical nursing. Clinical management for positive outcome. Volume 1. Eight Edition. Saunders Elsevier. St. Louis. Missouri. [Link]
- Karatza, A. A., Gkentzi, D., & Varvarigou, A. (2022). Nutrition of Infants with Bronchopulmonary Dysplasia before and after Discharge from the Neonatal Intensive Care Unit. Nutrients, 14(16). https://doi.org/10.3390/nu14163311
- Kheirandish-Gozal, L., & Gozal, D. (Eds.). (2021). Pediatric Sleep Medicine: Mechanisms and Comprehensive Guide to Clinical Evaluation and Management. Springer International Publishing.
- Kurtom, W., Schmidt, A., Jain, D., Vanbuskirk, S., Schott, A., Bancalari, E., & Claure, N. (2021, May 28). Efficacy of late postnatal dexamethasone on weaning from invasive mechanical ventilation in extreme premature infants. Journal of Perinatology, 41, 1951-1955. https://www.nature.com/articles/s41372-021-01108-4
- Leifer, G. (2018). Introduction to Maternity and Pediatric Nursing. Elsevier.
- Owen, L. S., Manley, B. J., Hodgson, K. A., & Roberts, C. T. (2021, December). Impact of early respiratory care for extremely preterm infants. Seminars in Perinatology, 45(8). https://doi.org/10.1016/j.semperi.2021.151478
- Pellico, L. H., Bautista, C., & Esposito, C. (2012). Focus on adult health medical-surgical nursing. [Link]
- Silbert-Flagg, J., & Pillitteri, A. (2018). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. Wolters Kluwer.
- Taghinejad, F., Nikfarid, L., Monfared, M. N., Hoseini, N., & Habibi, S. (2021, December). Nursing diagnoses of preterm infants in the neonatal intensive care unit: A cross sectional study. Journal of Neonatal Nursing, 27(6), 451-458. https://doi.org/10.1016/j.jnn.2021.06.007
- Thebaud, B., Gross, K. N., Laughon, M., Whitsett, J. A., Abman, S. H., Steinhom, R. H., Aschner, J. L., Davis, P. G., McGrath-Morrow, S. A., Soll, R. F., & Jobe, a. H. (2019, November 14). Bronchopulmonary dysplasia. Nature Reviews Disease Primers, 5(78). https://www.nature.com/articles/s41572-019-0127-7
- Trumello, C., Candelori, C., Cofini, M., Cimino, S., Cerniglia, L., Paciello, M., & Babore, A. (2018, December). Mothers’ Depression, Anxiety, and Mental Representations After Preterm Birth: A Study During the Infant’s Hospitalization in a Neonatal Intensive Care Unit. Frontiers in Public Health. https://doi.org/10.3389/fpubh.2018.00359
- Vendettuoli, V., Veneroni, C., Zannin, E., Mercadante, D., Matassa, P., Pedotti, A., Colnaghi, M., Dellaca, R.L., & Mosca, F. (2015, August). Positional Effects on Lung Mechanics of Ventilated Preterm Infants with Acute and Chronic Lung Disease. Pediatric Pulmonology, 50(8), 798-804. 10.1002/ppul.23049
- Yang, B. H., Chen, Y. C., Chiang, B. L., & Chang, Y. C. (2005). Effects of nursing instruction on asthma knowledge and quality of life in schoolchildren with asthma. The journal of nursing research: JNR, 13(3), 174-183. [Read Abstract]
- Pasha, A. B., Chen, X. -Q., & Zhou, G.-P. (2018, September 19). Bronchopulmonary dysplasia: Pathogenesis and treatment – PMC. NCBI. Retrieved November 12, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6257511/
- Jung, E., & Lee, B. S. (2019, January 17). Late-Onset Sepsis as a Risk Factor for Bronchopulmonary Dysplasia in Extremely Low Birth Weight Infants: A Nationwide Cohort Study. Scientific Reports. Retrieved November 14, 2022, from https://www.nature.com/articles/s41598-019-51617-8
- Ambalavanan, N., & Aslam, M. (2020, January 13). Bronchopulmonary Dysplasia: Practice Essentials, Background, Pathophysiology. Medscape Reference. Retrieved November 12, 2022, from https://reference.medscape.com/article/973717-overview#a1
- Raffay, T. M., & Martin, R. J. (2020, November 01). Premie Brains Don`t Like Mechanical Ventilation! The Journal of Pediatrics, 226, 12-14. https://doi.org/10.1016/j.jpeds.2020.06.004
- Karkoutli, A. A., Brumund, M. R., & Evans, A. K. (2020, December). Bronchopulmonary dysplasia requiring tracheostomy: A review of management and outcomes. International Journal of Pediatric Otorhinolaryngology, 139. https://doi.org/10.1016/j.ijporl.2020.110449
- Arroyo, R., & Kingma, P. S. (2021, May 8). Surfactant protein D and bronchopulmonary dysplasia: a new way to approach an old problem – Respiratory Research. Respiratory Research. Retrieved November 12, 2022, from https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-021-01738-4
- Provasi, J., Blanc, L., & Carchon, I. (2021, July 29). settings Open AccessReview The Importance of Rhythmic Stimulation for Preterm Infants in the NICU. Children, 8(8). https://doi.org/10.3390/children8080660
- Hennelly, M., Greenberg, R. G., & Aleem, S. (2021, August 11). An Update on the Prevention and Management of Bronchopulmonary Dysplasia. NCBI. Retrieved November 14, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8364965/
- Sahni, M. (2022, June 21). Bronchopulmonary Dysplasia – StatPearls. NCBI. Retrieved November 12, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK539879/
2 thoughts on “7 Bronchopulmonary Dysplasia (BPD) Nursing Care Plans”
Wonderful information bravo.