NURSING CARE PLAN

GOAL 1.

The Child with Cerebral Palsy

RATIONALE EXPECTED OUTCOME

INTERVENTION

Impaired Physical Mobility related to decreased muscle strength and control NIC Priority Intervention: Exercise Therapy, Joint Mobility: Use of active and passive body movement to maintain joint flexibility NOC Suggested Outcome: Joint MovementActive: Range of motion of joints with self-limited movement

The child 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 child to complete activities Perform range-of-motion exercises every 4 hours for the child unable to move body parts. Position the child 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.

Delayed development milestones are common with cerebral palsy. Once one milestone is achieved, interventions are revised to assist in the next skill necessary. Many activities of daily living and play activities promote physical development.

The child reaches maximum physical mobility and all developmental milestones.

The child may perform tasks more slowly than most children. Promotes mobility and increased circulation, and decreases the risk of contractures.

A regular and frequently reevaluated rehabilitation program assists in promoting development. Adaptive devices are often necessary to maximize physical mobility.

2. Sensory/Perceptual Alteration: Visual or Auditory related to cerebral damage NIC Priority Intervention: Communication Enhancement: Visual Deficit or Auditory Deficit: Assistance with accepting or learning alternative methods for living with diminished vision or hearing. The child will receive and benefit from varied forms of sensory and perceptual input.

NOC Suggested Outcome: Body Image: Positive perception of own appearance and body functioning

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 a child with poor vision, allow touching of objects, provide visual materials to enhance learning in the child with impaired hearing, use computers to promote communication).

Adaptive devices often enhance sensory input. These devices need frequent changes as the child grows.

The child receives adequate sensory/perceptual input to maximize developmental outcome.

Other senses can compensate for those that are impaired.

NURSING CARE PLAN

GOAL

The Child with Cerebral Palsy (continued)

RATIONALE EXPECTED OUTCOME

INTERVENTION

3. Altered Nutrition: Less than Body Requirements related to difficulty in chewing and swallowing and high metabolic needs NIC Priority Intervention: Weight Gain Assistance: Facilitation of body weight gain. The child will receive nutrients needed for normal growth.

NOC Suggested Outcome: Nutritional Status: Extent to which nutrients are available to meet metabolic needs.

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 child 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.

Insufficient intake can lead to impaired growth and dehydration. Special techniques can facilitate food intake.

The child shows normal growth patterns for height, weight, and other physical parameters.

Aspiration pneumonia is a risk for the child with poor swallowing. Special feeding techniques may be needed.

4. Ineffective Management of Therapeutic Regimen: Family related to excessive demands made on family with childs complex care needs NIC Priority Intervention: Family Process Maintenance: Minimization of family process disruption effects. The family will adapt to growth and development needs of the child with cerebral palsy.

NOC Suggested Outcome: Not yet developed.

Allow opportunities for parents to verbalize the impact of cerebral palsy on the family. Provide referral to other parents and support groups. Explore community services for rehabilitation, respite care, childcare, and other needs and refer family as appropriate. During home and office visits review the childs achievements and praise the family for care provided. Teach the families skills needed to manage the childs care (e.g., medication administration, physical rehabilitation, seizure management). Teach case management techniques. Involve siblings in the care for the child with cerebral palsy. Review for parents the needs of all children in the family.

The family needs an opportunity to explore the emotional and social impact of the childs care to integrate and grow from the experience. Diverse services are available and will be needed due to the multiple impacts of cerebral palsy on the child. The childs achievements are positive reinforcement of the familys efforts. Complex skills must be learned before they can be performed with efficiency.

The family continues its development and provides support for all of its members.

The child requires care by many specialists. Many parents become case managers to coordinate care. Siblings of the child with cerebral palsy may feel left out because of the care provided. Special efforts contribute to meeting the developmental needs of all family members.

(continued)

NURSING CARE PLAN

GOAL

The Child with Cerebral Palsy (continued)

RATIONALE EXPECTED OUTCOME

INTERVENTION

5. Diversional Activity Deficit (Child) related to poor social skills NIC Priority Intervention: Recreation Therapy: Purposeful use of recreation to promote relaxation and enhancement of social skills. The child will engage in adequate diversional activity to maximize growth and development.

NOC Suggested Outcome: Play Participation: Use of activities as needed for enjoyment, entertainment, and development by children.

Refer the family to early childhood stimulation programs. Encourage contact with other children. When hospitalized, place the child in a room with other children when possible. Work with the local school to develop an individualized education plan that allows the child contact with other children and a variety of activities. Investigate recreational programs for children with disabilities and share information with the parents.

The child needs a variety of activities and contact with other children and adults to maximize development.

The child engages in activities that maximize development.

Public schools must provide an individualized education plan. Parents may need assistance to interact effectively with the school system. Recreational programs for children with disabilities may promote social experiences and physical activity.