Cerebral Palsy Nursing Care Plans Diagnosis and Interventions
Cerebral Palsy NCLEX Review and Nursing Care Plans
Cerebral palsy refers to a group of neurologic conditions that affect movement and coordination. It occurs when the brain develops abnormally before or after a baby is born.
It can also affect the person’s ability to talk, chew, and swallow. People with cerebral palsy may be affected differently. Symptoms can vary from mild to severe disability.
The problems in the brain caused by cerebral palsy are not known to get worse overtime.
However, as the child develops, the effects of the condition may change. Constant support and assessment are necessary to promote as much independence as possible.
There area different types of cerebral palsy depending on how the symptoms manifest.
Spastic cerebral palsy is the most common type. It is characterized by muscle stiffness and weakness.
Athetoid cerebral palsy, on the other hand, affects muscle tone which causes involuntary spasms.
The third type is called ataxic cerebral palsy which affects balance and coordination.
Signs and Symptoms of Cerebral Palsy
The clinical manifestations of cerebral palsy vary greatly from person to person.
The following are the signs and symptoms that may be noted in children with cerebral palsy:
- Muscle tone may be too stiff or too floppy
- Spasticity of muscles – stiff muscles with exaggerated reflexes
- Muscle rigidity – stiff muscles with normal reflexes
- Ataxia – loss of balance and muscle coordination
- Muscle tremors and involuntary movements
- Slow, writhing movements
- Delays in motor skills development
- Favoring one side of the body
- Abnormal gait
- Problems swallowing which may be manifested by excessive drooling
- Issues with sucking and eating
- Delays in speech development
- Learning difficulties
- Issues with fine motor skills which include picking things up and buttoning of clothes
- Seizures – 1 in 3 children with cerebral palsy are diagnosed with epilepsy.
Causes and Risk Factors of Cerebral Palsy
Cerebral palsy occurs due to the abnormal development in the part of the brain that control movements.
Oftentimes the reason behind this pathology is unknown; however, some cases are influenced by the following risk factors:
- Genetics – gene mutation can occur and may affect brain development.
- Maternal infections – Some infections during pregnancy can cause damage to the developing baby.
- Fetal stroke – disruption in the blood supply of the developing brain can lead to cerebral palsy.
- Bleeding into the brain – bleeding may occur in the womb or as a newborn.
- Infant infections – infections can lead to inflammation around the brain which may cause abnormal development.
- Traumatic head injury – direct trauma to the brain especially affecting the part that controls movement can also cause cerebral palsy.
- Lack of oxygen – asphyxia may occur during a difficult labor and delivery. Issues with oxygenation can cause permanent damage to the brain.
Complications of Cerebral Palsy
- Contractures. Contractures refer to muscle shortening due to severe muscle spasticity or tightening. It can inhibit growth and bending of bones resulting to deformities and dislocation.
- Premature aging. The strain that cerebral palsy causes the body can result to premature aging in people over 40 years of age.
- Malnutrition. Issues with swallowing can impede proper nutrition.
- Mental health conditions. The challenges of coping with cerebral palsy can cause depression and social isolation.
- Heart and lung diseases. The abnormal muscle control can lead to heart and lung problems.
- Osteoarthritis. Osteoarthritis is a degenerative disease. It may occur early on because of abnormal joint alignments and muscle spasticity.
- Osteopenia. This refers to a condition causing fractures due to low bone density. This may occur due to the challenges in mobility, nutrition, and drug use.
Diagnosis of Cerebral Palsy
Although cerebral palsy may occur before, during, and after birth, the diagnosis of this condition may not happen until a few months later.
Once cerebral palsy is suspected, tests and procedures will be conducted, such as:
- Medical history and physical exam – a detailed history and physical examination will be performed to outline the presence of risk factors and to evaluate the child’s developmental milestones.
- Brain scans – scans of the brain through an MRI or cranial ultrasound will help identify abnormal brain structures.
- Electroencephalogram (EEG) – an EEG is specially performed in children suspected of having cerebral palsy who are having seizures. It is a test that records the electrical activity of the brain.
- Laboratory tests – laboratory tests may include examinations to identify genetic and metabolic problems in the child.
- Additional tests – other tests may be requested to identify associated problems affecting the child’s vision, hearing, speech, intellect, development, and movement.
Treatment of Cerebral Palsy
Treatment for cerebral palsy is usually lifelong. It may include different specialty teams to work together to promote independence.
