nursing intervention

1. Cerebral palsy
Done by :ROAA HAJJAM
Intern student nurse

2. Objectives
At the end of this presentation my expectations to be able :
•Recognize the causes of having child with cerebral palsy .
•Identify the clinical feature of the syndrome
•Anticipate how to diagnose and what is the prognosis of the
disease.
•List the medical resources that can help patient with this
disability .
•Create care plan for patient with cerebral palsy.

3. Introduction
• CP is nonspecific term applied to neurologic disorders
characterized by early onset and impaired movement and
posture, it is non-progressive and may be accompanied by
perceptual problems, language deficits, and intellectual
involvement.

4. Etiology
• A)prenatal.
• -Exposures to radiation or toxins.
• - diabetes or hyperthyroidism.
- Genetic abnormalities.
- Incompetent cervix.
- Medication use.
• B) birth and delivery.
• -Prolonged rupture of membranes.
• -Fetal heart depression.
• -Abnormal presentation.
• -Long labor.
• C) Perinatal.
• Sepsis or central narvous system infection.
• seizures.
• Meconium aspiration .
• D) Childhood , postnatal.
• Brain injury
• Meningitis.

5. Clinical feature
• Speech impairment
• Pulmonary disease.
• Orthopedic disorder.
• Urinary disorders .
• Growth failure.
• Dystonia .
• Ataxic syndrome.
• Visual disorder.
• Psychiatric disorders.
• Learning disabilities.

6. Diagnosis and prognosis
• Diagnosis of cerebral palsy is not always easy ,and it needs a
lot of examinations to determine the case.
• Cerebral palsy diagnosis is usually made during the first 18
months and up to the first three years of a child’s life.
• Usually the prognosis is very poor and depend mainly on the
improvement of the patient and family quality of life.

7. Multidisciplinary team
• Medical –surgical team
• Social and emotional developmental .
• Nutrition.
• Occupational therapy.
• Psychological therapy.
• Life style modification consultation.

8. Treatment goal
• Interventions for CP should be directed at maximizing the
quality of life by improvement and reduction of extent of
disability.
• The patient should achieve maximal independence in the
activity at home with the help of family.

9. Medical resources
•Sultan bin Abdul-Aziz human train city .
•Disabled children association .

10. Nursing care plane
1) Impaired Physical Mobility related to decreased muscle strength and
control.
2) 2. Sensory/Perceptual Alteration: Visual or Auditory related to cerebral
damage.
3) . Altered Nutrition: Less than Body Requirements related to difficulty in
chewing and swallowing and high metabolic needs.
4) 4. Ineffective Management of Therapeutic Regimen: Family related to
excessive demands made on family with child’s complex care needs .

11. Goal Nursing interventions Expected out comes
The pt will attain maximum
physical abilities possible.
■ Perform development assessment
and record age of achievement of
milestones (e.g., reaching for
objects, sitting)
■ Plan activities to use gross and fine
motor skills (e.g., holding pen or
eating utensils, toys positioned to
encourage reaching and rolling
over)
■ Allow time for the pt to
complete activities
■ Perform range-of-motion exercises
every 4 hours for the pt unable
to move body parts. Position the
pt to promote tendon stretching
(e.g., foot plantar flexion instead of
dorsiflexion, legs extended instead
of flexed at knees and hips)
■ Arrange for and encourage parents
to keep appointments with a
rehabilitation therapist.
■ Teach the family to maintain
appropriate brace wear.
The pt reaches maximum
physical
mobility and all
developmental
Milestones.

12. Goal Nursing intervention Expected outcomes
The pt will
receive and
benefit
from varied
forms of
sensory and
perceptual
input.
 Facilitate eye and auditory
examinations by specialist. Promote
the use of adaptive devices (glasses,
contact lenses, hearing aids), and
encourage recommended return
visits to specialists.
■ Maximize the use of intact senses
(e.g., describe verbally the
surroundings to pt with poor
vision, allow touching of objects,
provide visual materials to enhance
learning in the pt with impaired
hearing, use computers to promote
communication).
The pt receives
adequate
sensory/perceptual
input to maximize
developmental
outcome.

13. 3. Altered Nutrition: Less than Body Requirements related to difficulty
in chewing and swallowing and high metabolic needs.
Goal Nursing interventions Expected outcomes
The pt will receive
nutrients
needed for normal
growth.
■ Monitor height and weight and
plot on a growth grid. Perform
hydration status assessment.
■ Teach the family techniques to
promote caloric and nutrient
intake:
■ Position the pt 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.
■ Perform frequent respiratory
assessment. Teach the family to
avoid aspiration pneumonia. Teach
care of gastrostomy and tube
feeding technique as appropriate.
The pt shows normal
growth
patterns for height,
weight, and other
physical parameters.

16. REFERENCES
• www.uptodate.com
• Nursing care of infants and children 5th
edition .