A nurse is assessing a 6-week-old infant diagnosed with bron… | 마이메르시 MyMerci
Maternal Newborn Health
문제

A nurse is assessing a 6-week-old infant diagnosed with bronchopulmonary dysplasia (BPD). Which assessment finding would be most characteristic of this condition?

해설
Bronchopulmonary dysplasia is characterized by chronic lung inflammation and scarring, leading to increased work of breathing and tachypnea as compensatory mechanisms.

심화 해설

Core Nursing Explanation Key Concept Analysis: This question assesses the characteristic clinical presentation of Bronchopulmonary Dysplasia (BPD), a chronic lung disease primarily affecting premature infants who required prolonged oxygen therapy and mechanical ventilation. The core pathophysiology involves arrested alveolar and vascular development, leading to chronic inflammation, scarring, and airway hyperreactivity. This results in poor lung compliance and increased airway resistance, forcing the infant to work harder to breathe.

Answer Rationale: Key Point! The hallmark signs of BPD are Tachypnea (rapid breathing) and Increased work of breathing. The infant's lungs are stiff and obstructed, so they must breathe faster and use accessory muscles (seen as nasal flaring, grunting, and retractions) to maintain adequate gas exchange. This is a direct compensatory mechanism for the underlying lung pathology.

Distractor Analysis:
Watch out for confusion! Option ①, "Bradycardia and decreased respiratory rate," is incorrect. Bradycardia and bradypnea are signs of severe respiratory depression or failure, often from narcotic overdose or neurological insult. In BPD, the respiratory drive is high, not depressed.
Option ②, "Pink skin color and regular breathing pattern," describes a healthy, well-oxygenated infant. BPD infants often have chronic hypoxemia and may appear pale or have circumoral cyanosis, especially during feeding or crying.
Option ④, "Normal oxygen saturation on room air," is also incorrect. A defining feature of BPD is a continued need for supplemental oxygen or respiratory support beyond 28 days of age (or at 36 weeks postmenstrual age). They typically cannot maintain normal saturations without support.

Related Concepts: BPD management focuses on supporting growth and minimizing lung injury. Key interventions include adequate nutrition for lung repair, careful fluid management to prevent pulmonary edema, bronchodilators for airway reactivity, diuretics to reduce lung fluid, and often home oxygen therapy. Preventing respiratory syncytial virus (RSV) infection is also critical. Concept Summary
ConceptKey Points
Bronchopulmonary Dysplasia (BPD)Chronic lung disease of prematurity. Results from lung injury during critical development phase. Characterized by inflammation, scarring, and abnormal lung growth.
PathophysiologyArrested alveolar development (fewer, larger alveoli). Increased airway resistance. Decreased lung compliance. Pulmonary hypertension is a common complication.
Clinical ManifestationsTachypnea, retractions, nasal flaring, grunting. Chronic hypoxemia. Failure to thrive. Increased risk of pulmonary infections.
Diagnostic CriteriaOxygen requirement >21% for at least 28 days in an infant born at

임상 시나리오

Nursing Clinical Practice Guide Clinical Scenario: You are caring for Michael, a former 26-week preemie, now 2 months old (corrected age). He was diagnosed with BPD and is being prepared for discharge. He is on 0.5 L/min of low-flow nasal cannula oxygen. His mother is learning how to care for him at home.

Nursing Intervention Strategy: 1. Assessment: Continuously monitor respiratory rate, effort (look for retractions, nasal flaring), oxygen saturation (goal typically 90-95% to prevent further lung injury), and heart rate. Auscultate lung sounds for wheezes or crackles. Weigh daily to monitor growth. 2. Care & Education: - Oxygen Therapy: Teach safe use of home O2: no smoking, securing cannula, checking skin integrity, and understanding flow rate. - Nutrition: Emphasize high-calorie formula or fortified breast milk. Feeding may be exhausting; teach paced feeding and signs of fatigue (tachypnea, color change). - Infection Prevention: Stress strict hand hygiene. Ensure Michael receives Palivizumab (Synagis) injections for RSV prophylaxis as per schedule. - Developmental Care: Cluster care to conserve energy. Provide a calm, low-stimulation environment. 3. Evaluation: Evaluate for adequate weight gain, stable oxygenation, and parents' confidence in performing care and recognizing warning signs (increased work of breathing, lethargy, poor feeding).

Patient Safety and Precautions: - Avoid Over-Sedation: Use caution with medications that depress respiratory drive. - Fluid Balance: Strict intake and output monitoring; fluid overload can worsen pulmonary status. - Emergency Plan: Ensure parents know when to call 911 (severe retractions, cyanosis, inability to wake). Nursing Procedure & Medication Flow Administering a Bronchodilator (e.g., Albuterol) via Nebulizer to an Infant with BPD: 1. Assessment: Check respiratory status and heart rate baseline. Infants are prone to tachycardia from beta-agonists. 2. Preparation: Use a small, infant-sized mask. Hold the infant comfortably or have a parent hold them. 3. Administration: Place mask securely over nose and mouth. Administer medication over 5-10 minutes. Observe for improved breath sounds and work of breathing. 4. Monitoring: Monitor heart rate (watch for tachycardia > 180-200 bpm) and for tremors or irritability as side effects.

A Word from Your Senior Nurse: Caring for a BPD baby teaches you the true meaning of resilience—both the infant's and the family's. Your keen assessment skills are their first line of defense. Notice the subtle increase in respiratory rate from 50 to 70, the slight subcostal retraction that wasn't there before lunch. These are the clues that prevent an ER visit. On the NCLEX, they test your ability to recognize these classic patterns. In real life, you use that knowledge to be a vigilant advocate, ensuring these fragile lungs have every chance to grow stronger every day.

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