Cerebral Palsy and 7 Cerebral Palsy Nursing Care Plan Examples

Cerebral Palsy and 7 Cerebral Palsy Nursing Care Plan Examples

This guide is about Cerebral Palsy and 7 Cerebral Palsy Nursing Care Plan Examples. It can be used in the development of educational nursing care plans for Cerebral Palsy.

Cerebral Palsy

What is Cerebral Palsy?

Cerebral Palsy and 7 Cerebral Palsy Nursing Care Plan Examples
Cerebral Palsy

Cerebral Palsy refers to a group of neurological disorders that affect body movement, balance, and posture. In many cases, speech, vision difficulties, seizure or cognitive problem are also affected. It is caused by the abnormal development or damage to a part of the brain that controls movement. It usually appears early in life, usually in infancy or early childhood.

Symptoms of a child with cerebral palsy vary from one person to person which may include: delayed in reaching developmental milestones, weakness in one or more arm or leg, lack of muscle coordination when performing voluntary movements (ataxia), muscle spasms, muscle tone that either are too stiff or too floppy, fidgety, jerky or clumsy movements, walking on tip-toes, or excessive drooling or difficulties swallowing or speaking.

There is no known cure for the condition, but supportive treatments, therapy, medications, and surgery are facilitated to improve the life of the child.

What are the Symptoms of Cerebral Palsy?

Signs and symptoms of cerebral palsy can vary greatly from person to person. Cerebral palsy can affect the whole body, or it might be limited primarily to one or two limbs, or one side of the body. Generally, signs and symptoms include problems with movement and coordination, speech and eating, development, and other problems.

Movement and coordination

  • Stiff muscles and exaggerated reflexes (spasticity), the most common movement disorder
  • Variations in muscle tone, such as being either too stiff or too floppy
  • Stiff muscles with normal reflexes (rigidity)
  • Lack of balance and muscle coordination (ataxia)
  • Tremors or jerky involuntary movements
  • Slow, writhing movements
  • Favoring one side of the body, such as only reaching with one hand or dragging a leg while crawling
  • Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing, a wide gait or an asymmetrical gait
  • Difficulty with fine motor skills, such as buttoning clothes or picking up utensils

Speech and eating

  • Delays in speech development
  • Difficulty speaking
  • Difficulty with sucking, chewing or eating
  • Excessive drooling or problems with swallowing

Development

  • Delays in reaching motor skills milestones, such as sitting up or crawling
  • Learning difficulties
  • Intellectual disabilities
  • Delayed growth, resulting in smaller size than would be expected

Other problems

Damage to the brain can contribute to other neurological problems, such as:

  • Seizures (epilepsy)
  • Difficulty hearing
  • Problems with vision and abnormal eye movements
  • Abnormal touch or pain sensations
  • Bladder and bowel problems, including constipation and urinary incontinence
  • Mental health conditions, such as emotional disorders and behavioral problems

The brain disorder causing cerebral palsy doesn’t change with time, so the symptoms usually don’t worsen with age. However, as the child gets older, some symptoms might become more or less apparent. And muscle shortening and muscle rigidity can worsen if not treated aggressively.

What are the Causes of Cerebral Palsy?

Cerebral palsy is caused by abnormal brain development or damage to the developing brain. This usually happens before a child is born, but it can occur at birth or in early infancy. In many cases, the cause isn’t known. Many factors can lead to problems with brain development. Some include:

  • Gene mutations that result in genetic disorders or differences in brain development
  • Maternal infections that affect the developing fetus
  • Fetal stroke, a disruption of blood supply to the developing brain
  • Bleeding into the brain in the womb or as a newborn
  • Infant infections that cause inflammation in or around the brain
  • Traumatic head injury to an infant, such as from a motor vehicle accident, fall or physical abuse
  • Lack of oxygen to the brain related to difficult labor or delivery, although birth-related asphyxia is much less commonly a cause than historically thought

What are the Risk factors of Cerebral Palsy?

A number of factors are associated with an increased risk of cerebral palsy.

