Nursing Care Plan (NCP) for Cerebral Palsy (CP)
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Lesson Objective for Cerebral Palsy (CP) Nursing Care Plan
Cerebral palsy is a condition that affects movement, muscle tone, and coordination. It happens because of a problem in the brain that can occur before, during, or soon after birth.
Think of the brain like a control center sending out signals to different parts of the body to move and function. In cerebral palsy, this control center has some areas that aren’t working as they should, so the signals to move muscles get mixed up or don’t get sent correctly.
This can lead to various symptoms, like muscles being too stiff or too floppy, difficulty with balance and coordination, and trouble with precise movements like writing. Some people with cerebral palsy might have difficulty walking and may need assistance with daily activities. The condition can also affect speaking and learning in some cases.
By the end of this lesson, nursing students will be able to:
- Understand Cerebral Palsy (CP):
- Define Cerebral Palsy, its etiology, and the impact on motor function and coordination.
- Identify Types and Severity:
- Differentiate between the types of Cerebral Palsy (spastic, dyskinetic, ataxic) and understand the variations in severity.
- Comprehensive Nursing Assessment:
- Learn to conduct a thorough nursing assessment, including physical and developmental assessments, to identify individual needs and challenges of patients with Cerebral Palsy.
- Develop Individualized Care Plans:
- Develop individualized care plans based on the specific needs and abilities of patients with Cerebral Palsy, considering their physical, developmental, and psychosocial aspects.
- Implement Supportive Interventions:
- Understand and implement supportive interventions aimed at optimizing the patient’s independence, mobility, and overall quality of life.
Pathophysiology of Cerebral Palsy (CP)
- Brain Injury During Development:
- Cerebral Palsy results from brain damage or abnormalities during fetal development, childbirth, or shortly after birth.
- Disruption of Motor Control Areas:
- The brain lesions primarily affect the motor control areas of the brain, including the cortex, basal ganglia, and cerebellum.
- Types of Brain Damage:
- The type and location of brain damage determine the classification of Cerebral Palsy, with spastic, dyskinetic, and ataxic forms being common.
- Perinatal Factors:
- Perinatal factors such as prematurity, low birth weight, birth asphyxia, and infections contribute to the risk of developing Cerebral Palsy.
- Ongoing Challenges in Movement and Coordination:
- The brain injury leads to impaired muscle coordination, muscle tone abnormalities (spasticity, rigidity, or floppiness), and challenges in motor skills, affecting mobility and daily activities.
Etiology of Cerebral Palsy (CP)
- Prenatal Factors:
- Genetic Factors: Some cases have a genetic predisposition, with certain gene mutations increasing the risk.
- Infections: Maternal infections, especially during early pregnancy, can contribute to brain damage in the developing fetus.
- Perinatal Factors:
- Birth Asphyxia: Oxygen deprivation during childbirth can lead to brain injury.
- Prematurity: Babies born prematurely are at a higher risk due to incomplete brain development.
- Postnatal Factors:
- Infections and Illnesses: Infections affecting the brain postnatally can contribute to the development of Cerebral Palsy.
- Head Injuries: Trauma or injuries to the head in early childhood may result in brain damage.
Desired Outcome for Cerebral Palsy (CP)
- Enhanced Mobility and Independence:
- Improve or maintain the child’s ability to move and perform daily activities independently.
- Optimized Quality of Life:
- Focus on interventions that contribute to an improved overall quality of life for the individual with CP.
- Effective Communication Skills:
- Support the development and utilization of communication strategies, considering the unique needs and abilities of the individual.
- Pain Management:
- Implement strategies to minimize pain and discomfort associated with muscle spasms, contractures, or other related issues.
- Family Education and Support:
- Educate and support the family in understanding the condition, managing challenges, and accessing resources for ongoing care and support.
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 Assessment for Cerebral Palsy (CP)
- Developmental Milestones:
- Evaluate the individual’s achievement of developmental milestones to identify any delays or deviations in motor skills, speech, and other developmental domains.
- Muscle Tone and Strength:
- Assess muscle tone, strength, and coordination to understand the extent of motor impairments and plan appropriate interventions.
- Mobility and Motor Skills:
- Observe and document the individual’s ability to move, walk, sit, and perform fine and gross motor skills.
- Communication Abilities:
- Evaluate the individual’s communication skills, including speech, non-verbal communication, and the use of any assistive communication devices.
- Functional Independence:
- Assess the level of functional independence in activities of daily living (ADLs) and identify areas where assistance or adaptive devices may be needed.
- Pain Assessment:
- Inquire about the presence of pain, discomfort, or any musculoskeletal issues that may affect the individual’s well-being.
- Orthopedic Considerations:
- Examine for any orthopedic complications, such as contractures or skeletal deformities, which may impact mobility and comfort.
- Psychosocial Assessment:
- Consider the psychosocial aspects, including the individual’s emotional well-being, coping mechanisms, and support systems in place.
Implementation for Cerebral Palsy (CP)
- Physical Therapy:
- Collaborate with physical therapists to design and implement exercises aimed at improving muscle strength, flexibility, and overall motor function.
- Occupational Therapy:
- Integrate occupational therapy interventions to enhance the individual’s ability to perform activities of daily living and improve fine motor skills.
- Assistive Devices and Adaptive Equipment:
- Identify and provide appropriate assistive devices or adaptive equipment to enhance independence and facilitate mobility.
- Speech Therapy:
- Include speech therapy sessions to address communication challenges and improve speech or alternative communication methods.
- Educational Support:
- Collaborate with educators to implement strategies that support the individual’s learning needs, considering any cognitive or learning challenges associated with CP.
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
Evaluation for Cerebral Palsy (CP)
- Functional Improvement:
- Assess changes in the individual’s functional abilities, such as improved motor skills, mobility, and independence in daily activities.
- Pain Management:
- Evaluate the effectiveness of pain management strategies and interventions in alleviating discomfort associated with muscle spasms or orthopedic issues.
- Adaptive Equipment Utilization:
- Measure the successful integration and utilization of assistive devices and adaptive equipment to determine their impact on daily life.
- Communication Progress:
- Monitor improvements in communication skills, including speech or the effective use of alternative communication methods.
- Quality of Life:
- Assess the overall quality of life, considering psychosocial well-being, participation in activities, and satisfaction with implemented interventions.
References
- https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999
- https://cerebralpalsygroup.com/cerebral-palsy/
- https://www.cdc.gov/ncbddd/cp/facts.html
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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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