- Medications. Drugs are often used to help manage muscle problems.
- Muscle or nerve injections – drugs can be given through injections every 3 months to treat tightening of specific muscle groups.
- Oral muscle relaxants – these may be used to promote muscle relaxation. However, long-term effects of the drugs must be considered.
- Therapies. A variety of therapies can help improve the management of the signs and symptoms of cerebral palsy.
- Physical therapy – muscle training and exercises can help promote muscle strength. The use of mobility support such as braces, and splints may also be recommended.
- Occupational therapy – occupational therapists are particularly helpful in helping children cope with activities of daily living.
- Speech and language therapy – speech-language pathologists are helpful in improving the child’s ability to communicate.
- Recreational therapy – other therapies can help children with cerebral palsy improve their motor skills and emotional well-being. Recreational therapies may include activities such as horseback riding or skiing.
- Surgeries. Some surgical procedures may be helpful in managing the effects of cerebral palsy.
- Orthopedic surgery – severe deformities may require surgical interventions to improve movement and growth.
- Cutting of nerve fibers – a procedure called selective dorsal rhizotomy may be helpful in other cases. It involves the surgical removal or cutting of nerves to relax muscles and reduce pain.
Nursing Diagnosis for Cerebral Palsy
Nursing Care Plan on Cerebral Palsy 1
Nursing Diagnosis: Risk for Trauma/Injury related to loss of sensory coordination and muscular control secondary to cerebral palsy and seizures
Desired Outcome: The patient will be able to prevent trauma or injury by means of maintaining his/her treatment regimen in order to control or eliminate seizure activity.
|Cerebral Palsy Nursing Interventions||Rationale|
|Explore the usual seizure pattern of the patient and enable to patient and caregiver to identify the warning signs of an impending seizure.||To empower the patient and his/her caregiver to recognize a seizure activity and help protect the patient from any injury or trauma. To reduce the feeling of helplessness on both the patient and the caregiver.|
|Place the bed in the lowest position. Put pads on the bed rails and the floor.||To prevent or minimize injury in a patient during a seizure.|
|Advise the caregiver to stay with the patient during and after the seizure.||To promote safety measures and support to the patient. To ensure that the patient is safe if the seizure recurs.|
|Administer anti-epileptic and muscle relaxant drugs (such as benzodiazepines) as prescribed.||To prevent the occurrence of seizures and treat epilepsy related to cerebral palsy.|
|During seizure, turn the patient’s head to the side, and suction the airway if needed. Use a plastic bite block only when the jaw is relaxed.||To maintain a patent airway. Avoid inserting the plastic bite block when the teeth are clenched to prevent any dental damage. Do not use wooden tongue depressors as they can break or splinter, causing oral damage.|
|Minimize noise and light stimuli in the child’s room.||Light from gadgets, bright flashing lights, or too much noise may trigger a seizure activity.|
Nursing Care Plan on Cerebral Palsy 2
Nursing Diagnosis: Impaired Verbal Communication related to neurologic impairment secondary to cerebral palsy as evidenced by difficulty of establishing verbal communication and difficulty vocalizing words
Desired Outcome: The child will be able to express his/her needs to the caregiver effectively.
|Cerebral Palsy Nursing Interventions||Rationales|
|Assess and monitor the patient’s developmental and cognitive ability. Observe for both verbal and non-verbal cues that the child shows to express his/her needs.||To help establish baseline, as well as short-term and long-term goals.|
|Create an environment that is calm, quiet, well-lit, and conducive to effective communication.||Having an environment that is free from disturbing stimuli helps in preventing distractions. This will help the child focus on expressing what he/she needs or wants.|
|Speak slowly, keep voice in low volume, and use clear and simple words when communicating with the child.||Using simple words and speaking clearly can help the patient understand what is being said.|
|Educate the patient on how to use alternative ways of communication.||Using flashcards with drawings and simple words, whiteboard and marker, and hand signals can help improve communication between the child and the parent/caregiver.|
|Refer the child to a speech therapist as needed.||A speech therapist can help improve the coordination of the tongue and lips for a clearer speech.|
Nursing Care Plan on Cerebral Palsy 3
Nursing Diagnosis: Impaired physical mobility related to neuromuscular impaired secondary to cerebral palsy as evidenced by difficulty of movement, unsteady gait, generalized weakness, and limited range of motion
Desired Outcome: The patient will be able to perform activities of daily living within the limits of the present condition.
