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Wednesday, April 6, 2011

NCP Nursing Care Plans for Cerebral Palsy

NCP Nursing Care Plans for Cerebral Palsy. Cerebral palsy the most common crippling disease in children includes several neuromuscular disorders resulting from prenatal, perinatal, or postnatal central nervous system damage. Cerebral palsy, a disorder that affects motor skills, muscle tone, and muscle movement, is a disorder which is most commonly due to damage during prenatal, perinatal, and postnatal periods during the pregnancy process. Although nonprogressive, these disorders may become more obvious as an affected infant grows older.
Types of cerebral palsy:
  • Spastic cerebral palsy (affecting about 70% of children with cerebral palsy)
  • Athetoid cerebral palsy (affecting about 20%)
  • Ataxic cerebral palsy (affecting about 10%)
  • Mixed cerebral palsy
Incidence of cerebral palsy is highest in premature neonates and in those who are small for gestational age. Cerebral palsy is slightly more common in boys than in girls and occurs more commonly in whites.

Causes for Cerebral Palsy
About 40% of all cases, the cause for cerebral palsy is unknown. The most prevalent cause of cerebral palsy is prenatal factors. Cerebral palsy usually stems from conditions that result in cerebral anoxia, hemorrhage, or other damage. Conditions that cause these problems can occur before, during, or after birth.
  1. Prenatal causes include Rhesus (Rh) factor or ABO blood type incompatibility, maternal infection (especially rubella in the first trimester), maternal diabetes, irradiation, anoxia, toxemia, malnutrition, abnormal placental attachment, and isoimmunization.
  2. During parturition, conditions that can cause cerebral palsy include trauma during delivery, depressed maternal vital signs from general or spinal anesthesia, asphyxia from the cord wrapping around the neck, prematurity, prolonged or unusually rapid labor, and multiple births
  3. Postnatal causes include infections, such as meningitis and encephalitis, head trauma, poisoning, and any condition that results in cerebral thrombus or embolus.
Complications for Cerebral Palsy
• Cerebral palsy may produce complicating conditions, including
• Language and perceptual deficits speech, vision, and hearing problems
• Mental retardation
• Dental problems
• Respiratory difficulties, such as poor swallowing and gag reflexes.

Nursing Assessment Nursing Care Plans for Cerebral Palsy
The patient's history and physical examination findings, including results of the neurologic assessment, confirm the diagnosis of cerebral palsy.
  • Patient history, maternal history often reveals the possible cause of cerebral palsy. Patients who have mixed forms of the disorder may display a combination of clinical findings
  • Generally, inspection reveals a child with retarded growth and development. If you observe the patient eating, you may notice that he has difficulty chewing and swallowing. Other findings vary depending on the type of cerebral palsy.
  • Neurologic examination may reveal hyperactive deep tendon reflexes and increased stretch reflexes, rapid alternating muscle contraction and relaxation, and weakness. Muscle contraction in response to manipulation with a tendency toward contractures also occurs.
Diagnostic tests for Cerebral Palsy
Appropriate tests are performed to diagnose conditions associated with cerebral palsy and to determine the degree of visual, auditory, and mental impairment.
  • Brain scans; Magnetic resonance imaging (MRI), Cranial ultrasound, Computerized tomography (CT)
  • Electroencephalogram (EEG)
  • Vision impairment tests
  • Hearing impairment tests
  • Speech delays or impairments tests
  • Intellectual disabilities or mental retardation tests
  • Other developmental delays tests
Nursing diagnosis Nursing Care Plans for Cerebral Palsy
  • Chronic low self-esteem
  • Compromised family coping
  • Deficient knowledge (diagnosis and treatment)
  • Delayed growth and development
  • Disturbed body image
  • Disturbed sensory perception: Visual, hearing
  • Imbalanced nutrition: Less than body requirements
  • Impaired physical mobility
  • Impaired swallowing
  • Interrupted family processes
  • Risk for impaired parenting
  • Risk for impaired skin integrity
Nursing Key outcomes Nursing Care Plans for Cerebral Palsy
Nursing Key outcomes Nursing Care Plans for Cerebral Palsy, Patient will:
  • Verbalize feelings related to self-esteem.
  • Develop adequate coping mechanisms.
  • Demonstrate knowledge of the condition and the treatment plan.
  • Achieve age-appropriate growth, behaviors, and skills to the fullest extent possible.
  • Express positive feelings about himself.
  • Maintain optimal functioning within the limits of the visual or hearing impairment.
  • Remain oriented to person, place, time, and situation.
  • Consume adequate daily calories as required.
  • Maintain joint mobility and ROM.
  • Swallow without pain or aspiration.
  • Family members will discuss how the patient's condition has affected the family's daily life.
  • The parents will identify realistic goals according to the abilities of the child.
  • Skin will show no signs of breakdown.
Nursing interventions Nursing Care Plans for Cerebral Palsy
  • Self-Esteem Enhancement, Emotional Support, Body Image Enhancement: Assisting a patient to increase his/her personal judgment of self-worth. Provision of reassurance, acceptance, and encouragement during times of stress. Improving a patient’s conscious and unconscious perceptions and attitudes toward body
  • Family Involvement Promotion, Family Support, Family Mobilization: Facilitating family participation in the emotional and physical care of the patient. Promotion of family values, interests, and goals. Utilization of family strengths to influence patient’s health in a positive direction
  • Teaching Individual Planning, implementation, and evaluation of a teaching program designed to address a patient’s diagnosis and treatment. Learning Facilitation Promoting the ability to process and comprehend information Learning Readiness Enhancement Improving the ability and willingness to receive information.
  • Developmental Enhancement Child, Developmental Care: Facilitating or teaching parents/caregivers to facilitate the optimal gross motor, fine motor, language, cognitive, social, and emotional growth of preschool and school-age children/of individuals during the transition from childhood to adulthood Structuring the environment and providing care in response to the behavioral cues and states of the preterm infant. Nutritional Monitoring: Collection and analysis of patient data to prevent or minimize malnourishment
  • Self-Esteem Enhancement Assisting a patient to increase personal judgment of self-worth
  • Communication Enhancement, Environmental Management: Hearing/Vision Deficit: Assistance in accepting and learning alternative methods for living with diminished hearing/vision, Manipulation of the patient’s surroundings for therapeutic benefit
  • Nutrition Management, Weight Gain Assistance, Eating Disorders Management: Assisting with or providing a balanced dietary intake of foods and fluids, Facilitating gain of body weight.
  • Exercise Therapy: Use of active or passive body movement to maintain or restore flexibility; use of specific activity or exercise protocols to enhance or restore controlled body movement.
  • Swallowing Therapy, Aspiration Precautions: Facilitating swallowing and preventing complications of impaired swallowing. Prevention or minimization of risk factors in the patient at risk for aspiration
  • Family Process Maintenance, Family Integrity Promotion, Normalization Promotion: Minimization of family process disruption effects. Facilitating family participation in the emotional and physical care of the patient. Assisting parents and other family members of children with chronic diseases or disabilities in providing normal life experiences for their children and families
  • Skin Surveillance, Pressure Management, Pressure Ulcer Prevention: Collection and analysis of patient data to maintain skin and mucous membrane integrity. Minimizing pressure to body parts. Prevention of pressure ulcers for a patient at high risk for developing them


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