Cerebral Palsy Flashcards
Spastic (70% of all cases)
Tight stiff muscles
Can’t inhibit
Dyskinetic (athetoid)
Dystonia
Chorea- random dance like mvmts
Ataxic
Shaky or uncoordinated
Associated with cerebellum
Other symptoms
Pain from tight muscles and abnormal posture
Difficulty sleeping, leads to sleep disorders
Treatment
Aim is to improve quality of life
PT
Muscle relaxants
Surgery
ETIOLOGY
INTRAUTERINE INSULTS TO CNS
CONGENITAL
HYPOXIC
ISCHEMIC
INFECTIOUS
RATE OF CP INCREASES WITH DECREASING GESTATIONAL AGE
RISK FACTORS
INCREASED WITH ADVANCED OR YOUNG MATERNAL AGE
YOUNG PATERNAL AGE
AFRICAN AMERICAN ETHNICITY
MULTIPLE BIRTHS
CERTAIN MEDICAL DISORDERS SLIGHTLY INCREASE CHILD’S RISK OF CP
MATERNAL VIRAL INFECTION DURING PREGNANCY
PREVENTION
MATERNAL INFECTION PREVENTION
PREGNANT WOMEN KEEP CURRENT WITH VACCINATIONS
INJURY PREVENTION FOR INFANTS
CLINICAL MANIFESTATIONS
ABNORMAL MUSCLE TONE
LACK OF COORDINATION
SPASTICITY
DEVELOPMENTAL DELAYS
BACK ARCHING, LITTLE SPONTANEOUS MOVEMENT
VISUAL DEFECTS
FEEDING DIFFICULTIES
USUALLY DELAY IN DEVELOPMENTAL MILESTONES
DIAGNOSTIC TESTS
BASED ON CLINICAL FINDINGS:
ULTRASONOGRAPHY USED TO DETECT FETAL, NEONATAL ABNORMALITIES OF BRAIN
CT SCANS
MRI
PET SCANS
SURGERY
MAY BE NEEDED TO IMPROVE FUNCTION BY BALANCING MUSCLE POWER AND STABILIZING UNCONTROLLABLE JOINTS
ACHILLES TENDON LENGTHENED
HAMSTRINGS RELEASED
PROCEDURES TO IMPROVE HIP ADDUCTION, CORRECT FOOT’S POSITION, CUT AFFERENT FIBERS
PHARMACOLOGIC THERAPY
SEIZURE CONTROL
CONTROL SPASMS
MINIMIZE GI SIDE EFFECTS
BACLOFEN, ADMINISTERED BY INTRATHECAL PUMP
NONPHARMACOLOGIC
FOCUS ON DEVELOPING TO MAXIMUM LEVEL OF INDEPENDENCE
REFERRALS FOR PT, OT, SLP
BRACES, SPLINTS PROMOTE RANGE OF MOTION
EARLY INTERVENTION PROGRAMS
**PROGNOSIS DEPENDS ON LEVEL OF INVOLVEMENT
NURSING PROCESS
FOCUS ON
- EARLY INTERVENTION
- PREVENTION OF COMPLICATIONS
- SUPPORT OF CHILDREN AND FAMILIES
ASSESSMENT
HEALTH HISTORY
ASSESS AT EACH HEALTHCARE VISIT FOR DEVELOPMENTAL DELAYS
SCREENING ASSESSMENTS
DIAGNOSIS
NURSING DIAGNOSES MAY INCLUDE:
RISK FOR INJURY
IMPAIRED MOBILITY
RISK FOR CONSTIPATION
IMPAIRED TISSUE INTEGRITY
IMPAIRED VERBAL COMMUNICATION
IMPAIRED HOME MAINTENANCE
CHRONIC PAIN
DELAYED GROWTH AND DEVELOPMENT
CAREGIVER ROLE STRAIN
PLANNING
GOALS MAY INCLUDE THAT CLIENT WILL:
REMAIN FREE FROM INJURY
DEMONSTRATE APPROPRIATE GROWTH, DEVELOPMENT
MAINTAIN APPROPRIATE DIET TO MEET NUTRITIONAL NEEDS
MONITOR BONY PROMINENCES TO AVOID ALTERED SKIN INTEGRITY
IMPLEMENTATION
Prevent Injury
CLIENT NEEDS TO RECEIVE THE DEGREE OF ASSISTANCE REQUIRED FOR SAFE AMBULATION
ORTHOTIC AND ASSISTIVE DEVICES ARE PROPERLY USED
ELIMINATE ALL OBSTACLES FROM WALKWAYS
PROVIDE ADEQUATE LIGHTING
SAFETY BELTS FOR CHILDREN IN STROLLERS AND WHEELCHAIRS
IMPLEMENTATION
Provide adequate nutrition
HIGH-CALORIE DIETS, SUPPLEMENTS
MANY CHILDREN HAVE DIFFICULTY CHEWING AND SWALLOWING
IMPLEMENTATION
MAINTAIN SKIN INTEGRITY
PROTECT BONY PROMINENCES
MONITOR SKIN INTEGRITY
MAINTAIN BODY ALIGNMENT
IMPLEMENTATION
PROMOTE PHYSICAL MOBILITY
RANGE-OF-MOTION EXERCISES
ADAPTIVE, ASSISTIVE TECHNOLOGY
IMPLEMENTATION
PROMOTE GROWTH AND DEVELOPMENT
NOT NECESSARILY INTELLECTUALLY DISABLED
USE TERMINOLOGY APPROPRIATE FOR CHILD’S DEVELOPMENTAL LEVEL
HELP CHILD DEVELOP POSITIVE SELF-IMAGE
IMPLEMENTATION
FOSTER PARENTAL KNOWLEDGE
TEACH ABOUT CHILD’S SPECIAL NEEDS
TEACH ADMINISTRATION, DESIRED EFFECTS, AND SIDE EFFECTS OF MEDICATIONS PRESCRIBED FOR SEIZURES
NEED FOR DENTAL CARE FOR CHILDREN TAKING ANTICONVULSANTS
IMPLEMENTATION
Provide emotional support
PROVIDE EMOTIONAL SUPPORT
REFER TO COUNSELING IF APPROPRIATE
EVALUATION
EXPECTED OUTCOMES MAY INCLUDE:
CLIENT’S GROWTH IS APPROPRIATE FOR AGE
CLIENT MEETS DEVELOPMENTAL MILESTONES APPROPRIATE FOR AGE
CLIENT’S NUTRITIONAL STATUS IS ADEQUATE FOR AGE, ENERGY NEEDS
