Week No.
__ – Complete Date (Month/Day/Year) (Day of the Week)
PRIORITIZED NURSING PROBLEM FOR BRONCHOPULMONARY DISPLASIA
Nursing Diagnosis Nursing Intervention
1. IMPAIRED GAS Independent
EXCHANGE Position patient with head of
bed elevated, in a semi-
Fowler’s position (head of bed
at 45 degrees when supine) as
tolerated
Regularly check the patient’s
position so that he or she does
not slump down in bed.
if patient has unilateral lung
disease, position the patient
properly to promote
ventilation-perfusion.
Turn the patient every 2 hours.
Monitor mixed venous oxygen
saturation closely after turning.
If it drops below 10% or fails
to return to baseline promptly,
turn the patient back into a
supine position and evaluate
oxygen status.
Encourage or assist with
ambulation as per physician’s
order.
if patient is obese or has
ascites, consider positioning in
reverse Trendelenburg position
at 45 degrees for periods as
tolerated.
Consider positioning the
patient prone with upper thorax
and pelvis supported, allowing
the abdomen to protrude.
Monitor oxygen saturation, and
turn back if desaturation
occurs. Do not put in prone
position if patient has
multisystem trauma.
If patient is acutely dyspneic,
consider having patient lean
forward over a bedside table, if
tolerated.
Maintain an oxygen
administration device as
Rationale
Upright position or semi-
Fowler’s position allows
increased thoracic capacity, full
descent of diaphragm, and
increased lung expansion
preventing the abdominal
contents from crowding.
Slumped positioning causes the
abdomen to compress the
diaphragm and limits full lung
expansion.
Gravity and hydrostatic pressure
cause the dependent lung to
become better ventilated and
perfused, which increases
oxygenation. When the patient
is positioned on the side, the
good side should be down (e.g.,
lung with pulmonary embolus
or atelectasis should be up).
However, when conditions like
lung hemorrhage and abscess is
present, the affected lung should
be placed downward to prevent
drainage to the healthy lung.
Turning is important to prevent
complications of immobility,
but in critically ill patients with
low hemoglobin levels or
decreased cardiac output,
turning on either side can result
in desaturation
Ambulation facilitates lung
expansion, secretion clearance,
and stimulates deep breathing.
Trendelenburg position at 45
degrees results in increased tidal
volumes and decreased
respiratory rates.
Partial pressure of arterial
oxygen has been shown to
increase in the prone position,
possibly because of greater
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)
ordered, attempting to maintain
oxygen saturation at 90% or
greater.
Avoid a high concentration of
oxygen in patients with COPD
unless ordered.
If the patient is permitted to
eat, provide oxygen to the
patient but in a different
manner (changing from mask
to a nasal cannula).
Administer humidified oxygen
through appropriate device
(e.g., nasal cannula or face
mask per physician’s order);
watch for onset of
hypoventilation as evidenced
by increased somnolence after
initiating or increasing oxygen
therapy.
For patients who should be
ambulatory, provide extension
tubing or a portable oxygen
apparatus.
Help patient deep breathe and
perform controlled coughing.
Have patient inhale deeply,
hold breath for several
seconds, and cough two to
three times with mouth open
while tightening the upper
abdominal muscles as
tolerated.
Encourage slow deep breathing
using an incentive spirometer
as indicated.
Suction as necessary.
For postoperative patients,
assist with splinting the chest
Provide reassurance and reduce
anxiety.
Pace activities and schedule
rest periods to prevent fatigue.
Assist with ADLs.
Administer medications as
prescribed.
contraction of the diaphragm
and increased function of
ventral lung regions. Prone
positioning improves
hypoxemia significantly.
Leaning forward can help
decrease dyspnea, possibly
because gastric pressure allows
better contraction of the
diaphragm.
Supplemental oxygen may be
required to maintain PaO2 at an
acceptable level.
Hypoxia stimulates the drive to
breathe in the patient who
chronically retains carbon
dioxide. When administering
oxygen, close monitoring is
imperative to prevent unsafe
increases in the patient’s PaO2
which could result in apnea.
more oxygen will be consumed
during the activity. The original
oxygen delivery system should
be returned immediately after
every meal.
a patient with chronic lung
disease may need a hypoxic
drive to breathe and may
hypoventilate during oxygen
therapy.
These measures may improve
exercise tolerance by
maintaining adequate oxygen
levels during activity.
These measures may improve
exercise tolerance by
maintaining adequate oxygen
levels during activity.
This technique can help increase
sputum clearance and decrease
cough spasms. Controlled
coughing uses the
diaphragmatic muscles, making
the cough more forceful and
effective.
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)
Monitor the effects of sedation
and analgesics on patient’s
respiratory pattern; use
judiciously.
Consider the need for
intubation and mechanical
ventilation.
Schedule nursing care to
provide rest and minimize
fatigue.
Assess the home environment
for irritants that impair gas
exchange. Help the patient to
adjust home environment as
necessary (e.g., installing air
filter to decrease presence of
dust).
Instruct patient to limit
exposure to persons with
respiratory infections.
