Question

physical assessment of a child who is cerebral palsy, hydrocephalus, seizure disorder, and feeding difficulty.

A.please provide the outcome and evaluation

B. potential complication

c. Nursing interventions

d. client education

Answer 1

CEREBRAL PALSY: It is a neurological disease caused by brain damage and is the common motor and movement disability of childhood

Physical assessment:

• Delay in movements and motor skills such as holding head up sitting,crawling and walking.
• Body parts are stiff and floppy.
• Favoring one side of the body
• Unable to stand,even with support.
• Scooting on the bottom instead of crawling.

Evaluation:

• Electroencephalogram(EEG) is used to evaluate the electrical activity in the brain and also showed the signs of epilepsy which cause seizures.
• MRI is used to produce detailed images of the brain and can identify abnormalities in the brain.
• CT Scan can create clear,cross sectional images of the brain and also reveal brain damage.
• Cranial ultrasound is a quick and inexpensive method of using high frequency sound waves to produce images of brain in infants
• Blood test may be taken to rule out bleeding disorders.
• Thyroid function studies used to study abnormalities in muscle tone or deep tendon refleses or movement disorders.

Complications:

• Spasticity and muscle stiffness
• Atrophy(Thinning of muscle)
• Choking
• Aspiration pneumonia
• Pressure ulcers
• Bladder infections
• Constipation

Nursing intervention:

• Ensure therapeutic communication with the family to learn as much as about the child activities at home.
• Assist the patient to increase personal judgement of self worth.
• Provide emotional support
• Utilize the family strength ton influence health in a positive direction
• Provide safe environment and protective gear to prevent physical injury by
• Use the correct prescribed braces and other devices to prevent physical deformity.
• Promote mobility by encouraging the child to perform appropriate motor activities
• Increased oral nutritional fluid intake
• Manage foster relaxation and general health by providing rest periods.
• Encourage self care by urging the child to participate in activities by daily living.
• Enforce therapeutic measure designed to establish locomotion,communication,and self help and and optimal integration of motor functions.

Client education:

• Physical therapy can help you child strength,flexible,balance and motor development and mobility.
• Occupational therapy helps your child gain independence in daily activities like school and in home.Adaptive equipment should be recommended that includes walkers,electrical wheel chairs
• Speech and language therapy can help to improve your child ability to speak by using sign language.Speech therapists can also address difficulties with eating and swallowing
• Recreational therapy can improve child motor skills by sport activities.

HYDROCEPHALUS:

It is a caused by bulidup of fluid in the cavities deep with in the brain.Increased level of fluid can results to increased the size of ventricles and pressure on the brain.

Physical examination:

• Abnormal head enlargement
• Prominent scalp veins
• Skull bones may feel separtaed
• Headache,nausea
• Downward deviation of eyes
• Bulging frontal
• Urinary urgency

Outcome and evaluation:

• Patient will have partial brain function without developmental delay ;Patient should be free fro injury;Patient should be free from infection.
• MRI,CT scan be used to detect enlarged ventricles
• Neurological examination
• Cerebro spinal fluid tests used to predict responsiveness and determine shunt pressure include lumbar puncture,intracranial pressure,external lumbar drainage.

Complication:

• Subdural hematoma
• Seizures
• Shunt infection
• Death

Nursing intervention:

• Asses vital sign of increased intracranial pressure such as tachycardia and blood pressure
• Assess neurological status such as motor function,changes in pupil reaction
• Asses head circumference and fontanelles to indicate accumulating fluid
• Initial safety an seizure precautions:
• Place infant in crib
• Keep oxygen and suction at bed side
• Keep head elevated
• Support enlarged head when holding toddler.
• Administer diuretics and corticosteroids medication.

Client education:

• Encourage parents to practice good hygiene to prevent spread of infections
• Educate the care given about the warning sign of intracranial pressure after discharged.
• Advise safely measures to reduce the risk of brain injury.

SEIZURES:It is sudden uncontrolled disturbances in electrical activity in the brain and it can cause changes in behavior,movement, feeling,level of consciousness.

Physical examination:

• Temporary confusion
• Staring spell
• Fear anxiety
• Loss of consciousness.
• Cynosis

Evaluation:

• EEG is used to study electrical activity of brain
• MRI is used to visualize the lesions on the brain.
• Positron emission tomography is used to help visualize active area of the brain and detect abnormalities.
• Computerized tomography reveal abnormalities in the brain such as tumour,cyst,bleeding.

Complications:Aspiration,cardiac arrhythmias,Permanent brain damage

Nursing intervention:

• Prevent trauma injury
• Promote airway clearance
• Enforce education about disease to discuss about possible triggers for seizure like bright light,stress,dehydration.Instill the importance of oral hygiene,medication regimen missed dose

Client education:

• Dietary: Ketogenic diet is high fat, low carbohydrate can control seizure condition.
• Vagus nerve stimulation
• Deep brain stimulation

FEEDING DIFFICULTY:

Physical assessment:

• Consider the age and development stage of child.
• Implement behaviors that show for child age ,gender,personal preference.
• Examine least intrusive area such as hands arms nad painful area(ears,nose,mouth)
• Determine heart lungs,abdomen is to be completed before crying which may be seen in some children.
• Motor skills
• Facial features
• Communication

Outcomes:

• Achieve effective breast feeding
• Verbalize techniques to manage breast feeding.
• Infant manifest sign of adequate intake at the breast
• Explain a safe alternative method of infant feeding if unable to continue breastfeeding.

Complications:

• Dehydration
• Poor nutrition
• Chronic lung disease
• Aspiration

Nursing education:

• Assess for presence or absence of related factors that would preclude breastfeeding.
• Assess nipple and breast structures
• Evaluate the infant ability to properly grasp and compress the areola with lips jaw and tongue.
• Evaluate the infant suckling and swallowing pattern at the breast.
• Evaluate the time for feeding.
• Assess the knowledge regarding psychophysiology of lactation and treatment measure for underlying conditions.

Client education:

• Provide instructions for correct positioning and nutrition values to infant by breast feeding
• Provide education to support as needed.