{ "name": "Cerebral Palsy", "slug": "cerebral-palsy", "url": "https://nursingplex.com/care-plans/cerebral-palsy", "category": "Pediatric", "summary": "Non-progressive motor disorder; mobility support, nutrition and developmental promotion.", "nursing_diagnoses": [ "Impaired physical mobility", "Risk for aspiration", "Delayed growth and development" ], "overview": [ "Cerebral palsy is a group of permanent, non-progressive disorders of movement and posture caused by injury to the developing brain before, during or shortly after birth. The brain lesion does not worsen, but its musculoskeletal consequences do: untreated spasticity leads to contracture, hip subluxation and scoliosis. Spastic CP is the most common type, with hypertonia, scissoring gait, persistent primitive reflexes and toe-walking; dyskinetic and ataxic forms produce involuntary movement or poor coordination.", "CP affects far more than mobility. Feeding and swallowing difficulty, drooling, constipation, poor growth, seizures, vision and hearing deficits, communication barriers and pain are common. Intelligence is often normal even when speech and motor control are severely impaired, so nursing must never assume cognitive impairment from physical presentation. The goal is not cure but maximal function, participation and comfort, achieved through consistent therapy, adaptive equipment and family partnership." ], "key_facts": [ { "label": "Early clues", "text": "Persistent primitive reflexes beyond expected age, hand preference before 12 months, scissoring of legs, stiff or floppy tone, delayed milestones." }, { "label": "Non-progressive", "text": "The brain injury is static; deformity progresses only if spasticity and positioning go unmanaged." }, { "label": "Aspiration risk", "text": "Poor oral-motor control, reflux and impaired cough make aspiration pneumonia a leading cause of hospitalization." }, { "label": "Spasticity care", "text": "Stretching, positioning, orthoses, oral baclofen or diazepam, botulinum toxin injections, intrathecal baclofen pump, orthopedic surgery." }, { "label": "Communication", "text": "Assume competence — use augmentative and alternative communication and address the child directly." } ], "nursing_priorities": [ "Prevent aspiration and maintain a safe airway during feeding.", "Maintain mobility and joint range; prevent contracture, hip dislocation and skin breakdown.", "Ensure adequate nutrition and growth despite feeding difficulty.", "Establish a reliable communication method and assume normal cognition until proven otherwise.", "Control seizures, pain, spasticity and constipation.", "Support the family, prevent caregiver burnout, and promote the child's independence and participation." ], "assessment": { "subjective": [ "Parent reports of long, exhausting mealtimes, coughing or gagging with feeds", "Reports of stiffness, painful spasms or trouble with positioning and dressing", "Child's expressions of frustration at not being understood", "Family reports of caregiver fatigue, financial strain and social isolation", "Concerns about school placement, transportation and future independence" ], "objective": [ "Hypertonia or hypotonia, spasticity, scissoring, clonus, exaggerated deep tendon reflexes", "Persistent primitive reflexes and delayed gross and fine motor milestones", "Involuntary writhing (athetoid) movements, tremor or ataxia", "Contractures, joint deformity, hip subluxation, scoliosis, leg-length discrepancy", "Drooling, poor lip closure, tongue thrust, coughing or wet voice after swallowing", "Poor weight gain, low BMI, dental caries and gingival hyperplasia from phenytoin", "Pressure areas over bony prominences and under orthoses", "Seizure activity, strabismus, hearing deficit, constipation" ], "related_factors": [ "Static injury to the developing brain from hypoxia, prematurity, kernicterus, infection or trauma", "Spasticity and muscle imbalance across joints", "Impaired oral-motor coordination and gastroesophageal reflux", "Increased energy expenditure from abnormal tone and movement", "Impaired verbal communication and dependence for activities of daily living" ] }, "goals": [ "The child will remain free of aspiration, with clear lungs and no fever or respiratory distress.", "The child will maintain full available range of motion with no new contracture or skin breakdown.", "The child will maintain growth along their individual curve with adequate calorie and fluid intake.", "The child will communicate needs consistently using speech, signs or an assistive device.", "The child will achieve the highest attainable level of self-care and participation for their ability.", "Caregivers will describe a sustainable care routine and use respite and community resources." ], "interventions": [ { "title": "1. Safe feeding