Maternal health

Certain infections or toxic exposures during pregnancy can significantly increase cerebral palsy risk to the baby. Inflammation triggered by infection or fever can damage the unborn baby’s developing brain.

  • Cytomegalovirus. This common virus causes flu-like symptoms and can lead to birth defects if a mother has her first active infection during pregnancy.
  • German measles (rubella). This viral infection can be prevented with a vaccine.
  • Herpes. This infection can be passed from mother to child during pregnancy, affecting the womb and placenta.
  • Syphilis. This is a sexually transmitted bacterial infection.
  • Toxoplasmosis. This infection is caused by a parasite found in contaminated food, soil and the feces of infected cats.
  • Zika virus infection. This infection is spread through mosquito bites and can affect fetal brain development.
  • Intrauterine infections. This includes infections of the placenta or fetal membranes.
  • Exposure to toxins. One example is exposure to methyl mercury.
  • Other conditions. Other conditions affecting the mother that can slightly increase the risk of cerebral palsy include thyroid problems, preeclampsia or seizures.

Infant illness

Illnesses in a newborn baby that can greatly increase the risk of cerebral palsy include:

  • Bacterial meningitis. This bacterial infection causes inflammation in the membranes surrounding the brain and spinal cord.
  • Viral encephalitis. This viral infection similarly causes inflammation in the membranes surrounding the brain and spinal cord.
  • Severe or untreated jaundice. Jaundice appears as a yellowing of the skin. The condition occurs when certain byproducts of “used” blood cells aren’t filtered from the bloodstream.
  • Bleeding into the brain. This condition is commonly caused by the baby having a stroke in the womb or in early infancy.

Factors of pregnancy and birth

While the potential contribution from each is limited, additional pregnancy or birth factors associated with increased cerebral palsy risk include:

  • Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of developing cerebral palsy. This risk increases as birth weight drops.
  • Multiple babies. Cerebral palsy risk increases with the number of babies sharing the uterus. The risk also can be related to the likelihood of premature birth and low birth weight. If one or more of the babies die, the survivors’ risk of cerebral palsy increases.
  • Premature birth. Babies born prematurely are at higher risk of cerebral palsy. The earlier a baby is born, the greater the cerebral palsy risk.
  • Delivery complications. Problems during labor and delivery may increase the risk of cerebral palsy.

What happens when Cerebral Palsy Goes Untreated?

Muscle weakness, muscle spasticity and coordination problems can contribute to a number of complications either during childhood or in adulthood, including:

  • Contracture. Contracture is muscle tissue shortening due to severe muscle tightening that can be the result of spasticity. Contracture can inhibit bone growth, cause bones to bend, and result in joint deformities, dislocation or partial dislocation. These can include hip dislocation, curvature of the spine (scoliosis) and other orthopedic deformities.
  • Malnutrition. Swallowing or feeding problems can make it difficult for someone who has cerebral palsy, particularly an infant, to get enough nutrition. This can impair growth and weaken bones. Some children or adults need a feeding tube to get enough nutrition.
  • Mental health conditions. People with cerebral palsy might have mental health conditions, such as depression. Social isolation and the challenges of coping with disabilities can contribute to depression. Behavioral problems can also occur.
  • Heart and lung disease. People with cerebral palsy may develop heart disease, lung disease and breathing disorders. Problems with swallowing can result in respiratory problems, such as aspiration pneumonia.
  • Osteoarthritis. Pressure on joints or abnormal alignment of joints from muscle spasticity may lead to the early onset of this painful degenerative bone disease.
  • Osteoporosis. Fractures due to low bone density can result from several factors such as lack of mobility, inadequate nutrition and anti-epileptic drug use.
  • Other complications. These can include sleep disorders, chronic pain, skin breakdown, intestinal problems and issues with oral health.

How Can Cerebral Palsy be Prevented?

