Child - Cerebral Palsy 474417

762

■

CHAPTER 20

NURSING CARE PLAN GOAL 1.

The Child with Cerebral Palsy

INTERVENTION

RATIONALE

EXPECTED OUTCOME

Impaired Physical Mobility related to decreased muscle strength and control NIC Priority Intervention: Exercise Therapy, t Mobility: Use of active and ive body movement to maintain t flexibility

The child will attain maximum physical abilities possible.

NOC Suggested Outcome: t Movement—Active: Range of motion of ts with self-limited movement

■

Perform development assessment and record age of achievement of milestones (e.g., reaching for objects, sitting)

■

Delayed development milestones are common with cerebral palsy. Once one milestone is achieved, interventions are revised to assist in the next skill necessary.

■

Plan activities to use gross and fine motor skills (e.g., holding pen or eating utensils, toys positioned to encourage reaching and rolling over)

■

Many activities of daily living and play activities promote physical development.

■

Allow time for the child to complete activities

■

The child may perform tasks more slowly than most children.

■

Perform range-of-motion exercises every 4 hours for the child unable to move body parts. Position the child to promote tendon stretching (e.g., foot plantar flexion instead of dorsiflexion, legs extended instead of flexed at knees and hips)

■

Promotes mobility and increased circulation, and decreases the risk of contractures.

■

Arrange for and encourage parents to keep appointments with a rehabilitation therapist.

■

A regular and frequently reevaluated rehabilitation program assists in promoting development.

■

Teach the family to maintain appropriate brace wear.

■

Adaptive devices are often necessary to maximize physical mobility.

The child reaches maximum physical mobility and all developmental milestones.

2. Sensory/Perceptual Alteration: Visual or Auditory related to cerebral damage NIC Priority Intervention: Communication Enhancement: Visual Deficit or Auditory Deficit: Assistance with accepting or learning alternative methods for living with diminished vision or hearing. The child will receive and benefit from varied forms of sensory and perceptual input.

NOC Suggested Outcome: Body Image: Positive perception of own appearance and body functioning

■

Facilitate eye and auditory examinations by specialist. Promote the use of adaptive devices (glasses, lenses, hearing aids), and encourage recommended return visits to specialists.

■

Adaptive devices often enhance sensory input. These devices need frequent changes as the child grows.

■

Maximize the use of intact senses (e.g., describe verbally the surroundings to a child with poor vision, allow touching of objects, provide visual materials to enhance learning in the child with impaired hearing, use computers to promote communication).

■

Other senses can compensate for those that are impaired.

The child receives adequate sensory/perceptual input to maximize developmental outcome.

Alterations in Neurologic Function

NURSING CARE PLAN GOAL

■

763

The Child with Cerebral Palsy (continued)

INTERVENTION

RATIONALE

EXPECTED OUTCOME

3. Altered Nutrition: Less than Body Requirements related to difficulty in chewing and swallowing and high metabolic needs NIC Priority Intervention: Weight Gain Assistance: Facilitation of body weight gain. The child will receive nutrients needed for normal growth.

NOC Suggested Outcome: Nutritional Status: Extent to which nutrients are available to meet metabolic needs.

■

Monitor height and weight and plot on a growth grid. Perform hydration status assessment.

■

Insufficient intake can lead to impaired growth and dehydration.

■

Teach the family techniques to promote caloric and nutrient intake: ■ Position the child upright for feedings. ■ Place foods far back in the mouth to overcome tongue thrust. ■ Use soft and blended foods. ■ Allow extra time and quiet environment for meals.

■

Special techniques can facilitate food intake.

■

Perform frequent respiratory assessment. Teach the family to avoid aspiration pneumonia. Teach care of gastrostomy and tube feeding technique as appropriate.

■

Aspiration pneumonia is a risk for the child with poor swallowing. Special feeding techniques may be needed.

The child shows normal growth patterns for height, weight, and other physical parameters.

4. Ineffective Management of Therapeutic Regimen: Family related to excessive demands made on family with child’s complex care needs NIC Priority Intervention: Family Process Maintenance: Minimization of family process disruption effects. The family will adapt to growth and development needs of the child with cerebral palsy.

