Question

2) Case Studies Chapter 44: Nursing Care of the Child with a Neuromuscular Disorder

Question is

developed 3 nanda a nursing care plan on , 3 nanda’s for Cerebral palsy

a) Medication: for cerebral palsy

Answer 1

Ans) Nursing Care Plan: Cerebral Palsy

1) Impaired Physical Mobility related to disease condition.

Expected goal: Child/infant will achieve maximum movement ability and absence of contractures.

Nursing Intervention & rationale:

Assess the type of auditory, visual, motor, or intellectual deficit. Knowing the type of deficit will aid in planning interventions appropriate for the child.

Do a developmental assessment and note the development of milestones (such as stand with help, or walk when led). A client with cerebral palsy usually has delayed developmental milestones.

If one skill is attained, interventions are changed in order to achievet the succeeding one.

Facilitate activities in using fine and gross motor skills (such as giving a ball on hand to encourage throwing, holding a spoon) Most of the activities of daily living and

play exercises hasten physical development.

Allow the child to perform activities or care routines at his or her own pace. A child may have difficulty completing tasks in time compared to normal children.

Encourage the child to rest between activities that are tiring. Given the limitations of the child’s ability, rest periods are given to maintain energy.

Perform range-of-motion exercises

every 4 hours for the child unable to move body parts. Children with cerebral palsy have a decreased range of motion (ROM) due to limited mobility and the presence of spasticity. ROM exercises promote movement and minimize the risk of contractures.

Educate the family on how to use an orthotic device as indicated. Orthotic devices help build stability while increasing strength, balance, comfort, and independence.

2) In general:

Risk for injury related to spasms, uncontrolled movements, and seizures.

Impaired physical mobility related to spasms and muscle weakness.
Changes in growth and development related to neuromuscular disorders.
Impaired verbal communication related to difficulty in articulation.
Risk for aspiration related to neuromuscular disorders.
Disturbed thought processes related to cerebral injury, learning disabilities.
Self-care deficit related to muscle spasms, increased activity, cognitive changes.
Deficient knowledge related to home care and therapeutic needs.

Major goals for the patient with cerebral palsy include:

Verbalize feelings related to self-esteem.
Develop adequate coping mechanisms.
Demonstrate knowledge of the condition and the treatment plan.
Achieve age-appropriate growth, behaviors, and skills to the fullest extent possible.
Express positive feelings about himself.
Maintain optimal functioning within the limits of the visual or hearing impairment.
Remain oriented to person, place, time, and situation.
Consume adequate daily calories as required.
Maintain joint mobility and ROM.
Swallow without pain or aspiration.
Family members will discuss how the patient’s condition has affected the family’s daily life.
The parents will identify realistic goals according to the abilities of the child.
Nursing Interventions
Nursing interventions for the child with cerebral palsy are:

Ensure therapeutic communication. To ease the change of environment, the nurse needs to communicate with the family to learn as much as possible about the child’s activities at home.
Enhance self-esteem. Assist the patient to increase his/her personal judgment of self-worth.
Provide emotional support. Provide of reassurance, acceptance, and encouragement during times of stress.
Strengthen family support. Utilize the family’s strengths to influence patient’s health in a positive direction.
Prevent injury. Prevent physical injury by providing the child with a safe environment, appropriate toys, and protective gear (helmet, kneepads) if needed.
Prevent deformity. Prevent physical deformity by ensuring the correct use of prescribed braces and other devices and by performing ROM exercises.
Encourage mobility. Promote mobility by encouraging the child to perform age-and condition-appropriate motor activities.
Increase oral fluid intake. Promote adequate fluid and nutritional intake.
Manage sleep and rest periods. Foster relaxation and general health by providing rest periods.
Enhance self-care. Encourage self-care by urging the child to participate in activities of daily living (ADLs) (e.g. using utensils and implements that are appropriate for the child’s age and condition).
Facilitate communication. Talk to the child deliberately and slowly, using pictures to reinforce speech when needed; encourage early speech therapy to prevent poor or maladaptive communication habits; and provide means of articulate speech such as sign language or a picture board.
Enforce therapeutic measures. Assist in multidisciplinary therapeutic measures designed to establish locomotion, communication, and self-help, gain optimal appearance and integration of motor functions.
Evaluation
Evaluation of the nursing care plan would prove to be successful if evidenced by:

Verbalization of feelings related to self-esteem.
Development of adequate coping mechanisms.
Demonstration of knowledge of the condition and the treatment plan.
Achievement of age-appropriate growth, behaviors, and skills to the fullest extent possible.
Expression of positive feelings about himself.
Maintenance of optimal functioning within the limits of the visual or hearing impairment.
Orientation to person, place, time, and situation.
Consummation of adequate daily calories as required.
Maintenance of joint mobility and ROM.
Swallowing without pain or aspiration.
Family members’ discussion on how the patient’s condition has affected the family’s daily life.
The parent’s identification of realistic goals according to the abilities of the child.