Most cases of cerebral palsy can’t be prevented, but you can reduce risks. If you’re pregnant or planning to become pregnant, you can take these steps to keep healthy and minimize pregnancy complications:

  • Make sure you’re vaccinated. Getting vaccinated against diseases such as rubella, preferably before getting pregnant, might prevent an infection that could cause fetal brain damage.
  • Take care of yourself. The healthier you are heading into a pregnancy, the less likely you’ll be to develop an infection that results in cerebral palsy.
  • Seek early and continuous prenatal care. Regular visits to your doctor during your pregnancy are a good way to reduce health risks to you and your unborn baby. Seeing your doctor regularly can help prevent premature birth, low birth weight and infections.
  • Avoid alcohol, tobacco and illegal drugs. These have been linked to cerebral palsy risk.

Rarely, cerebral palsy can be caused by brain damage that occurs in childhood. Practice good general safety. Prevent head injuries by providing your child with a car seat, bicycle helmet, safety rails on the bed and appropriate supervision.

7 Cerebral Palsy Nursing Care Plan Examples

How do you care for someone with cerebral palsy?

Cerebral Palsy and 7 Cerebral Palsy Nursing Care Plan Examples
7 Cerebral Palsy Nursing Care Plan Examples

Nursing goals for a client with cerebral palsy include optimize mobility and prevent deformity, improve nutritional status, strengthen family support, foster self-care, enhanced communication and provide quality of life.

Here are seven (7) nursing care plans (NCP) and nursing diagnosis (NDx) for cerebral palsy:

  1. Impaired Physical Mobility
  2. Imbalanced Nutrition: Less than Body Requirements
  3. Impaired Verbal Communication
  4. Ineffective Therapeutic Regimen Management
  5. Risk for Injury
  6. Risk for Delayed Growth and Development
  7. Risk for Self-Care Deficit

1. Impaired Physical Mobility

Nursing Diagnosis

  • Impaired Physical Mobility

May be related to

  • Disease condition (Cerebral Palsy)
  • Decrease muscle control
  • Neuromuscular impairment

Possibly evidenced by

  • Inability to control lower extremities
  • Limited range of motion (ROM)
  • Muscle spasm

Desired Outcomes

  • Child/infant will achieve maximum movement ability and absence of contractures.
Nursing Interventions Rationale
Assess the type of auditory, visual, motor, or intellectual deficit. Knowing the type of deficit will aid in planning interventions appropriate for the child.
Do a developmental assessment and note the development of milestones (such as stand with help, or walk when led). A client with cerebral palsy usually has delayed developmental milestones.
If one skill is attained, interventions are changed in order to achieve
the succeeding one.
Facilitate activities in using fine and gross motor skills (such as giving a ball on hand to encourage throwing, holding a spoon) Most of the activities of daily living and
play exercises hasten physical
development.
Allow the child to perform activities or care routines at his or her own pace. A child may have difficulty completing tasks in time compared to normal children.
Encourage the child to rest between activities that are tiring. Given the limitations of the child’s ability, rest periods are given to maintain energy.
Perform range-of-motion exercises
every 4 hours for the child unable to move body parts.
Children with cerebral palsy have a decreased range of motion (ROM) due to limited mobility and the presence of spasticity. ROM exercises promote movement and minimize the risk of contractures.
Educate the family on how to use an orthotic device as indicated. Orthotic devices help build stability while increasing strength, balance, comfort, and independence.
Administer medications as prescribed: 
  • Anticholinergics (e.g., Benztropine mesylate)
These medications are used to treat uncontrolled body movements such as tremors, muscle stiffness, and spasms.
  • Muscle relaxants (e.g., Baclofen [Lioresal])
These medications are used to relax contracted, overactive, or stiff muscles.
  • Anticonvulsants (e.g., Gabapentin [Neurontin])
These medications are given to reduce or prevent seizure activity.
Assist the parents in referring the child to a rehabilitation therapist as appropriate. A rehabilitation therapist
can provide specialized services in promoting effective mobility.