NOC Suggested Outcome: Not yet developed.

■

Allow opportunities for parents to verbalize the impact of cerebral palsy on the family. Provide referral to other parents and groups.

■

The family needs an opportunity to explore the emotional and social impact of the child’s care to integrate and grow from the experience.

■

Explore community services for rehabilitation, respite care, childcare, and other needs and refer family as appropriate.

■

Diverse services are available and will be needed due to the multiple impacts of cerebral palsy on the child.

■

During home and office visits review the child’s achievements and praise the family for care provided.

■

The child’s achievements are positive reinforcement of the family’s efforts.

■

Teach the families skills needed to manage the child’s care (e.g., medication istration, physical rehabilitation, seizure management).

■

Complex skills must be learned before they can be performed with efficiency.

■

Teach case management techniques.

■

The child requires care by many specialists. Many parents become case managers to coordinate care.

■

Involve siblings in the care for the child with cerebral palsy. Review for parents the needs of all children in the family.

■

Siblings of the child with cerebral palsy may feel left out because of the care provided. Special efforts contribute to meeting the developmental needs of all family .

The family continues its development and provides for all of its .

(continued)

764

■

CHAPTER 20

NURSING CARE PLAN GOAL

The Child with Cerebral Palsy (continued)

INTERVENTION

RATIONALE

EXPECTED OUTCOME

5. Diversional Activity Deficit (Child) related to poor social skills NIC Priority Intervention: Recreation Therapy: Purposeful use of recreation to promote relaxation and enhancement of social skills. The child will engage in adequate diversional activity to maximize growth and development.

NOC Suggested Outcome: Play Participation: Use of activities as needed for enjoyment, entertainment, and development by children.

■

Refer the family to early childhood stimulation programs. Encourage with other children. When hospitalized, place the child in a room with other children when possible.

■

The child needs a variety of activities and with other children and adults to maximize development.

■

Work with the local school to develop an individualized education plan that allows the child with other children and a variety of activities.

■

Public schools must provide an individualized education plan. Parents may need assistance to interact effectively with the school system.

■

Investigate recreational programs for children with disabilities and share information with the parents.

■

Recreational programs for children with disabilities may promote social experiences and physical activity.

■

■

The child engages in activities that maximize development.

Impaired home maintenance management, related to child’s developmental disability and inadequate system Altered growth and development, related to lack of muscle strength or limited social interaction

Planning and Implementation The accompanying nursing care plan summarizes care for the child with cerebral palsy. Because the condition can range from mild to severe and involve numerous manifestations, interventions need to be adapted to the particular child and family. Nursing care focuses on providing adequate nutrition, maintaining skin integrity, promoting physical mobility, promoting safety, promoting growth and development, teaching parents how to care for the child, and providing emotional .

P ROVIDE A DEQUATE N UTRITION CLINICAL TIP Provide audio and visual activities for the child who is quadriplegic. Encourage the use of a computer to interact with peers, participate in educational programs, and locate resources for adaptation to the disability. Television, videotapes, and music are good diversions. Encourage the child who is paraplegic to use his or her arms and hands in interactive games. Children can use special hand controls or pointers for computer or video game use and other adaptive devices to manipulate the television or radio.

Children with cerebral palsy require high-calorie diets or supplements to the diet because of feeding difficulties associated with spasticity. Many children have difficulty chewing and swallowing. Give the child small amounts of soft foods at a time. Feeding utensils with large, padded handles may be easier for the child to use.

M AINTAIN S KIN I NTEGRITY Take special care to protect the bony prominences from skin breakdown. See Table 20-5 for specific nursing interventions. Proper body alignment should be maintained at all times. the child with pillows, towels, and bolsters whether the child is in bed or in a chair. the head and body of a floppy infant. A spastic child with scissored, extended legs or an athetoid child who writhes constantly is difficult to carry and transport.

P ROMOTE P HYSICAL M OBILITY Range-of-motion exercises are essential to maintain t flexibility and to prevent contractures. Consult with the physical therapists who work with the child and assist with recommended exercises. Teach parents to position the child to foster flexion rather than extension so