|Cerebral Palsy Nursing Interventions||Rationales|
|Assess the patient’s level of functional mobility and perform a child developmental assessment.||To assist in creating an accurate diagnosis and monitor effectiveness of treatment and therapy.|
|Assist the child when performing activities of daily living. Encourage the development of fine and gross motor skills.||To encourage the patient to perform exercises that can help develop fine and gross motor skills optimally, and to promote the child’s autonomy by allowing him/her to perform their ADLs while maintaining safety.|
|Ensure the safety of the environment. Check that the bed rails are up when the patient is on the bed, the bed is in the lowest level, the room is well-lit, and the floor is not slippery.||To maintain patient safety and reduce the risk of falls.|
|Encourage the patient to perform range of motion (ROM) exercises in all extremities.||To improve venous return, muscle strength, and stamina while preventing stiffness and contracture deformation.|
|Refer to the physiotherapy team. Encourage the family to help the child use orthotic devices.||To provide a specialized care for the patient to gain physical and mental support in performing ADLs and mobilizing. The physiotherapy team can teach the child and family on how to properly use the orthotic devices.|
Nursing Care Plan on Cerebral Palsy 4
Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis: Imbalanced Nutrition Less Than Body Requirements related to the patient’s increased metabolic needs and inability to ingest food properly, secondary to cerebral palsy as evidenced by difficulty in chewing, swallowing, and sucking and uncoordinated hand movement, and decreased weight.
- The patient will re-establish an adequate level of calories or nutrients desirable for normal growth.
- The patient will regain a weight that is appropriate for the patient’s age and ideal body mass index (BMI).
Nursing Care Plan on Cerebral Palsy 5
Ineffective Therapeutic Regimen Management
Nursing Diagnosis: Ineffective Therapeutic Regimen Management related to excessive demands made on the family of the patient and deficient knowledge about the prescribed regimen secondary to cerebral palsy as evidenced by verbalization of anxiety and difficulty of the prescribed regimen by the patient’s parents.
Desired Outcome: The patient’s family / guardian will be able to adapt to the changes, growth, and developmental needs of the patient.
|Cerebral Palsy Nursing Interventions||Rationale|
|1. Allow the parents to verbalize and express the effect of the patient’s condition on the family and assess the ability of the family to cope with the situation. Explain the condition of the patient to the family members and the support needed by the patient from his or her family.||Verbalization and expression of the family’s feelings and concerns and determining how the family copes with the situation are important to assess how much support and guidance the family may need.|
|2. Teach the family/ guardian about the different skills that may be needed to manage the patient’s care such as physical rehabilitation, proper nutrition, medication administration, ROM exercises, and management of seizures.||Learning about complex skills is also important before other skills can be performed with competence. Complex skills include complex movements which require high levels of coordination and control. Physical rehabilitation, proper nutrition, medication administration, and range of motion exercises as well as management of seizures are important for the recovery of the patient.|
|3. Include other significant others in planning for the home care of the patient with cerebral palsy.||Support from significant others will help the family to learn and integrate their experience into their own.|
|4. Check for the circumstances that may influence the resolution with the programs negatively.||Being aware of the causative factors will help provide direction for the interventions that may range from financial limitations to physical limitations.|
|5. Review the previous/ current therapeutic regimen and modify interventions as needed.||It is important to assess the knowledge about the previous regimen used to have a starting point in understanding the complexities of the implementation of the treatment plan.|
|6. Evaluate the family’s view of the patient’s health condition and their ability to perform the desired behavior.||A positive conviction of the family can favorably help in performing a behavior and will cause successful outcomes and performance in caring for the patient.|
|7. Check for the ability of the patient to achieve and do the desired activities and assess the patient’s ability to absorb or understand related activities.||The ability of the patient to do activities will help the nurse to determine the amount and type of care that needs to be implemented. The patient with cognitive impairments needs to be recognized and should be given alternative methods and actions.|
|8. Explain the regimen to the family properly in a way the family would easily understand. The family may be suggested to use long-acting medications as needed and as prescribed by the physician.||Family may more likely disregard medication if the prescribed regimen and medication are taken multiple times a day.|
|9. Unnecessary clinic visits should be avoided.||Going to an appointment increases the physical requirements as well as the financial costs to the family, which may cost the family’s withdrawal from follow-ups.|
|10. Assess the family/ caregiver’s behavior that has the greatest contribution to the therapeutic effect and interventions.||Changes in behavior are not easy. To result in specific benefits to the activities is directed through their efforts.|
|11. Advise the family and initiate a referral to a support group if the family is lacking a sufficient support system that affects the treatment regimen for the patient. Look for the available community services for rehabilitation, respite care, childcare, and other needs.||Patients with chronic illnesses need several groups that may help the patient and the family in achieving the goals for the patient care. Available diverse services may be needed because of the multiple impacts of cerebral palsy on the patient.|
|12. Instruct the family members about the anxiety-reducing skills such as relaxation, deep breathing, and positive visualization of the patient’s condition.||Teaching the family of the patient with cerebral palsy about stress management skills is needed. Using the stress management skills will help the family to cope and accept the changes that the family and patient may experience.|
Nursing Care Plan on Cerebral Palsy 6
Nursing Diagnosis: Risk for Self-care Deficit related to impaired mobility, cognitive changes, and decreased muscle strength and endurance secondary to cerebral palsy.