and aspiration prevention", "points": [ "Position upright at 90 degrees with the head slightly flexed forward for all feeds and keep upright 30–60 minutes afterward.", "Use thickened liquids and modified textures per the speech-language pathologist's swallow assessment, and adaptive utensils and cut-out cups.", "Feed slowly with small bites, allow full swallowing between bites, and stop for coughing, wet voice or color change.", "Apply gentle jaw and lip support to improve closure and reduce loss of food and drooling.", "Keep suction available; assess breath sounds and temperature for silent aspiration and report new cough or fever.", "Support gastrostomy feeding when oral intake is unsafe or insufficient, and continue tastes orally when safe for quality of life." ] }, { "title": "2. Mobility, positioning and deformity prevention", "points": [ "Perform passive and active range of motion several times daily and integrate stretching into dressing and bathing routines.", "Reposition at least every 2 hours; use standers, side-lyers, wedges and supportive seating to vary posture through the day.", "Apply braces, splints and orthoses as prescribed and inspect the skin at every removal for redness that does not fade.", "Support scheduled hip surveillance imaging — silent hip subluxation is common and painful if missed.", "Give antispasmodics as ordered and monitor for sedation and weakness; assist with botulinum toxin injections or intrathecal baclofen pump care, and know that abrupt pump failure causes dangerous withdrawal.", "Coordinate closely with physical and occupational therapy so the home program continues between sessions." ] }, { "title": "3. Nutrition, elimination and growth", "points": [ "Calculate calorie needs individually — some children need more from spastic movement, others fewer from immobility — and plot growth on CP-appropriate curves.", "Offer high-calorie, nutrient-dense foods and supplements; make mealtimes unhurried and enjoyable rather than a battle.", "Manage constipation proactively with fluid, fiber, activity and a scheduled bowel program.", "Treat reflux with upright positioning, smaller volumes and prescribed medication.", "Maintain rigorous oral hygiene; drooling, reflux and phenytoin all damage teeth and gums." ] }, { "title": "4. Communication, cognition and development", "points": [ "Speak directly to the child in age-appropriate language and allow generous time for a response — never talk over them to the caregiver.", "Establish a consistent yes/no signal and use picture boards, switches, eye-gaze systems or speech-generating devices with speech therapy.", "Provide developmentally appropriate play, school participation and peer interaction, adapting the activity rather than lowering expectations.", "Screen vision and hearing regularly, since uncorrected deficits are often mistaken for cognitive impairment.", "Encourage self-care participation with adaptive equipment even when it takes far longer." ] }, { "title": "5. Seizure, pain and safety management", "points": [ "Give anticonvulsants on schedule, monitor levels and side effects, and teach seizure first aid to the family.", "Assess pain with a nonverbal scale such as FLACC or a validated individualized tool; irritability is often hip pain, constipation or a pressure sore.", "Ensure safe transfers with proper body mechanics and lifts, and secure wheelchairs and car seats correctly.", "Prevent injury from falls, seizures and equipment with padding, helmets and supervision as needed." ] }, { "title": "6. Family support and care coordination", "points": [ "Teach the home program with return demonstration and written, illustrated instructions.", "Assess caregiver fatigue, back strain and mental health at every visit and arrange respite care.", "Connect the family to early intervention, school IEP services, financial and equipment resources, and parent support groups.", "Plan transition to adult services, vocational support and long-term living arrangements well before adolescence ends.", "Coordinate the many specialists involved so the family is not left assembling the plan alone." ] } ], "patient_teaching": [ "Feed sitting fully upright with the chin slightly tucked and keep upright afterward; stop for coughing or a wet-sounding voice.", "Do stretching and range-of-motion exercises every day — they are what prevent permanent deformity.", "Check skin under braces and at pressure points daily and report redness that does not fade.", "Call for fever with cough, new breathing trouble, seizure change, refusal to eat, or unexplained crying that suggests pain.", "Talk to your child normally and directly; motor impairment is not the same as cognitive impairment.", "Use respite care and support groups before you are exhausted, not after." ] }