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
Ineffective Breathing Pattern
Mechanical ventilation is highly implicated as a risk factor for BPD. It is evident in the medical literature that unnecessary mechanical ventilation should be avoided, if possible, during the early management of prematurity. Unfortunately, dependence on oxygen supplementation often persists in a subset of infants who develop BPD. The recommended mechanical ventilation approach for severe BPD should allow enough exhalation time to avoid hyperinflation and ventilation/perfusion (V/Q) mismatch. Low ventilation rates are required to maintain longer exhalation rates, hence higher tidal volumes are required to achieve adequate carbon dioxide removal (Karkoutli et al., 2020).
May be related to
- Impaired spontaneous ventilation
- Respiratory muscle weakness
- Noncompliant lung tissue
- Alteration of client’s usual oxygen/carbon dioxide ratio
Possibly evidenced by
- Alterations in rate and depth of respirations
- Use of accessory muscles
- Tachypnea when off the ventilator
- Altered ABG levels
- Increased restlessness and irritability
- The infant will reestablish and maintain effective respiratory pattern via a ventilator.
- The infant will demonstrate the absence of retractions and use of accessory muscles, cyanosis, or other signs of hypoxia.
- The parents will participate in efforts to wean the infant as appropriate within the infant’s ability.
- The parents will demonstrate behaviors necessary to maintain the infant’s respiratory function.
Nursing Assessment and Rationales
1. Observe respiratory rate and distinguish between spontaneous and ventilator breaths.
The infant on a ventilator may experience hyperventilation, hypoventilation, or dyspnea and “air hunger” and attempt to correct the deficiency by over-breathing. Intermittent hypoxic episodes, which are a consequence of immature respiratory control, are most frequent in preterm infants mechanically ventilated beyond the first weeks of life (Raffay & Martin, 2020).
2. Auscultate the chest regularly for the presence of abnormal breath sounds.
Auscultation provides information regarding airflow through the tracheobronchial tree and the presence or absence of mucous obstruction. Frequent crackles that do not clear with suctioning may indicate developing complications such as atelectasis, pneumonia, and pulmonary edema. Changes in chest symmetry may indicate the development of barotrauma.
3. Assess the client’s respirations by counting the breaths for one full minute.
The infant’s respirations may vary depending on the problem requiring ventilatory assistance. The infant may be totally ventilator dependent or be able to take breaths on their own between ventilator-delivered breaths. Rapid respirations may lead to respiratory alkalosis; slow respirations may increase PaCO2 levels and result in acidosis.
4. Monitor if the infant’s respirations are in phase with the ventilator.
Adjustments may be required in flow, tidal volume, respiratory rate, and dead space of the ventilator, or the infant may need sedation to synchronize respirations and reduce the work of breathing and energy expenditure. Synchronization of ventilator inflations with infant breathing, through the detection of change in airway flow or pressure at the start of inspiration, is considered standard care (Owen et al., 2021).
5. Assess ventilator settings routinely and readjust as indicated.
Controls or settings are adjusted according to the infant’s current health status and diagnostic test results to maintain parameters within appropriate limits. Volume-targeted ventilation (VTV) modes allow greater control of tidal volume than pressure-limited ventilation (PLV), limiting volutrauma. Ideal set tidal volumes vary with gestational age, lung pathophysiology, and duration of mechanical ventilation. Based on small trials, ideal initial tidal volumes are approximately four to six mL/kg (Owen et al., 2021).
6. Observe the oxygen concentration percentage (FiO2) and check if the oxygen line is in the proper outlet or tank.
FiO2 is adjusted to maintain an acceptable oxygen percentage and saturation for the infant’s condition. Currently, oxygen administration to preterm infants is titrated to achieve certain oxygen saturation ranges. A meta-analysis of five high-quality randomized controlled trials comparing high (91 to 95%) and low (85 to 89%) saturation ranges provides useful guidance for healthcare professionals (Thebaud et al., 2019).
Nursing Interventions and Rationales
1. Elevate the infant’s head of the bed, as appropriate, and position the infant in a prone position.
Elevating the client’s head helps decrease the risk of aspiration. The difficulty in assessing lung mechanics in small preterm infants is a major factor preventing a better understanding of the effect of prone positioning. Recently, the forced oscillation technique (FOT), a non-invasive method for the assessment of respiratory mechanical properties has been successfully applied to the study of respiratory mechanics in preterm infants during mechanical ventilation. Prone versus supine positioning does not lead to significant changes in short-term lung function assessed by FOT in mechanically ventilated infants. In infants with evolving BPD, prone positioning is associated with lower resistance values and could have a role in the clinical management of a highly obstructed client as it reduces the time constants of the respiratory system (Vendettuoli et al., 2015).
2. Check cuff inflation of tracheal or ET tube every four to eight hours.
The cuff must be properly inflated to ensure adequate ventilation and delivery of desired tidal volume and to decrease the risk of aspiration. In infants with long-term oxygen therapy, the cuff may be deflated most of the time or a non-cuffed tracheostomy tube may be used if the client’s airway is protected.
3. Check tubings for obstruction, kinking, or accumulation of water. Drain properly as indicated.
Kinks in the tubing prevent adequate volume delivery and increase airway pressure. Condensation in the tubing prevents proper gas distribution and predisposes the infant to bacterial growth.
4. Ensure that ventilator alarms can be heard at the nurse’s station. Check if the alarms are functioning properly.
Ventilators have a series of visual and audible alarms, such as oxygen, low volume or apnea, high pressure, and inspiratory/expiratory (I:E) ratio. Turning off or failing to reset alarms places the infant at risk for unobserved ventilator failure or respiratory distress/arrest.
5. Keep a resuscitation bag at the bedside and ventilate manually if indicated.
Manual ventilation through a resuscitation bag provides or restores adequate ventilation when infant or equipment problems require the infant to be temporarily removed from the ventilator.
6. Monitor the client’s ABG levels and oxygen saturation.
Adjustments to ventilator settings may be required, depending on the client’s response and trends in gas exchange parameters. Indwelling arterial lines are often inserted early in the acute management of respiratory distress syndrome. Samples obtained from these lines provide the most accurate information about the pulmonary function. Following trends in transcutaneous PO2 and pCO2 may reduce the need for frequent blood gas measurements (Ambalavanan & Aslam, 2020).
7. Start volume-targeted ventilation (VTV) and synchronization for the infant, as indicated.
The use of lung-protective ventilation strategies is essential to mitigate the long-term risk of BPD in the preterm population. Meta-analysis of low-moderate quality RCTs suggests that VTV significantly reduces the combined outcome of death or BPD at 36 weeks postmenstrual age, pneumothorax, and severe intraventricular hemorrhage. Synchronization improves comfort and oxygenation, and reduces pneumothoraces and ventilation duration, without reducing mortality or BPD (Owen et al., 2021).
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 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.
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2 thoughts on “7 Bronchopulmonary Dysplasia (BPD) Nursing Care Plans”
Wonderful information bravo.