Cerebral palsy is a disorder of movement, muscle tone or posture that is caused by damage that occurs to the immature, developing brain, most often before birth. Show
What is Cerebral Palsy?Cerebral palsy is one of the most complex of the common permanent disabling conditions.
ClassificationSeveral major types of cerebral palsy occur; each has distinctive clinical manifestations.
PathophysiologyGiven the complexity of prenatal and neonatal brain development, injury or abnormal development may occur at any time, resulting in the varied clinical presentations of cerebral palsy (whether due to a genetic abnormality, toxic or infectious etiology, or vascular insufficiency).
Statistics and IncidencesThe incidence of cerebral palsy have not changed in more than 4 decades, despite significant advances in the medical care of neonates.
CausesAlthough the cause of cerebral palsy cannot be identified in many cases, several causes are possible.
Clinical ManifestationsSigns of cerebral palsy include the following:
Assessment and Diagnostic FindingsThe diagnosis of cerebral palsy is generally made based on the clinical picture; there are no definitive laboratory studies for diagnosing the condition, only studies, including the following, to rule out other symptom causes:
Medical ManagementTreatment of cerebral palsy focuses on helping the child to make the best use of residual abilities and achieve maximum satisfaction and enrichment in life.
Pharmacologic TherapyNumerous medications, including the following, may relieve the movement difficulties associated with cerebral palsy:
Nursing ManagementThe child with cerebral palsy may be seen in the healthcare setting at any age level. Nursing AssessmentAssessment of the child with cerebral palsy includes the following methods:
Nursing DiagnosisBased on the assessment data, the major nursing diagnoses include:
Nursing Care Planning and GoalsMain Article: 7 Cerebral Palsy Nursing Care Plans Major goals for the patient with cerebral palsy include:
Nursing InterventionsNursing interventions for the child with cerebral palsy are:
EvaluationEvaluation of the nursing care plan would prove to be successful if evidenced by:
Documentation GuidelinesDocumentation for a patient with cerebral palsy include:
Practice Quiz: Cerebral PalsyHere’s a 5-item quiz about the study guide. Please visit our nursing test bank page for more NCLEX practice questions. 1. Mrs. Cooper is concerned about her 4-month-old son’s unusual condition; which of the following statements made by her would indicate that the child may have cerebral palsy? A. “He holds his
left leg so stiff that I have a hard time putting on his diapers.” 1. Answer: B. “My baby won’t lift his head up and look at me; he’s so floppy.” Hypotonia or floppy infant is an early manifestation of cerebral palsy. Typically, the infant lifts his head to 90-degree angle by age 4 months with only a partial head lag by age 2 months.
2. A toddler has recently been diagnosed with cerebral palsy. Which of the following information should the nurse provide to the parents? Note: More than one answer may be correct. A. Regular developmental screening is important to avoid secondary developmental delays. 2. Answers: A, B, and D. Delayed developmental milestones are characteristic of cerebral palsy, so regular screening and intervention is essential; Because of injury to upper motor neurons, children may have ocular and speech difficulties; Parent support groups help families to share and cope.
3. The nurse is caring for a 4-year-old with cerebral palsy. Which nursing intervention will help ready the child for rehabilitative services? A. Patching one of the eyes to strengthen the muscles. 3. Answer: B. Providing suckers and pinwheels to help strengthen tongue movement. The nurse can help ready the child with cerebral palsy for speech therapy by providing activities that help the child develop tongue control.
4. The nurse answers a call bell and finds a frightened mother whose child, the patient, is having a seizure. Which of these actions should the nurse take? A. The nurse should insert a padded tongue blade in the patient’s mouth to prevent the child from swallowing or choking on his tongue. 4. Answer: D. The nurse should clear the area and position the client safely. The primary role of the nurse when a patient has a seizure is to protect the patient from harming him or herself.
5. When assessing the development of a 15month old child with cerebral palsy, which of the following milestones would the nurse expect a toddler of this age to have achieved? A. Walking up steps. B. Using a spoon. C. Copying a circle. D. Putting a block in cup. 5. Answer: D. Putting a block in cup. Delay in achieving developmental milestones is a characteristic of children with cerebral palsy; a 15month old child can put a block in a cup.
Which developmental milestone would the nurse expect a typically developing 4Gross motor behaviors the nurse would expect for a 4-year-old client include skipping, catching a ball, and hopping on one foot. Skating and jumping rope are expected for a 5-, not 4-year-old client.
What are the typical developmental milestones from 3/4 years?3- to 4-Year-Old Development: Language Milestones
Speak 250 to 500 words. Answer simple questions. Speak in sentences of five to six words, and speak in complete sentences by age 4. Speak clearly, although they may not be fully comprehensible until age 4.
Which cognitive development milestone is characteristic of a 4Speak clearly using more complex sentences. Count 10 or more objects. Correctly name at least four colors and three shapes. Recognize some letters and possibly write their name.
What developmental skills do preschoolers exhibit?From learning to cut with scissors or hold a pencil to learning to share, take turns, and problem solve, these are developmental skills for preschoolers. The early years are the time to build a strong foundation in all developmental areas.
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