Desired Outcome: The patient will perform self-care safely to the patient’s highest capability.
|Cerebral Palsy Nursing Interventions||Rationale|
|1. Do a complete nursing assessment of the patient’s condition and determine the capability of the patient to do activities such as self-care. Assess the patient’s capability to learn self-care activities such as eating, tooth brushing, toileting, bathing, and dressing. Observe the cognitive and functional capability of the patient.||Doing the baseline assessment is important to determine the patient’s capabilities to do activities and self-care. Baseline assessment will also help in determining the intervention that is necessary for the patient.|
|2. Provide the patient assistance and assist the patient to learn self-care such as brushing teeth, eating, toileting, bathing, and dressing.||Assisting and teaching the patient about self-care skills will help the patient to gain self-esteem when accomplishing the activity.|
|3. Advise the parents and significant others to supervise and assist the patient when taking a bath.||Lack of muscle coordination is common in patients with cerebral palsy. The family must assist the patient because the patient is at risk of slipping underwater and drowning.|
|4. Arrange modification techniques for self-care activities such as using straps on the utensils that the patient used for eating.||Using straps on the utensils will securely hold the utensils which will help in easy utilization of the utensils.|
|5. Demonstrate to the patient some t energy-conservation techniques.||Energy-conservation techniques will decrease the unnecessary movement of the body that will minimize fatigue of the muscles, joint stress, and pain. Conserving energy helps the patient to bind up the strength to take part in the daily activities of the patient. This will also help to increase the patient capability to execute the task.|
|6. Advise the parents to monitor the patient during meals and snacks to check for the signs of difficulty swallowing.||Patients with cerebral palsy may have difficulty swallowing due to the patient’s uncontrollable movements which will cause choking and aspiration.|
|7. Instruct the parents to increase the intake of the patient of foods that are high-roughage such as whole-grain foods, vegetables, and fruits.||Foods such as whole-grain foods, vegetables, and fruits will help in bowel evacuation and will help prevent constipation.|
|8. Allow the patient to have extra time for self-care and activities and provide a calm environment.||The patient may often be easily stressed with activities and may need to have extra time to be able to complete the tasks. Avoid rushing the patient during the activities to allow the patient to understand the activities and make the patient more comfortable while doing the activity which will help to prevent mental stress. Letting the patient finish the self-care activities will give the patient confidence and a feeling of self-worth.|
|9. Encourage the family to provide assistive devices and grooming aids for self-care as needed. Teach the patient the proper use of toiletries and hygiene aids such as soap, shampoo, washcloth, and toothbrush.||This will help promote autonomy when the patient performs self-care activities and will help the patient to increase his or her self-esteem.|
|10. Teach the patient about the step-by-step methods when doing self-care.||Cerebral palsy can decrease the level of concentration and cognition of the patient. Breaking down tasks into simple steps can help in organizing the patient’s thoughts and actions.|
|11. Provide and instruct a urinary and bowel routine care plan to the family if the patient is not able to do toileting on his or her own.||A Urinary and bowel routine care plan will help identify urinary and bowel problems. Urinary and bowel care plans will also help resolve the issues through planning and monitoring of the patient.|
|12. Encourage the patient to seek occupational therapist consultation.||Consultation with the occupational therapists will help the patient to achieve optimal performance in the patient’s daily activities such as bathing, dressing, and personal hygiene activities.|
More Cerebral Palsy Nursing Diagnosis
- Risk for Delayed Growth and Development
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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