2. Imbalanced Nutrition: Less than Body Requirements

Nursing Diagnosis

  • Imbalanced Nutrition: Less Than Body Requirements

May be related to

  • Increased metabolic needs
  • Inability to ingest food properly

Possibly evidenced by

  • Difficulty chewing, swallowing and sucking
  • Inadequate caloric intake
  • Uncoordinated hand movement
  • Underweight

Desired Outcomes

  • Child/infant takes adequate amount of calories or nutrients needed for normal growth.
Nursing Interventions Rationale
Monitor and record height and weight. These anthropomorphic assessments are vital that they need to be accurate. These will be used as a basis for caloric and nutrient requirements.
Assess the infant sucking and swallowing ability. Infants with cerebral palsy often suck poorly due to the uncoordinated movements of the lips, tongue, and jaw and tongue thrusting make them push food out of their mouth.
Offer small frequent meals more throughout the day. Adequate time is required between meals to allow for natural swallowing.
Position the child upright during
feedings.
Aspiration pneumonia is a risk for
a child with poor swallowing.
Use soft and blended foods. Foods can be softened by combining it with milk, juice, or broth to avoid aspiration. Liquids can be thickened to facilitate safety and ease in swallowing.
Encourage adequate fluid intake and high fiber foods such as wholegrain cereals, fruit, and vegetables. High fiber diet and increase fluid intake avoid constipation.
Offer high protein supplements based on individual needs and capabilities. Such supplements can be used to increase calories and protein without conflict with voluntary food intake.
Teach the family regarding proper enteral tube feeding as appropriate. Enteral tube feeding is indicated in children with CP who are unable to meet their nutritional requirements orally.

3. Impaired Verbal Communication 

Impaired Verbal Communication 

Nursing Diagnosis

  • Impaired Verbal Communication

May be related to

  • Neurologic impairment

Possibly evidenced by

  • Difficulty vocalizing words
  • Difficulty discerning and maintaining the usual communication pattern

Desired Outcomes

  • Children will verbally make essential needs known to health care providers and family members.
Nursing Interventions Rationale
Learn patient needs and pay attention to nonverbal cues. The nurse should set aside enough time to attend to all of the details of patient care. Care measures may take longer to complete in the presence of a communication deficit.
Maintain a calm, unhurried manner. Provide ample time for the child to respond. Hurrying up the child’s speech will make it less clear and communications will be impaired.
Keep distractions such as television and radio at a minimum when talking to the child. Removing such distractions maintain the focus of the child, and decreases stimuli going to the brain for interpretation.
Provide an alternative means of communication. Alternative form such as flash cards, whiteboards, hand signs or a picture board allows the client to express oneself if speaking is difficult to obtain.
Involve family and significant others in the plan of care as much as possible. Enhances participation and commitment to plan.
Coordinate the child with a speech therapist as indicated. A speech therapist helps the child with cerebral palsy in learning how to speak slowly and how to coordinate their lips and tongue to form speech sounds.

4. Ineffective Therapeutic Regimen Management

Nursing Diagnosis

  • Ineffective Therapeutic Regimen Management

May be related to

  • Excessive demands made on family with child’s complex care
    needs
  • Knowledge deficits of prescribed regimen

Possibly evidenced by

  • Anxious parents
  • Verbalized difficulty with prescribed regimen

Desired Outcomes

  • Family will adapt to growth and development needs of a child with cerebral palsy.
Nursing Interventions Rationale
Encourage the parent to express the impact of their child’s condition on the family. Helps the parents to vent their feelings/concerns.
Assess the coping ability of the family. This will determine how much support and guidance the family may need.
Evaluate the child’s various progress and commend the family for care provided during the home visits. The child’s progress is a
positive reinforcement of the family’s efforts in handling the situation.
Educate the family on different skills needed to manage the child’s care (such as physical rehabilitation, proper nutrition, medication administration, ROM exercises, seizure management). Complex skills must be learned
before they can be performed with
competence.
Involve siblings in the care of the
child with cerebral palsy.
Siblings of the child with cerebral
palsy may feel neglected because of
the care provided. Special efforts
contribute to meeting the
developmental needs of all family
members.
Provide referral to other parents and support groups. These support groups will enable the family to learn and integrate their experience into their own.
Explore community services for
rehabilitation, respite care,
childcare, and other needs and
refer family as appropriate.
Diverse services are available and
will be needed due to the multiple
impacts of cerebral palsy on the
child.

