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									Meds: Carbidopa,                               Medical Diagnosis:                                 Labs: No labs specific                  Pathophysiology: Cerebral palsy is a term
                                                                                                  to CP were taken; his                   used to describe a group of crippling
lorazepam, Keppra,                             Cerebral Palsy                                     abnormal labs were                      syndromes that appear during childhood
                                                                                                                                          and involves permanent, non-progressing
and prn Haldol                                                                                    related to possible                     encephalopathic damage to the motor
                                                                                                                                          control areas of the brain (6). The
                                                                                                  infection & excessive                   damage may be present at birth or
                                                                                                  diaphoresis                             develop soon after birth (2). Cerebral
                                                                                                                                          palsy is not contagious, inherited, or
                                                                                                                                          progressive. Causes include prenatal
                                                                                                                                          infections of the mother (ex: chicken pox,
Clinical Manifestations: Hypertonia, clonus, rigidity of the               Risk Factors: Baby: Prematurity, low birth weight, sustained   measles, syphilis); mechanical trauma to
extremities, contractures, difficulty w/ purposeful movement               on ventilator for 4 wks, brain hemorrhage, exposed to toxic
                                                                                                                                          the head before, during or after birth;
and fine motor coordination, jerky, uncontrolled, and abrupt                                                                              nerve-damaging poisons; or reduced
movements, seizures, intellectual difficulties, communication              substances. Other: complications with pregnant mom(high        oxygen supply to the brain (6). Certain
disorders, bowel and bladder problems, orthopedic disabilities,            BP, Rh incompatibility, seizures), breech birth, L&D           infant illnesses are may be linked to CP
difficulty swallowing/excessive drooling , scoliosis(6)                    complications, multiple births, birth defects, newborn         including meningitis and viral encephalitis
                                                                           seizures, low APGAR scores (10)- (Pt. birth HX unknown)        (10). CP can also be caused by congenital
                                                                                                                                          abnormalities where the brain did not
                                                                                                                                          develop properly; strokes; or
ND: Risk for injury:                           ND: Self-care deficit: bathing/hygiene         ND: Impaired verbal communication
                                                                                              r/t impaired ability to articulate or       kernicterus(10). The damage to the
inability to control                           r/t neuromuscular impairments AEB                                                          motor areas of the brain impair the
                                                                                              speak words because of facial muscle
                                               pt inability to access bathroom, dry                                                       body’s ability to control movement and
spasticity r/t involuntary                     body, obtain water source, regulate
                                                                                              involvement AEB patient’s inability to
                                                                                              speak, use facial expressions, or use       posture. Severity of symptoms differs
movements.                                     bath water, and wash body.                     body language.                              from person to person.

Interventions:                                                                                Interventions:
1. Ask family to stay with patient             Interventions:                                 1. Involve a familiar person when           Patient’s Story: The patient is a 32 year old
to prevent the client from                     1. Have only one trusted caregiver             attempting to communicate with the          male who was admitted to the ER with
accidentally falling or pulling out            assist w/ bathing and post privacy             patient to increase comfort and assist      involuntary movements. He has a history of
tubes (2).                                     signs in order to ensure privacy (2).          with communication (2).                     cerebral palsy. His movements become more
                                               2. Keep the client warmly covered to           2. Listen carefully and check for           erratic with an increase in pain and metabolic
2. Monitor skin condition for color                                                           nonverbal expressions for pain to
or texture changes, bruising, and              prevent cooling during bathing.                                                            distress. His birth history and mother’s
                                               3. Perform a towel bath frequently to
                                                                                              ensure pain management (2).                 prenatal care are unknown. His chart
lesions to identify problems early                                                            3. Maintain eye contact to improve
and susceptible areas for injury.              reduce aggression and bathing time             communication (2).                          indicated he suffered from a stroke at age 3
3. Use specialty mattress to keep              while maintaining proper hygiene(2).           4. Use touch as appropriate to              months. This was not stated as the cause of
the client comfortable and                     4. Develop a bathing plan based on             convey caring to the patient (2).           his CP. Due to the CP, he has many problems,
decrease injury from jerky                     client’s history of bathing practices in       5. Be persistent in deciphering what        including inability to feed (has a J-tube),
movements.                                     order to promote comfort and focus             the patient is saying, and do not           incontinence, immobility (bedbound), and
4. Cover railings with padding in              on the client’s needs instead of being a       pretend to understand when                  inability to speak. He makes sounds and
order to decrease pain and injury              routine task(2).                               message is unclear to ensure the            gestures that are difficult to understand. His
                                                                                              patients’ needs are met (2).
of bumping against.                            5. Inspect skin while bathing (2).                                                         grandparents are his caregivers and remained
                                                                                                                                          with him in the hospital and were able to
                                                                                                                                          assist with care and communication. He has
Expected Outcome: Pt                           Expected Outcome:                                                                          pain in his right shoulder due to a previous fall
                                               Pt will remain free of body                    Expected Outcome:                           out of bed, and has a possible infection. His
will remain free from                          odor and maintain intact                       Pt will communicate using                   temp is elevated, and he is extremely
injuries during                                skin during hospitalization.                   alternative methods by end                  diaphoretic. He is also hypernatremic which
                                                                                                                                          may be due to fluid loss (sweat); it may be
hospitalization.                                                                              of shift.
                                                                                                                                          intensifying his involuntary movements.

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