Nursing Care Plan (NCP) for Cerebral Palsy (CP)

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Outline

Pathophysiology

Cerebral palsy (CP) is a common group of neurological developmental disorders that affect a person’s ability to move as well as muscle tone and posture. Patients with CP often have spastic movements, lack of muscle coordination, excessive drooling or problems with speech. There is no known cure for this condition, but treatment is geared toward supportive therapy and management of symptoms.

Etiology

Cerebral palsy is caused by a problem, usually before birth, that affects the development of the brain. Sometimes, the exact cause is not known, but genetic mutations are often a factor. Other factors may include maternal infections that affect the fetus and fetal distress that results in fetal stroke or lack of oxygen to the brain. A traumatic injury to the brain after birth or during infancy such as a fall or motor vehicle accident can be serious enough to result in cerebral palsy.

Desired Outcome

Patient will have optimal muscle tone and control; patient will not have contractures; patient will have optimal communication ability

Cerebral Palsy (CP) Nursing Care Plan

Subjective Data:

  • Delays in reaching motor skills milestones
  • Difficulty walking
  • Delays in speech development
  • Difficulty sucking or feeding

Objective Data:

  • Lack of muscle coordination
  • Tremors or involuntary movements
  • Muscle rigidity
  • Muscle spasticity
  • Seizures
  • Abnormal fine motor skills

Nursing Interventions and Rationales

  • Perform complete nursing assessment to determine type of deficits present (auditory, visual, motor or intellectual)

 

Get a baseline to determine what interventions are necessary.

Look for muscle rigidity or spasticity, note if there are involuntary or uncontrolled movements. Note any difficulties with speech, hearing or vision.

 

  • Assess developmental milestones

 

Infants and toddlers with CP often will miss many developmental milestones in verbal, gross motor and fine motor categories. Assessing this helps get a baseline and determine severity of condition.

 

  • Perform range of motion exercises routinely per facility protocol

 

ROM exercises help to promote movement and strengthen muscle tone, and to prevent contractures.

 

  • Provide education and assistance with orthotic devices as required

 

Patient may require use of braces or other orthotic supports for optimal mobility. Assist patient and parents to understand the need for and proper use of such devices.

 

  • Monitor during meals and snacks for signs of swallowing difficulty

 

Patients often have difficulty swallowing due to uncontrollable movements which can lead to choking or aspiration.

 

  • Observe for signs of pain or discomfort and pay attention to nonverbal cues. Provide alternative communication (hand signals, pictures, etc.)

 

Many CP patients have difficulty with speech and expressing their needs. Spending time to become familiar with the patient helps to anticipate and recognize needs.

 

  • Provide skin care as appropriate. Provide barrier creams and change undergarments as necessary. Note areas of friction or irritation.

 

Patients who are incontinent or have limited mobility are at risk for skin breakdown and infections.

 

  • Administer medications appropriately
    • Anticholinergics
    • Muscle relaxers
    • Anticonvulsants

 

  • Anticholinergics (benztropine) are given to help treat uncontrolled movements and tremors.
  • Muscle relaxers (baclofen) are given to help relax contracted or stiff muscles.
  • Anticonvulsants (gabapentin) are given to prevent seizures.

 

  • Allow extra time for care and activities. Provide calm environment.

 

Patients are often easily stressed with daily activities and may need extra time to complete tasks.

Avoid rushing patient during care or treatments to allow time for patient to understand and feel more comfortable.

 

  • Assist parents and providers develop Individual Education Plans for educational success

 

Patient with CP have varying degrees of disabilities. Help family and providers create educational plans with schools and learning facilities to meet the patient’s individual needs and provide the best learning experience.

