Cerebral palsy results from abnormal brain development or damage to the developing brain, typically occurring before, during, or shortly after birth. The condition affects motor function with varying degrees of severity and impact on daily life.
Types of Cerebral Palsy
- Spastic Cerebral Palsy: Characterized by increased muscle tone and stiff movements.
- Spastic Diplegia: Primarily affects the legs
- Spastic Hemiplegia: Affects one side of the body
- Spastic Quadriplegia: Affects all four limbs and often the trunk and face
- Dyskinetic Cerebral Palsy: Involves involuntary movements and fluctuating muscle tone.
- Ataxic Cerebral Palsy: Affects balance, coordination, and depth perception.
- Mixed Cerebral Palsy: Combines symptoms from multiple types.
Causes and Risk Factors
- Premature birth
- Low birth weight
- Multiple births
- Infections during pregnancy
- Brain injuries during or after birth
- Genetic factors
- Maternal health issues (e.g., thyroid problems, seizures)
Nursing Assessment for Cerebral Palsy
A thorough nursing assessment is crucial for developing an effective care plan. Key areas to assess include:
- Motor Function: Evaluate muscle tone, strength, and range of motion.
- Communication Skills: Assess speech and language abilities.
- Cognitive Function: Determine intellectual capabilities and learning abilities.
- Sensory Processing: Check for vision and hearing impairments.
- Nutritional Status: Assess feeding abilities and nutritional intake.
- Respiratory Function: Evaluate breathing patterns and potential respiratory complications.
- Skin Integrity: Check for pressure sores, especially in patients with limited mobility.
Cerebral Palsy Nursing Diagnoses and Care Plans
Nurses can identify appropriate nursing diagnoses and develop tailored care plans based on the comprehensive assessment. Here are five essential nursing diagnoses commonly associated with cerebral palsy:
1. Impaired Physical Mobility
Nursing Diagnosis Statement: Impaired Physical Mobility related to neuromuscular impairment and muscle spasticity as evidenced by difficulty in performing activities of daily living and limited range of motion.
Related Factors/Causes:
- Neuromuscular impairment
- Muscle spasticity
- Contractures
- Pain or discomfort
Nursing Interventions and Rationales:
- Perform regular range of motion exercises.
Rationale: Maintains joint flexibility and prevents contractures. - Implement a positioning schedule.
Rationale: Prevents pressure ulcers and promotes comfort. - Collaborate with physical and occupational therapists.
Rationale: Ensures a comprehensive approach to mobility management. - Teach proper use of assistive devices.
Rationale: Promotes independence and mobility safety. - Encourage participation in daily activities as tolerated.
Rationale: Improves strength, coordination, and self-esteem.
Desired Outcomes:
- Patient demonstrates improved range of motion within individual capabilities.
- The patient shows increased participation in daily activities.
- The patient uses assistive devices correctly and safely.
2. Risk for Aspiration
Nursing Diagnosis Statement: Risk for Aspiration related to impaired swallowing reflex and decreased gag reflex secondary to cerebral palsy.
Related Factors/Causes:
- Impaired swallowing reflex
- Decreased gag reflex
- Poor head control
- Gastroesophageal reflux
Nursing Interventions and Rationales:
- Assess swallowing ability and gag reflex regularly.
Rationale: Early identification of aspiration risk allows for prompt intervention. - Position the patient in an upright or semi-Fowler’s position during and after meals.
Rationale: Reduces the risk of aspiration by using gravity to assist swallowing. - Collaborate with a speech-language pathologist for swallowing therapy.
Rationale: Improves swallowing techniques and reduces aspiration risk. - Implement thickened liquids or altered food textures as recommended.
Rationale: It makes swallowing easier and safer for patients with dysphagia. - Teach family members signs of aspiration and proper feeding techniques.
Rationale: Empowers caregivers to prevent aspiration and respond appropriately if it occurs.
Desired Outcomes:
- The patient demonstrates improved swallowing ability.
- No signs or symptoms of aspiration are present.
- Caregivers demonstrate proper feeding techniques.
3. Impaired Verbal Communication
Nursing Diagnosis Statement: Impaired Verbal Communication related to neuromuscular impairment affecting speech production as evidenced by difficulty expressing needs verbally.
Related Factors/Causes:
- Neuromuscular impairment affecting speech muscles
- Cognitive impairment
- Hearing impairment
Nursing Interventions and Rationales:
- Assess the patient’s current communication abilities and preferred methods.
Rationale: Establishes a baseline and identifies effective communication strategies. - Implement alternative communication methods (e.g., picture boards, communication devices).
