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 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
Disorganized Infant Behavior
Disoraganized Infant Behavior: Disintegrated physiological and neurobehavioral responses to the environment.
May be related to
- Environmental stimulation
Possibly evidenced by
- Alterations in heart rate, respiration
- Color changes
- Erratic body movements
- Difficulty with feedings or prolonged periods of wakefulness
- Infant will demonstrate quiet alert state and ability to habituate to environmental stimuli.
- Infant will demonstrate smoother transitions between sleeping and waking.
|Assess infant’s behavioral states|
(periods of quiet and active sleep, habituation, orientation, and self-consoling ability).
|Provides information about the infant’s unique abilities to adjust with environmental stimulation. Allows planning of individualized supportive care.|
|Introduce one caregiving intervention at|
a time, noticing responses; allow for
a rest once infant shows stress signals, such as finger splaying, grimacing, tongue extension, worried alertness, spitting up, back arching, gaze aversion, yawning, hiccuping, color changes, or changes in cardiac or respiratory functioning.
|Avoids overstimulation and additional environment maladaptation.|
|Continue to stay with the infant after procedures/caregiving to assess response; if maladaptive responses happen, use “time-out” to enable the infant to adjust.||Prevents or minimizes maladaptive responses which often occurs up to 20 minutes after caregiving is completed.|
|Perform caring measures in a cluster, while not overstimulating infant; continuously assess the infant for signs of stress during caregiving, providing rest periods as needed.||Promotes longer periods of alert and/or deep sleep which will improve the body’s own natural defenses; providing rest periods will allow the infant to recover before doing the next caregiving; avoids sudden sleep interruption; promotes stability and adaptive behaviors.|
|Facilitate handling by providing|
containment: holding infant’s arms and
legs in a flexed position, close to their midline using the caregiver’s hands and/or positioning aids such as rolled blankets; premature or ill infants should be positioned prone or side-lying, maintaining soft flexion.
|Promotes flexion and enhances infant’s motor and physiologic systems.|
|Alter physical environment by decreasing light and sound.||Prevents or decreases maladaptive behaviors; both light and sound levels in the NICU have been implicated in interfering with sleep and stable physiological functioning.|
|Place the infant in a flexed position with hands to midline, or swaddled with hands-free; providing pacifier and/or fingers to suck on; providing objects to encourage hand grasping such as blankets, tubing, and fingers during caregiving.||Promotes self-consoling or gentle behaviors which facilitate organization and adaptive behaviors.|
|Assist parents in learning their infant’s signals or cues and interpreting them appropriately.||Promotes positive parenting role and minimizes infant’s maladaptive behaviors, promoting improved long-term growth and development.|
|Provide a primary care team to work|
collaboratively with the parents in
developing an individualized plan of
care reviewed daily and discussed at
intervals with the parents.
|Promotes element of trust for both the infant and family, improving parent-infant relationships; allows caregivers to identify infant’s behavioral cues.|
|Provide individualized feeding support|
determined by the infant’s own needs and
strengths; feeding focus should be positive
and pleasurable, with attention to infant’s cues or signals.
|Promotes positive feeding experiences, that facilitate weight gain and feeding competency.|
|Provide an optimal level of family support|
through the use of family-centered
caregiving principles: enhanced involvement of parents in all aspects of caregiving and decision-making; promote family comfort with a homelike environment.
|Promotes feelings of belonging and control which enhances the parent-infant relationship.|
|Teach and assist parents in promoting|
infant adaptive behaviors through the use
of containment, swaddling, promotion, and
maintenance of flexion, non-nutritive sucking, and finger grasping.
|Promotes positive adaptive behaviors in the infant and increases parental participation and feelings of control.|
|Instruct and encourage parents in|
caregiving activities throughout the
NICU stay, at level parents are comfortable with.
|Promotes improved parental confidence, enhances parenting skills, and improves parent-infant relationship/interactions.|
|Teach and encourage parental participation in Kangaroo care or skin-to-skin holding when the infant is medically stable; this method is accomplished by placing the infant on parent’s chest under their clothing.||Promotes stable physiologic functioning, maintains thermoregulation, improves quiet/alert sleep periods, improves weight gain, promotes positive parent/infant relationship and improves parental confidence.|
|Encourage parents to personalize infant|
bed space by bringing in clothes, blankets to be used over isolettes/cribs, and pictures from home.
|Promotes positive parental identity and feelings of control. Decreases NICU stimulation.|
|Assist parents in making the hard transition from hospital to home;|
allow sufficient time for learning and
communication of needs and feelings;
validate feelings of anxiety as normal; give short and clear information, with time for clarification and provide supplemental written materials; allow parents permission to be in control of decisions and maintain structure in their own lives;
discuss feelings of anger and guilt openly; adapt teaching and communication techniques to different family styles, customs, and cultures.
|Promotes feelings of control and mastery through education and open communication; this will enhance the parent-infant relationship and foster the child’s growth and development.|
Recommended nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
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 | 8 Care Plans
- Bronchiolitis | 5 Care Plans
- Bronchopulmonary Dysplasia (BPD) | 5 Care Plans
- Chronic Obstructive Pulmonary Disease (COPD) | 7 Care Plans
- Cystic Fibrosis | 5 Care Plans
- Hemothorax and Pneumothorax | 3 Care Plans
- Influenza (Flu) | 5 Care Plans
- Lung Cancer | 5 Care Plans
- Mechanical Ventilation | 6 Care Plans
- Near-Drowning | 5 Care Plans
- Pleural Effusion | 6 Care Plans
- Pneumonia | 11 Care Plans
- Pulmonary Embolism | 4 Care Plans
- Pulmonary Tuberculosis | 5 Care Plans
- Tracheostomy | 5 Care Plans
References and Sources
- 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]
- 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]
- Pellico, L. H., Bautista, C., & Esposito, C. (2012). Focus on adult health medical-surgical nursing. [Link]
- 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]