5. Risk for Injury 

Nursing Diagnosis

  • Risk for Injury

May be related to

  • Impaired motor function
  • Seizure activity

Possibly evidenced by

  • [not applicable]

Desired Outcomes

  •  Child will be protected and free from injury.
Nursing Interventions Rationale
Assess level of consciousness Decrease alertness, arousal, eye-opening, or verbal response may indicating deteriorating neurological status hence a seizure will likely to happen.
Explain to the parents on different stimuli that can trigger a seizure activity. Bright flashing lights, lack of sleep, and lengthy exposure to television or computer games may precipitate a seizure activity.
Provide a safe environment for the child by wearing protective gear (helmet, kneepads) if needed. The use of helmet and kneepads may provide added protection for individuals during a seizure activity.
Assist the child in performing ADL Decreases the occurrence of injuries that can worsen the child’s condition.
Institute seizure precautions such as keeping padded side rails up with the bed in its lowest position. Decreases the incidence of fall should a seizure happen while the child is in bed.
Administer benzodiazepines (e.g., Diazepam [Valium]) as prescribed. Benzodiazepines are commonly used in treating cerebral palsy that acts as anticonvulsants, muscle relaxants, and anti-anxiety drugs.
Coordinate with a physical therapist for strengthening exercises and gait training as appropriate. Proper gait training in physical therapy has been shown to prevent falls.

6. Risk for Delayed Growth and Development

Nursing Diagnosis

  • Risk for Delayed Growth and Development

May be related to

  • Activity restrictions
  • Environmental and stimulation deficiencies

Possibly evidenced by

  • [not applicable]

Desired Outcomes

  • Child will receive environmental stimulation; express interest in people and activities around him/her; attends school setting that is as free of restrictions as possible.
Nursing Interventions Rationale
Reassess developmental levels at intervals appropriate for illness or other problem (specify). Provides evidence of progress to evaluate the care plan to improve any deficit in the growth and development.
Explore the family’s feelings regarding child’s health condition and required treatments. Encourages an attitude of acceptance and adjustment to child’s abilities and health status.
Provide positive encouragement to a child while doing his/her activities. As children learn how to perform activities themselves, it can promote a feeling of self-worth.
Encourage age-related play and other activities that strengthen gross and fine motor development, sensory and cognitive development such as letting the child put green balls on the left basket and red balls on the right. These activities enhance growth and development and provide needed stimulation for the child.
Choose appropriate toys that match an individual child’s skills to play with it. Choose a toy that is easy to grasp since some children with cerebral palsy have difficulty in gripping.
Initiate referral to an occupational therapy as appropriate. Occupational therapy improves physical, cognitive and social abilities, motor skills and posture of a child with cerebral palsy.
Encourage the parent to enroll the child in a school program. A school program that is consistent with the child’s intellectual abilities is necessary to provide needed outside exposure.

7. Risk for Self-Care Deficit

Nursing Diagnosis

  • Risk for Self-Care Deficit

May be related to

  • Impaired mobility
  • Cognitive changes
  • Decrease muscle strength and endurance

Possibly evidenced by

  • [not applicable]

Desired Outcomes

  • Child will safely perform self-care activities to utmost capability.
Nursing Interventions Rationale
Assist the child to learn self-care measures (e.g., eating, toothbrushing, toileting, bathing, and dressing). Learning these self-care skills will enable the client to gain self-esteem from accomplishing them.
Advise the parents to supervise the child during bathing. Due to the lack of muscle coordination, the child is at risk of slip underwater and drowning.
Provide modification techniques self-care activities such as putting straps on their feeding utensil or toothbrush. These straps allow the child to securely hold them and have an ease in utilizing.
Use energy-conservation techniques. Decreases fatigue, and improves child’s capability to execute tasks.
Encourage parents to increase intake of high-roughage foods such as whole grain foods, vegetables, and fruits. These food items aid in bowel evacuation and prevent constipation.
Encourage the parent to provide adequate time for the child to finish self-care activities. Letting the child to completely finish self-care measures will give them confidence and feeling of self-worth.

 

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