Rationale: Provides means for the patient to express needs and wants effectively. - Collaborate with a speech-language pathologist for communication therapy.
Rationale: Improves speech and language skills through specialized interventions. - Educate family members on effective communication strategies.
Rationale: Enhances communication between the patient and their support system. - Maintain a calm and patient environment during communication attempts.
Rationale: Reduces frustration and encourages communication efforts.
Desired Outcomes:
- The patient demonstrates an improved ability to communicate needs and wants.
- Patients and families utilize alternative communication methods effectively.
- The patient shows increased participation in social interactions.
4. Risk for Impaired Skin Integrity
Nursing Diagnosis Statement: Risk for Impaired Skin Integrity related to immobility and altered sensation secondary to cerebral palsy.
Related Factors/Causes:
- Immobility
- Altered sensation
- Poor nutritional status
- Incontinence
Nursing Interventions and Rationales:
- Perform regular skin assessments, focusing on pressure points.
Rationale: Early identification of skin breakdown allows for prompt intervention. - Implement a turning and repositioning schedule.
Rationale: Reduces pressure on bony prominences and promotes circulation. - Use pressure-relieving devices as appropriate (e.g., specialized mattresses, cushions).
Rationale: Distributes pressure evenly and reduces the risk of pressure ulcers. - Maintain proper hygiene and skincare routine.
Rationale: Keeps skin clean, dry, and well-moisturized to prevent breakdown. - Ensure adequate nutrition and hydration.
Rationale: Supports skin health and promotes healing if breakdown occurs.
Desired Outcomes:
- The patient maintains intact skin integrity.
- No signs or symptoms of pressure ulcers are present.
- Caregivers demonstrate proper skin care techniques.
5. Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis Statement: Imbalanced Nutrition: Less Than Body Requirements related to feeding difficulties and increased metabolic demands as evidenced by weight loss and poor muscle tone.
Related Factors/Causes:
- Feeding difficulties (e.g., dysphagia, poor coordination)
- Increased metabolic demands due to muscle spasticity
- Gastrointestinal issues (e.g., reflux, constipation)
Nursing Interventions and Rationales:
- Conduct regular nutritional assessments, including weight monitoring.
Rationale: Identifies nutritional deficits and tracks progress. - Collaborate with a dietitian to develop an individualized nutrition plan.
Rationale: Ensures nutritional needs are met considering the patient’s specific condition. - Implement feeding techniques to enhance safety and efficiency (e.g., proper positioning and pacing).
Rationale: Reduces the risk of aspiration and improves nutritional intake. - Consider alternative feeding methods if necessary (e.g., gastrostomy tube).
Rationale: Ensures adequate nutrition when oral feeding is insufficient or unsafe. - Educate caregivers on proper feeding techniques and nutritional requirements.
Rationale: Empowers caregivers to meet the patient’s nutritional needs effectively.
Desired Outcomes:
- The patient demonstrates weight gain or maintenance within the target range.
- The patient shows improved muscle tone and energy levels.
- Caregivers demonstrate proper feeding techniques and understanding of nutritional needs.
Conclusion
Practical nursing care for individuals with cerebral palsy requires a comprehensive understanding of the condition and its impact on various aspects of health and daily life. By implementing these nursing diagnoses and care plans, healthcare professionals can significantly improve the quality of life for patients with cerebral palsy and support their families in providing optimal care.
Remember that each patient with cerebral palsy is unique, and care plans should be tailored to individual needs and capabilities. Regular reassessment and adjustment of care plans are essential to ensure the best possible outcomes for these patients.
References
- Aisen, M. L., Kerkovich, D., Mast, J., Mulroy, S., Wren, T. A., Kay, R. M., & Rethlefsen, S. A. (2011). Cerebral palsy: clinical care and neurological rehabilitation. The Lancet Neurology, 10(9), 844-852.
- Hockenberry, M. J., & Wilson, D. (2018). Wong’s nursing care of infants and children-E-book. Elsevier Health Sciences.
- Novak, I., Morgan, C., Fahey, M., Finch-Edmondson, M., Galea, C., Hines, A., … & Badawi, N. (2020). State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Current neurology and neuroscience reports, 20(2), 1-21.
- Palisano, R., Rosenbaum, P., Bartlett, D., & Livingston, M. (2007). GMFCS-E & R: Gross motor function classification system expanded and revised. CanChild Centre for Childhood Disability Research, McMaster University.
- Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., Bax, M., Damiano, D., … & Jacobsson, B. (2007). A report: the definition and classification of cerebral palsy April 2006. Developmental medicine and child neurology. Supplement, 109, 8-14.