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1538 - Test 3 (Mobility, Cellular Regulation) > Mobility - Cerebral Palsy > Flashcards

Mobility - Cerebral Palsy Flashcards

1
Q

What is Cerebral Palsy (CP)

A

Cerebral Palsy is a disorder of the neuromuscular dysfunction.

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2
Q

Is cerebral palsy curable?

A

NO: CP is a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain

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3
Q

What causes CP?

A

Anoxia APPEARS to play the most significant role in causation.

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4
Q

What is Anoxia?

A

Anoxia is the absence of oxygen reaching the tissues

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5
Q

What are some risk factors of CP (prenatal)?

A
  • Premature Birth
  • existing prenatal brain abnormalities
  • maternal infections
  • multiple births
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6
Q

What are some risk factors of CP (postnatal)?

A
  • perinatal ischemic stroke
  • bacterial meningitis
  • viral encephalitis
  • Motor vehicle accidents
  • Child abuse (shaken baby syndrome)
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7
Q

single MOST important risk for CP:

A

PREMATURITY

  • *increased risk with birth weight 1000-1499 grams OR
  • *born prior to 28 week gestation completed
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8
Q

What types of CP are there?

A

Spastic (pyramidal) CP
Dyskinetic (nonspastic, extrapyramidal) CP
Ataxic (nonspastic, extrapyramidal) CP
Mixed: most commonly a mixture of spastic + dyskinetic

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9
Q

How is CP diagnoised?

A

-DXd via neurologic examination + history
^^^are there delayed developmental
milestones?
**infants at high-risk are monitored CLOSELY

-neuroimaging
^^^MRI + head ultrasound

-metabolic + genetic testing if NO structural abnormalities are identified

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10
Q

What are the S/S of CP in 0-6 month olds?

A
  • *poor head control
  • **feels stiff or floppy when held
  • clenched fists
  • failure to smile
  • poor sucking
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11
Q

What are the S/S of CP in 6-10 month olds?

A
  • *Inability to sit by 8 months
  • tongue pushing food out of mouth
  • difficulty bringing their hands to the center
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12
Q

What are the S/S of CP in 10+ month olds?

A
  • *using one side of the body to crawl
  • walking on toes
  • not speaking simple sentences by 24 months
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13
Q

Is CP progressive?

A

NO; cerebral palsy is NOT a progressive disease - prognosis depends on severity of impairment

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14
Q

Mild-Moderate CP

A

**usually able to participate in regular classes
85% have the ability to achieve ambulation between 2 - 7 years of age
-can usually participate in recreational activities

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15
Q

Moderate-Severe CP

A
  • *may have cognitive impairments

- often succumb to respiratory tract infection in childhood due to impaired mobility and feeding problems

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16
Q

CP & Seizures

A

***Development of SEIZURES is COMMON in patients with CP

17
Q

Independence and CP

A

**Normalization and promotion of self care activities that EMPOWER the child AND family is CRITICAL to nursing management

***One of the MOST USEFUL INTERVENTIONS to help children cope with immobility is participation in their OWN CARE!!!

18
Q

What are some “negative consequences” of immobility?

A
  • *feelings of helplessness/hopelessness
  • boredom
  • depression
  • grieving
  • anxiety
  • anger
  • disturbed body image
  • decreased verbal and nonverbal communication
19
Q

Functional Ability & CP

A
  • *goal is to promote MOBILITY & INDEPENDENCE
  • *Manual or powered WHEELCHAIRS allow for more independent mobility
  • strollers can be equipped with custom seats for dependent mobilization
  • ankle-foot orthoses (**AFO’s & braces)
20
Q

CP contractures - nursing interventions

A
  • *HIP SURVEILLANCE
  • ROM exercises
  • orthopedic surgery
21
Q

CP & Surgical Intervention

A
  • *goal is to IMPROVE FUNCTION of affected areas (not to cure CP)
  • used only after conservative methods have failed
  • correct deformities from spasticity
22
Q