Instruct family in
complications of disease and
importance of maintaining
medical regimen, including
when to call physician.
Support family of patient with
chronic illness.
These technique promotes deep
inspiration, which increases
oxygenation and prevents
atelectasis
Suction clears secretions if the
patient is not capable of
effectively clearing the airway.
Airway obstruction blocks
ventilation that impairs gas
exchange.
Splinting optimizes deep
breathing and coughing efforts.
Anxiety increases dyspnea,
respiratory rate, and work of
breathing
Activities will increase oxygen
consumption and should be
planned so the patient does not
become hypoxic.
The type depends on the
etiological factors of the
problem (e.g., antibiotics for
pneumonia, bronchodilators for
COPD,anticoagulants and
thrombolytics for pulmonary
embolus, analgesics for thoracic
pain).
Both analgesics and medications
that cause sedation can depress
respiration at times. However,
these medications can be very
helpful for decreasing the
sympathetic nervous system
discharge that accompanies
hypoxia.
Early intubation and mechanical
ventilation are recommended to
prevent full decompensation of
the patient. Mechanical
ventilation provides supportive
care to maintain adequate
oxygenation and ventilation.
The hypoxic patient has limited
reserves; inappropriate activity
can increase hypoxia.
Irritants in the environment
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)
2. IMBALANCED Ascertain healthy body weight
NUTRITION- for age and height. Refer to a
LESS THAN dietitian for complete nutrition
BODY assessment and methods for
REQUIREMENTS nutritional support.
Set appropriate short-term and
long-term goals.
Provide a pleasant
environment.
Promote proper positioning.
Provide good oral hygiene and
dentition
If patient lacks strength,
schedule rest periods before
meals and open packages and
cut up food for patient.
Provide companionship during
mealtime
Consider the use of seasoning
for patients with changes in
their sense of taste; if not
contraindicated
Consider six small nutrient-
dense meals instead of three
larger meals daily to lessen the
feeling of fullness.
For patients with physical
impairments, refer to an
occupational therapist for
adaptive devices.
decrease the patient’s
effectiveness in accessing
oxygen during breathing.
This is to reduce the potential
spread of droplets between
patients.
Knowledge of the family about
the disease is very important to
prevent further complications.
Severely compromised
respiratory functioning causes
fear and anxiety in patients and
their families. Reassurance from
the nurse can be helpful.
Experts like a dietician can
determine nitrogen balance as a
measure of the nutritional status
of the patient. A negative
nitrogen balance may mean
protein malnutrition. The
dietician can also determine the
patient’s daily requirements of
specific nutrients to promote
sufficient nutritional intake.
Patients may lose concern in
addressing this dilemma without
realistic short-term goals.
A pleasing atmosphere helps in
decreasing stress and is more
favorable to eating.
Elevating the head of bed 30
degrees aids in swallowing and
reduces risk for aspiration with
eating.
Oral hygiene has a positive
effect on appetite and on the
taste of food. Dentures need to
be clean, fit comfortably, and be
in the patient’s mouth to
encourage eating.
Nursing assistance with
activities of daily living (ADLs)
will conserve the patient’s
energy for activities the patient
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)
For patients with impaired
swallowing, coordinate with a
speech therapist for evaluation
and instruction.
Determine time of day when
the patient’s appetite is at peak.
Offer highest calorie meal at
that time.
Encourage family members to
bring food from home to the
hospital.
Offer high protein supplements
based on individual needs and
capabilities.
Offer liquid energy
supplements.
Discourage caffeinated or
carbonated beverages.
Keep a high index of suspicion
of malnutrition as a causative
factor in infections.
Encourage exercise.
Consider the possible need for
enteral or parenteral nutritional
support with the patient,
family, and caregiver, as
appropriate.
Validate the patient’s feelings
regarding the impact of current
lifestyle, finances, and
transportation on ability to
obtain nutritious food.
Once discharged, help the
patient and family identify area
to change that will make the
greatest contribution to
improved nutrition.
Adapt modification to their
current practices
values. Patients who take longer
than one hour to complete a
meal may require assistance.
Attention to the social
perspectives of eating is
important in both hospital and
home settings.
Seasoning may improve the
flavor of the foods and attract
eating.
ating small, frequent meals
lessens the feeling of fullness
and decreases the stimulus to
vomit.
Special devices may be
provided by an expert that can
help patients feed themselves.
djustments of the thickness and
consistency of foods to improve
nutritional intake may be
provided by a speech therapist
Patients with liver disease often
have their largest appetite at
breakfast time.
Patients with specific ethnic or
religious preferences or
restrictions may not consider
foods from the hospital.
Such supplements can be used
to increase calories and protein
without conflict with voluntary
food intake
Energy supplementation has
been shown to produce weight
gain and reduce falls in frail
elderly living in the community
These beverages will decrease
hunger and lead to early satiety.
Impaired immunity is a critical
adjunct factor in malnutrition-
associated infections in all age
groups.
Metabolism and utilization of
nutrients are improved by
activity.
Nutritional support may be
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)
3. INEFFECTIVE Set a working relationship with
COPING the patient through continuity
of care.