 

  • Provide patient and parent / caregiver education about nutrition, skin care and resources for therapy and support

 

Help patients and their families feel more comfortable with home and daily care of patient and have access to resources for specific needs

Writing a Nursing Care Plan (NCP) for Cerebral Palsy (CP)

A Nursing Care Plan (NCP) for Cerebral Palsy (CP) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

This here is the nursing care plan for cerebral palsy. So the patho behind it, cerebral palsy or CP is a common group of neurological developmental disorders that affect a person’s ability to move as well as muscle tone and posture. patients with CP often have spastic movements, lack of muscle coordination, excessive drooling, or problems with speech. At this moment, there is no known cure for this condition, but treatment is geared towards supportive therapy and management of symptoms. So some nursing considerations that we want to keep on the forefront of us first, we want to assess their developmental milestones. We want to assess for aspiration and the risk of aspiration. And we want to take a look and assess for skin breakdown. The desired outcome for this patient is that this patient is going to have optimal muscle tone and control. This patient is going to have, um, optimal communication ability and will not have any contractures. 

So subjective, the subjective data that we are going to take a look at with this patient. When they come in they may be complaining of, we may notice, some delays and milestones. They may not reach their milestones. They may have some difficulty walking. Okay. In addition to the difficulty walking, they may have delays in speech development. They may have difficulty sucking or feeding as a child. There are some objective things that we’re going to observe this well. Okay. The things that we may observe as nurses, when they come in to see us is they may have a decrease or lack of muscle coordination. 

Okay. They may have tremors or involuntary movement. Okay. Some other things that we can add to our objective list is there may be some muscle rigidity or spasms. Let’s see, let’s be right there, here, muscle. That means they’re going to have that. Um, hypertonic, okay. They may have some spasms, so spasms, and also there may be some seizures. These patients are at a high risk for seizures. So that’s increased seizure risk. And finally, they’re going to have abnormal fine motor skills. So something as simple as grabbing the pen and grabbing it with the two fingers are going to be very difficult for those patients with CP. So nursing interventions, there are a few things that we can do for these patients. The first thing we want to do is we want to assess them. Let’s assess their developmental milestones because they tend to be delayed with their milestones. We want to assess the infants and toddlers with CP because they often miss their milestones in verbal gross motor and fine motor categories. So assess development. Okay. In addition to assessing the developmental milestones, this is going to help us get a baseline and determine the severity of their condition. So this is equal to the baseline. We know when we start so we can know how far we have to go. Okay. The next thing is, we want to monitor them during meals and snacks for signs of swallowing, this difficulty or dysphasia. So let’s write that down. We want to monitor 

For dysphagia. Remember they have a difficulty swallowing due to the muscle coordination. They will have uncontrollable movements, which can lead to choking Or aspiration. They are at high risk for aspiration. Next. We want to provide skincare as appropriate. Remember, these patients don’t move as much as some other people without CP. So we want to make sure that we provide barrier creams. We want to change their undergarments as necessary if they are incontinent or they have limited mobility, they are at risk for skin breakdown and infections. So we want to manage the risk for skin breakdown. There are some medications that we can administer that may be prescribed by the doctor to assist these patients with their daily life. Some of the things that we might want to administer is we may want to administer: anticholinergics. We may want to administer muscle relaxers, Or we may want to administer anticonvulsants 

Remember they are given to help treat uncontrolled movements and tremors the anticholinergic, the muscle relaxers, some like Baclofen or give it to relax, contracted or stiff muscles. And antiepileptics such as Gabapentin are used to prevent seizures. Finally, we want to observe these patients for signs of pain or discomfort, observe for pain or discomfort. Remember, these patients often have difficulty with speech, okay? And they can’t express their needs like some other people. So we want to spend time becoming familiar with them, familiar with their habits. So that way we can anticipate and recognize their needs such as pain. If they need something for pain, we want to be able to recognize that and spending time with them will help us. So the key points, remember cerebral palsy is a group of neurological developmental disorders that affect a person’s ability to move as well as muscle tone. And as posture, remember the subjective data that they’re going to present with is difficulty walking, delays in speech, motor development. The objective thing that we’re going to see is muscle rigidity. They’re going to have some spasms. They’re going to have seizures and they’re going to have abnormal fine motor movement. The thing we want to do as nurses is we want to do a swallow evaluation. Remember these patients are at risk for aspiration and choking, and we want to give the medications. Proper medication administration relieves cerebral palsy related symptoms. 

We love you guys; go out and be your best selves today. And, as always, happy nursing.

 

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