CP & skin breakdown

A
  • *INCREASED RISK for children with orthotics and assistive devices
  • pressure areas
  • malalignment
  • poor bracing
  • nutrition
  • immobility
23
Q

Family support & CP

A
  • *One of the most valuable nursing interventions in care of the child with CP is FAMILY SUPPORT!
  • help in COPING with the emotional aspects of the disorder
  • provide education, assessment, and mobilization of resources
  • *stress principles of NORMALIZATION
24
Q

Parents & CP

A

**Parents SUPPORT GROUPS are most helpful through sharing experiences and accomplishments!

25
Q

CP & ADL: dental hygiene

A

DENTAL HYGIENE is ESSENTIAL

  • regular visits to the dentist
  • decreased oral intake can lead to more tartar buildup!
26
Q

CP & fatigue

A

**more frequent REST PERIODS should be arranged to avoid fatigue

27
Q

CP & Nutrition

A

The diet should be tailored to the child’s ACTIVITY & METABOLIC needs

  • *Gastrostomy feedings MAY be necessary to supplement regular feedings and ensure adequate weight gain
  • *CONSTIPATION management due to neurologic deficits and lack of exercise, may be necessary
28
Q

CP & Muscle spasms

A
  • *Intense pain may occur

* *PAIN MANAGEMENT is an important aspect of the care

29
Q

CP & Medications (for pain)

A

Oral pharmacologic agents for CP include:

  • baclofen (Lioresal) & diazepam (Valium)
  • **DIAZEPAM should be RESTRICTED to older children and adolescents
  • gabapentin (Neurontin) has been used for decreasing SPASTICITY PAIN
30
Q

CP & Botox

A

**Botulinum toxin A (Botox) is also used to
reduce spasticity in targeted muscles.
^^^minimizes muscle contractures

**often used in the LOWER EXTREMITIES
^^^delays or minimizes the need for
surgical procedures

  • the goal is to allow stretching of the muscle as it relaxes and permit ambulation with an AFO
  • onset of action occurs within 24 - 72 hours, with a peak effect observed at 2 weeks and a duration of action of 3 - 6 months
31
Q

CP & Baclofen pump

A

-Implantation of a pump to infuse baclofen directly into the intrathecal space surrounding the spinal cord to provide relief of spasticity
**best suited for children with SEVERE
SPASTICITY
^^^provides relief without as many side
effects

  • the pump is placed in the subcutaneous space of the mid-abdomen. An intrathecal catheter is tunneled from the lumbar area to the abdomen and connected to the pump.
  • outpatient visits to refill the pump and make dosage adjustments are scheduled about every 3 - 6 months depending on the patients response to the treatment.
32
Q

CP & collaborative care: physical therapy

A

**PHYSICAL THERAPY is one of the MOST frequently used treatment modalities.
^^^should involve the family; the physical therapist; and often other members of the healthcare team
»stretching, passive, active, and resistive movements applied to specific muscle groups or joints to maintain or increase ROM, strength, or endurance

33
Q

CP & collaborative care: occupational therapy

A

**OCCUPATIONAL THERAPY (OT) to help with posture and participation in ADLs

34
Q

CP & collaborative care: speech therapy

A

**SPEECH THERAPY (OT) to improve communication abilities and help with swallowing disorders

35
Q

CP & collaborative care: recreational therapy

A

**REC THERAPY to expand physical and cognitive abilities

36
Q

CP & Safety

A
  • **risk for altered perception and SUBSEQUENT FALLS
  • *ADAPT THE HOME and play environments to meet the child’s needs to prevent bodily harm
  • immunizations such as FLU or pneumonia in addition to normal well child vaccines
  • *REAR-FACING CAR SEATS as long as possible because of their poor head, neck and trunk control

1538 - Test 3 (Mobility, Cellular Regulation) (5 decks)

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