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
Risk for Dysfunctional Ventilatory Weaning Response
Weaning from mechanical ventilation and oxygen is often difficult in infants with moderate-to-severe bronchopulmonary dysplasia, and few criteria are defined to enhance the success of extubation. Atrophy and fatigue of the respiratory muscles may lead to atelectasis and extubation failure (Ambalavanan & Aslam, 2020). Extubation failure is more likely with lower gestational age and birth weight, and higher respiratory requirements during ventilation. An accurate prediction of successful extubation in extremely preterm infants can be difficult. However, preventing extubation failure improves outcomes, mostly via a reduced duration of mechanical ventilation (Owen et al., 2021).
Nursing Diagnosis
- Risk for Dysfunctional Ventilatory Weaning Response
Risk Factors
- Sleep disturbance
- Insufficient energy stores
- Caregiver-perceived inability to wean
Possibly evidenced by
- [Not applicable; the presence of signs and symptoms establishes an actual diagnosis]
Desired Outcomes
- The infant will reestablish independent respiration with ABGs within an acceptable range and free of signs of respiratory failure.
- The parents will actively participate in the weaning process.
- The infant will demonstrate increased tolerance for activity.
Nursing Assessment and Rationales
1. Assess physical factors involved in weaning, such as normal vital signs and clear breath sounds.
The infant’s heart will need to work harder to meet the increased energy needs associated with weaning. The healthcare provider may delay weaning if tachycardia, pulmonary crackles, or hypertension are present. An increase in the body temperature also increases the metabolic demands and oxygen demands by 7%, making weaning difficult for the infant.
2. Assess the infant’s nutritional status and muscle strength.
Weaning is hard work for infants, especially premature ones. The infant must not only be able to withstand the stress of weaning but also must have the stamina to breathe spontaneously for extended periods. Infants born extremely premature may have difficulties with oral feeding and experience gastroesophageal reflux (GERD), vomiting, and other issues associated with discoordinated sucking, swallowing dysfunction, poor swallow-breath coordination, and poor sucking endurance and performance. Early recognition of feeding difficulties and GERD is crucial for the nutritional management of these infants (Karatza et al., 2022).
3. Evaluate the infant’s progress while still attached to the mechanical ventilator.
Restlessness, changes in vital signs, use of accessory muscles when breathing, discoordinated breathing with the ventilator, and skin color changes are indicators that the infant may require slower weaning and an opportunity to stabilize first.
Nursing Interventions and Rationales
1. Explain weaning techniques to the parents and discuss expectations with them.
Educating the parents about weaning techniques helps them prepare for the infant’s weaning process. Acquiring more information about the process of weaning may alleviate the parents’ fear of the unknown and also promote cooperation, therefore enhancing the likelihood of a successful outcome. A recent systematic review concluded that gradual CPAP pressure reduction increases the likelihood of successful CPAP weaning at the first attempt compared with sudden discontinuation; that interval training or increasing periods off CPAP was ineffective; and that ‘stepping down’ to high-flow or low-flow nasal oxygen significantly reduced CPAP duration but increased overall duration of supplemental oxygen therapy (Owen et al., 2021).
2. Provide scheduled rest and sleep periods. Cluster care for the infant and avoid unnecessary activities and stressful procedures.
Energy demands in infants diagnosed with BPD are 15 to 20% higher compared with infants without BPD. This is probably due to laborious breathing, tachypnea, and oxygen demands (Karatza et al., 2022). Additionally, the infant’s oxygen requirements are frequently increased during stressful procedures and feedings. Giving the infant time to rest maximizes their energy for the weaning process and reduces fatigue and oxygen consumption when care is clustered instead of performing procedures every now and then.
3. Monitor cardiopulmonary response to activity.
Excessive oxygen consumption and demand increase the possibility of failure. When tidal volumes are adequate and respiratory rates are low, a trial of extubation and nasal CPAP may be indicated. A trial of endotracheal CPAP before extubation is controversial because of the increased work of breathing and airway resistance (Ambalavanan & Aslam, 2020).
4. Monitor laboratory results and diagnostic tests.
Potassium, electrolytes, calcium, phosphorus, albumin, iron, and transferrin must be sufficient to ensure that the infant’s nutrition is adequate to meet the energy requirements for weaning. Bronchoscopy evaluation may be considered in infants diagnosed with BPD for whom extubation is repeatedly unsuccessful (Ambalavanan & Aslam, 2020).
5. Provide adequate nutrition for the infant before the weaning process.
Enteral feeding should provide a sufficient quantity of calcium and phosphorus; however, it is usually deficient due to its low amount in oral feeds, which has been attributed to the usage of breastmilk without fortification (Karatza et al., 2022). Enteral feedings of breastmilk still provide the best nutrition while preventing feeding complications. The energy content of expressed breastmilk and formulas can be enhanced to increase energy intake while minimizing fluid intake. Infants may require 120 to 150 kcal/kg/day to gain weight (Ambalavanan & Aslam, 2020).
6. Review chest X-ray results, oxygen saturation, and ABG levels.
Chest X-ray should reveal clear lungs or a marked improvement in pulmonary congestion. ABG levels should reveal satisfactory oxygenation on a FiO2 of 40% or less. Repeated episodes of desaturation and hypoxia may occur in infants with BPD receiving mechanical ventilation as a result of decreased respiratory drive, altered pulmonary mechanics, excessive stimulation, bronchospasm, and forced exhalation efforts (Ambalavanan & Aslam, 2020).
7. Administer postnatal dexamethasone as indicated.
Abnormal lung development and BPD in preterm infants are in part due to ventilator-induced lung injury and are associated with prolonged mechanical ventilation. The use of postnatal steroids such as dexamethasone is associated with improved lung function and faster weaning from respiratory support. However, the use of postnatal dexamethasone has been associated with an increased risk of neurodevelopmental impairment. A study showed that postnatal dexamethasone administration after approximately eight weeks of age was associated with successful extubation in a large proportion of treated infants (Kurtom et al., 2021).
8. Consult with a dietitian for adjustments in the composition of the infant’s diet.
A reduction in carbohydrates and fats may be required to prevent excessive production of carbon dioxide, which could alter the respiratory drive. A study shows that calorically dense milk nowadays contains about 3 g of protein/100 kcal compared to formulas given ten years ago, which provided about 2 g of protein/100 kcal. BPD infants in the current era BPD had improved growth and required ventilator support for a shorter period of time (Karatza et al., 2022).
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.
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.
See Also
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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Nice work
Wonderful information bravo.