Assist patient set realistic goals
and identify personal skills and
knowledge.
Provide chances to express
concerns, fears, feeling, and
expectations.
Use empathetic
communication.
Convey feelings of acceptance
and understanding. Avoid false
reassurances.
Encourage patient to make
choices and participate in
planning of care and scheduled
activities.
Encourage the patient to
recognize his or her own
strengths and abilities.
Consider mental and physical
activities within the patient’s
ability (e.g., reading,
television, outings, movies,
radio, crafts, exercise, sports,
recommended for patients who
are unable to maintain
nutritional intake by the oral
route. If gastrointestinal tract is
functioning well, enteral tube
feedings are indicated. For those
who cannot tolerate enteral
feedings, parenteral nutrition is
recommended.
Validation lets the patient know
that the nurse has heard and
understands what was said, and
it promotes the nurse-patient
relationship
Change is difficult. Multiple
changes may be overwhelming.
Accepting the patient’s or
family’s preferences shows
respect for their culture.
An ongoing relationship
establishes trust, reduces the
feeling of isolation, and may
facilitate coping.
Involving patients in decision
making helps them move
toward independence.
Verbalization of actual or
perceived threats can help
reduce anxiety and open doors
for ongoing communication.
Acknowledging and
empathizing creates a
supportive environment that
enhances coping
An honest relationship
facilitates problem-solving and
successful coping. False
reassurances are never helpful
to the patient and only may
serve to relieve the discomfort
of the care provider.
Participation gives a feeling of
control and increases self-
esteem.
During crises, patients may not
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)
games, dinners out, and social
gatherings).
Assist patients with accurately
evaluating the situation and
their own accomplishments
If the patient is physically
capable, encourage moderate
aerobic exercise.
Provide information the patient
wants and needs. Do not give
more than the patient can
handle.
Provide touch therapy with
permission. Give patient a back
massage using slow, rhythmic
stroking with hands. Use a rate
of 60 strokes a minute for 3
minutes on 2-inch wide areas
on both sides of the spinous
process from the crown to the
sacral area.
Assist the patient with
problem-solving in a
constructive manner.
Provide information and
explanation regarding care
before care is given.
Eliminate stimuli in an
environment that could be
misinterpreted as threatening.
Discuss changes with patient
before making them.
Provide outlets that foster
feelings of personal
achievement and self-esteem.
Point out signs of positive
progress or change.
Encourage use of cognitive
behavioral relaxation (e.g.,
music therapy, guided
imagery).
Be supportive of coping
behaviors; give patient time to
relax.
Discuss with patient about his
or her previous stressors and
be able to recognize their
strengths. Fostering awareness
can expedite use of these
strengths.
Interventions that improve body
awareness such as exercise,
proper nutrition, and muscular
relaxation may be helpful for
treating anxiety and depression.
It can be helpful for the patient
to recognize that he or she has
the skills and reserves of
strength to effectively manage
the situation. The patient may
need help coming to a realistic
perspective of the situation.
Aerobic exercise improves
one’s ability to cope with acute
stress.
Patients who are coping
ineffectively have reduced
ability to absorb information
and may need more guidance
initially.
A soothing touch can reveal
acceptance and empathy. Slow
stroke back massage decreased
heart rate, decreased systolic
and diastolic blood pressure,
and increased skin temperature
at significant levels. The
conclusion is that relaxation is
induced by slow stroke back
massage.
Constructive problem solving
can promote independence and
sense of autonomy.
In traumatic situations, families
have a need for information and
explanations. Providing
information prepares the patient
and family for understanding
the situation and possible
outcomes.
The presence of noise
associated with medical
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)
the coping mechanisms used.
Use distraction techniques
during procedures that cause
patient to be fearful.
Apply systematic
desensitization when
introducing new people,
places, or procedures that may
cause fear and altered coping.
Refer for counseling as
necessary.
Refer to medical social
services for evaluation and
counseling.
If the patient is associated with
the mental health system,
actively engage in mental
health team planning.
equipment can increase anxiety
and make coping more
challenging.
Communication with the
medical staff provides patients
and families with understanding
of the medical condition.
Opportunities to role-play or
rehearse appropriate actions can
increase confidence for behavior
in actual situations.
Patients who are coping
ineffectively may not be able to
assess their progress toward
effective coping.
Relaxation techniques,
desensitization, and guided
imagery can help patients cope,
increase their sense of control,
and allay anxiety.
A supportive presence creates a
supportive environment to
enhance coping.
Describing previous experiences
strengthens effective coping and
helps eliminate ineffective
coping mechanisms.
Distraction is used to direct
attention toward a pleasurable
experience and block the
attention of the feared
procedure.
Fear of new things diminishes
with repeated exposure.
Arranging for referral assists the
patient in working with the
system, and resource use helps
to develop problem-solving and
coping skills.
This will promote adequate
coping as part of the medical
plan of care.
Based on knowledge of the
home and family, home care
nurses can often advocate for
patients. These nurses are often
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)

requested to monitor
medications and therefore need
to know the plan of care

References: