Cerebral palsy Done by :ROAA HAJJAM

Intern student nurse

Objectives At the end of this presentation my expectations to be able :•Recognize the causes of having child with cerebral palsy .•Identify the clinical feature of the syndrome •Anticipate how to diagnose and what is the prognosis of the disease.•List the medical resources that can help patient with this disability .•Create care plan for patient with cerebral palsy.

Introduction • CP is nonspecific term applied to neurologic disorders

characterized by early onset and impaired movement and posture, it is non-progressive and may be accompanied by perceptual problems, language deficits, and intellectual involvement.

Etiology • A)prenatal.• -Exposures to radiation or toxins.• - diabetes or hyperthyroidism.- Genetic abnormalities.- Incompetent cervix.- Medication use.

• B) birth and delivery.• -Prolonged rupture of membranes.• -Fetal heart depression.• -Abnormal presentation.• -Long labor.

• C) Perinatal.• Sepsis or central narvous system infection.• seizures.• Meconium aspiration .

• D) Childhood , postnatal.• Brain injury • Meningitis.

Clinical feature • Speech impairment • Pulmonary disease.• Orthopedic disorder.• Urinary disorders .• Growth failure.• Dystonia .• Ataxic syndrome.• Visual disorder.• Psychiatric disorders.• Learning disabilities.

Diagnosis and prognosis • Diagnosis of cerebral palsy is not always easy ,and it needs a

lot of examinations to determine the case.• Cerebral palsy diagnosis is usually made during the first 18

months and up to the first three years of a child’s life.

• Usually the prognosis is very poor and depend mainly on the improvement of the patient and family quality of life.

Multidisciplinary team • Medical –surgical team • Social and emotional developmental .• Nutrition. • Occupational therapy.• Psychological therapy. • Life style modification consultation.

Treatment goal • Interventions for CP should be directed at maximizing the

quality of life by improvement and reduction of extent of disability.

• The patient should achieve maximal independence in the activity at home with the help of family.

Medical resources

•Sultan bin Abdul-Aziz human train city .•Disabled children association .

Nursing care plane 1) Impaired Physical Mobility related to decreased muscle strength and

control.

2) 2. Sensory/Perceptual Alteration: Visual or Auditory related to cerebral damage.

3) . Altered Nutrition: Less than Body Requirements related to difficulty in chewing and swallowing and high metabolic needs.

4) 4. Ineffective Management of Therapeutic Regimen: Family related to excessive demands made on family with child’s complex care needs .

Goal Nursing interventions Expected out comes

The pt will attain maximum

physical abilities possible. ■ Perform development assessment

and record age of achievement ofmilestones (e.g., reaching forobjects, sitting)

■ Plan activities to use gross and finemotor skills (e.g., holding pen oreating utensils, toys positioned toencourage reaching and rollingover)

■ Allow time for the pt tocomplete activities

■ Perform range-of-motion exercisesevery 4 hours for the pt unableto move body parts. Position thept to promote tendon stretching(e.g., foot plantar flexion instead ofdorsiflexion, legs extended insteadof flexed at knees and hips)

■ Arrange for and encourage parentsto keep appointments with arehabilitation therapist.

■ Teach the family to maintainappropriate brace wear.

The pt reaches maximum physicalmobility and all developmental

Milestones.

Goal Nursing intervention Expected outcomes

The pt will receive and benefitfrom varied forms of sensory andperceptual input.

Facilitate eye and auditoryexaminations by specialist. Promotethe use of adaptive devices (glasses,contact lenses, hearing aids), andencourage recommended returnvisits to specialists.

■Maximize the use of intact senses(e.g., describe verbally thesurroundings to pt with poorvision, allow touching of objects,provide visual materials to enhancelearning in the pt with impairedhearing, use computers to promotecommunication).

The pt receives adequatesensory/perceptual input to maximizedevelopmental outcome.

3. Altered Nutrition: Less than Body Requirements related to difficulty in chewing and swallowing and high metabolic needs.

Goal Nursing interventions Expected outcomes

The pt will receive nutrientsneeded for normal growth.

■Monitor height and weight andplot on a growth grid. Performhydration status assessment.

■ Teach the family techniques topromote caloric and nutrientintake:

■ Position the pt upright forfeedings.

■ Place foods far back in themouth to overcome tonguethrust.

■ Use soft and blended foods. ■ Allow extra time and quiet

environment for meals. ■ Perform frequent respiratory

assessment. Teach the family toavoid aspiration pneumonia. Teachcare of gastrostomy and tubefeeding technique as appropriate.

The pt shows normal growthpatterns for height, weight, and other

physical parameters.

REFERENCES

• www.uptodate.com• Nursing care of infants and children 5th edition .