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5 Bronchopulmonary Dysplasia (BPD) Nursing Care Plans

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By Paul Martin, BSN, R.N.
5 Bronchopulmonary Dysplasia (BPD) Nursing Care Plans
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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):

  1. Impaired Gas Exchange
  2. Imbalanced Nutrition: Less Than Body Requirements
  3. Compromised Family Coping
  4. Disorganized Infant Behavior
  5. Risk for Infection

3. Disorganized Infant Behavior

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Disorganized Infant Behavior

Disoraganized Infant Behavior: Disintegrated physiological and neurobehavioral responses to the environment.

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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

Desired Outcomes

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  • Infant will demonstrate quiet alert state and ability to habituate to environmental stimuli.
  • Infant will demonstrate smoother transitions between sleeping and waking.
Nursing InterventionsRationale
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.
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3. Disorganized Infant Behavior

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See Also

Other recommended site resources for this nursing care plan:

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Other nursing care plans related to respiratory system disorders:

References and Sources

The following are the references and sources for the nursing diagnosis and nursing care plan for asthma:

  • 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]
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Paul Martin, BSN, R.N.
Paul Martin is a registered nurse with a bachelor of science in nursing since 2007. Having worked as a medical-surgical nurse for five years, he handled different kinds of patients and learned how to provide individualized care to them. Now, his experiences working in the hospital is carried over to his writings to help aspiring students achieve their goals. He is currently working as a nursing instructor and have a particular interest in nursing management, emergency care, critical care, infection control, and public health. As a writer at Nurseslabs, his goal is to impart his clinical knowledge and skills to students and nurses helping them become the best version of themselves and ultimately make an impact in uplifting the nursing profession.
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