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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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