79 Cerebral palsy
Overview/pathophysiology
Cerebral palsy (CP) is a term used to describe a group of chronic conditions affecting body movement and muscle coordination. It is caused by damage to one or more specific areas of the brain, which typically occurs before birth during fetal development but can occur during or shortly after birth—usually before age 3 yr. CP is the most common physical disability of childhood with 2-3 children in 1000 being affected each year. About 800,000 children and adults in the United States have CP (March of Dimes, Dec. 2007). It is nonprogressive, although secondary conditions (e.g., muscle spasticity) can develop and may remain the same, improve, or deteriorate. A child with CP may have intellectual, perceptual, and language deficits. A large number of factors may contribute to CP, either singly or multifactorially. Events occurring before birth that can disrupt normal development of the brain cause CP in most cases, whereas lack of oxygen during labor and delivery contributes to only a small minority of cases. A small number of infants/young children develop CP in the first few months or years of life due to severe infections (e.g., meningitis) or head trauma (March of Dimes, Dec. 2007). No identifiable cause is found in many cases but some risk factors that increase the chance of developing CP include prematurity, low birth weight, or multiple births. Some conditions during or after birth that increase the risk of developing CP include breech presentation, small for gestational age, severe jaundice, and seizures (NIH Pub, No. 06-159, 2006).There are three main types of CP, and there may be a mixture of types.
Diagnostic tests
Neuroimaging tests (cranial ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI):
Metabolic studies:
To rule out metabolic defects (e.g., Guthrie blood test for phenylketonuria or serum galactose levels for galactosemia). Use topical anesthetic with blood draws to decrease anxiety and pain (atraumatic care).
Nursing diagnosis:
Imbalanced nutrition: less than body requirements
related to chewing and/or swallowing difficulty and motor problems/activity
| ASSESSMENT/INTERVENTIONS | RATIONALES |
|---|---|
| Assess intake and output q2-4h. | This assessment reveals if child is receiving adequate nutrients and has adequate output. |
| Weigh weekly on same scale, at same time of day, and with child wearing same clothing. | Consistency with weight measurements helps ensure more accurate results. Child is receiving adequate nutrients if maintaining or gaining weight (as long as weight gain is not excessive). If weight is decreasing, diet may need to be supplemented. |
| Provide high-calorie meals and snacks. | Child likely will need increased calories because of increased muscle activity (i.e., spasticity or dyskinetic movements). |
| Provide foods that child likes. | This measure will stimulate appetite and promote cooperation in eating. |
| Encourage child to feed self as much as possible. | Allowing child to try to feed self may increase intake by decreasing frustration of having no control over other matters. |
| Make meal times pleasant with no interruptions, a relaxed environment, attractive meals, eye contact, and conversation appropriate for child. | This encourages focusing on eating, thereby increasing intake. |
| Approach child with a greeting that alerts him or her that movement or a change in activity is going to occur. | This prevents a startle reflex, which interferes with ability to chew and swallow successfully. |
| Use the following aids and techniques to facilitate feeding; seek input from occupational/speech therapists: | These measures improve likelihood of adequate oral intake. This prepares child for meals and increases likelihood of successful feeding. This signals for child that it is mealtime. Proper positioning decreases incidence of aspiration and gastroesophageal reflux (GER) and improves intake. Firmly supporting child through the hips and trunk provides a stable base for sitting up. Keeping head and neck in a midline, neutral position prevents aspiration and enables better oral muscular control. This measure prevents tonic bite reflex and tongue thrust. This facilitates eye contact, conversation, and use of prescribed therapy techniques. This promotes jaw control and facilitates chewing and swallowing. Some children aspirate when taking regular liquids (they need them to be thickened), and some children cannot chew. Giving foods/liquids at temperature child prefers increases chance of better intake. |
| If child has GER, position sitting up for 30 min to 1 hr after meal. | This position decreases incidence of GER and ultimately improves intake. |
| Ensure that child is receiving adequate nutrients. If child is unable to take sufficient nutrients orally, discuss child’s needs with health care provider. | Because of difficulty swallowing and increased motor activity, some children are unable to take sufficient nutrients orally, necessitating enteral feedings, which do not require adequate swallowing. |
Nursing diagnosis:
Risk for trauma
Desired Outcomes: Child remains free from signs and symptoms of trauma. Parents verbalize accurate knowledge about how to provide a safe environment for the child.
| ASSESSMENT/INTERVENTIONS | RATIONALES |
|---|---|
| Educate family about ways of childproofing the home based on child’s developmental age. | This information reduces child’s risk for trauma in the home. Examples include: < div class='tao-gold-member'> Only gold members can continue reading. Log In or Register to continue
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