Nursing Care Plan for Cerebral Palsy (CP)

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

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

  2. 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.

  3. Assess developmental milestones

  4. 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.

  5. Perform range of motion exercises routinely per facility protocol

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

  7. Provide education and assistance with orthotic devices as required

  8. 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.

  9. Monitor during meals and snacks  for signs of swallowing difficulty

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

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

  12. 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.

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

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

  15. 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.

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

  17. 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.

  18. Assist parents and providers develop Individual Education Plans for educational success

  19. 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.

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

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


References

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