Cerebral palsy (CP) and Nursing Care Plan

cerebral palsy

• CP is a non-progressive CNS disorder of strength, muscle control, posture or movement due to brain injury occurring early during brain growth. It can occur from developmental defects in the brain or trauma at birth or shortly after birth.

• Incidence

– 3.3% per live births

– 10% of low birth weight babies less than 1 kg.

– 50% of preterm babies with intraventricular hemorrhage.

 

Signs of Cerebral Palsy

• Physical signs

– Poor head control after 3 months

– Stiff or rigid arms or legs

– Pushing away or arching back

– Floppy or limp body posture

– Can not sit without support by 8 months

– Use only one side of the body or one arm to crawl

• Behavioral signs

– Extreme irritability or crying

– Failure to smile by 2 months

– Feeding difficulties

– Persistent choking while feeding

– Tongue pushes soft food out after 6 months

 

Types of Cerebral Palsy

• Spastic (Pyramidal)

• Hypotonic (Extrapyramidal)

• Choreoathetoid

• Ataxic

• Dystonic: Increased muscle tone, involuntary movements and speech impairments

• Mixed

Associated disabilities with Cerebral palsy

• Disturbed mental development

• Seizures

• Growth retardation

• Sensory impairment

• Visual impairment

• Hearing impairment

• Speech impairment

• Gait disturbance

 

Management of Cerebral Palsy

Early Intervention

• The earlier disabled children are given rehabilitation and education, the better they are able to realize their full potential later in life.

- Early intervention can have a really positive impact on a child’s life.

Physiotherapy

- Physiotherapy is extremely beneficial and the children love the interaction

Feeding

• Three finger jaw control helps in swallowing

• Speech therapy helps in better swallowing

- Care and dignity when feeding a disabled child improve trust and ensure a healthy, happy child.

Children with learning disabilities

- Encourage appropriate use of the curriculum and teacher’s guide for mentally disabled children.

- A teacher using teaching materials she has made herself and adapted to the individual needs of this child.

Children with hearing and visual impairments

- Special technical skills and training are to be provided to help deaf or blind children.

- Teaching self help skills through play for blind children.

 

Nursing care plan for Cerebral Palsy

Nursing diagnosis

Intervention

Rationale

Outcome

1. Altered health maintenance R/T deviations from normal growth and development.

- Teach parents the special care needed.

- Teach them the techniques for feeding.

- Plan activities so that rest and sleep are facilitated.

-Stress regular follow up and need for physiotherapy.

- Helps better understanding.

- Child may have feeding & swallowing difficulties.

- Fatigue increases symptoms of CP.

- PT helps to improve posture and prevent contractures.

Child maintains optimum level of health.

 2. High risk for impaired nutrition R/T feeding difficulties.

 - Plan a balanced age appropriate menu.

- Use 3 – finger jaw control technique for feeding.

- Excessive drooling is managed by frequent wipes.

- Correction of dental problems and speech therapy.

- Prevent nutritional deficiencies.

- Assists  the child to take the food from spoon.

- Enhances hygiene and helps in swallowing.

 Child gets adequate nutrition

 3. Altered elimination pattern R/T poor toilet training.

- Observe changes in child’s behavior indicating need for elimination.

- Establish a regular pattern for toilet training, 15- 20 minutes after a meal.

- Encourage positive behaviors.

- Enhance fluid intake.

 - Signaling behaviors show child is ready for toilet training.

- A routine pattern facilitates easy training.

- Reinforces acceptable behaviors.

- Prevents constipation.

 Child attains toilet training.

4. High risk for infection & injury R/T immobility.

- Good skin care.

- Food hygiene.

- Avoid contacts with people having infection.

- Vaccinations according to schedule.

- Prevent fall & injury by side rails or belts.

- Prevents skin breakdown.

- Prevent GI infections.

- Protective isolation.

- Provide immunity.

Child remains free from infection.

5. Knowledge deficit of parents.

- Health education to parents regarding all aspects of child’s care.

Parents demonstrate skill in caring for the child.

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