Cerebral Palsey, Metal Retardation Care Plan

  1. I am doing a care plan on an MR, CP with a possible partial bowel obstruction, with a G-tube, age 15. Bowel ostruction self resolving.

    I have Acute Pain and Nutrion Imbalance. But one of the diagnosis has to be pyschosocial.

    I was going to Delayed Growth and Development. But I am having a hard time coming up with realistic goals. 1 short term 1 long term.

    He is like a big baby..... had to change his diapers, does not speak. He does go to school, I don't know what he does there? Anyone with this experience, who can give me some insight as to realistic goals for someone like this? He may have been regressing in the hospital as he was sucking his hand and the IV tubing. Generally a happy kid, very amiable and cooperative, obviously well taken care of.

    Suggest another diagnosis, or give me a goal please.
    •  
  2. 6 Comments

  3. by   mercyteapot
    He actually isn't like a big baby, he is a young man. I suggest researching these disorders on the websites of reputable organizations such as the National Down Syndrome Society www.ndss.org and United Cerebral Palsy www.ucp.org This would be preferable to anyone here suggesting or giving you answers. The whole purpose of this exercise is for you to understand these developmental disorders better. Someone else giving you answers isn't going to serve that purpose.
  4. by   kimber1985
    I've know people cerebral palsey and he doesn't have down syndrome.

    It is really just the severity that stumps me. The hospital wasn't addressing any Physical Therapy issues, which would be my choice for short term goal.
    He stayed in his crib all day, and I thought he should get some kind of stimulation, but this wasn't the case. All the other kids get to go to the play room or watch videos or play video games. There was nothing implemented for this child in terms of child life activities or therapy of any kind. That makes it hard for me to come up with a short term goal, as none appeared to exist.

    He only weighed 80 lbs, which I am sure is due to lack of muscle tissue not necessarily nutrition or knowledge deficet on the part of the mother. I can't come up with a way to improve his growth.

    We are going to a school for developmently delayed children in a couple of weeks, and I am sure I will get insight then, but the careplan is due now.

    Researching CP or MR is not helping me with this particular child. It's the combination and lack of experience that makes me ask the question, not laziness. It's not like I am finding anything that gives specific examples of how to improve gross and fine motor skills with a child like this. I am not an occupational therapist. I am looking for realistic nursing goals for improving the psychosocial development of this child while he is in my care.
  5. by   mercyteapot
    Sorry, I'm not sure why I said NDSS instead of ARC. We work pretty closely with both of them at my agency.
  6. by   VickyRN
    Long term goal for delayed growth and development for your patient: Look into treatment plan written by social worker, physical therapist, or occupational therapist. There should be such a plan in the chart. You can find a realistic long-term goal there.

    You should also be able to find realistic short-term goals in the child's treatment plan (in the chart). Such as: Child will open eyes in response to verbal cues and will track and follow a ball of red yarn to 180 degrees during student nurse shift.

    Sometimes with very severe disability (as in the case of a child in a persistent vegetative state), the only reasonable goal is: Patient will maintain present level of functioning during stay at facility without experiencing any further neurological insults or loss of function.

    Hope this helps
  7. by   Daytonite
    i've been giving a great deal of thought to this since i saw your post. i think that a better psychosocial nursing diagnosis to use would be deficient diversional activity r/t lack of available activities aeb observation that patient has no activities to engage in while hospitalized

    i wasn't satisfied with the suggested outcomes in my ackley and ladwig nursing diagnosis book. i got to thinking about the kinds of interventions that might be involved here. basically, you want to have interventions that are going to describe some appropriate activities that the staff could engage in with this young patient. the staff is who really needs the teaching here. that's ok. that is also part of nursing intervention and part of the nurses management and teaching functions. outcomes describe patient states that follow and are expected to be influenced by interventions. i'm looking at my copy of nursing outcomes classification (noc), 3rd edition, from the iowa outcomes project to see what kind of outcomes they associate with this nursing diagnosis. they list many more than ackley and ladwig do. it includes child development outcomes for ages 2 to adolescence. now, you didn't mention this child's mental age, only his physical age, so i don't know what outcomes to list for you because there are so many listed under each of the age groups for the children. if you know his mental age (that would have been listed somewhere in his medical or psychological evaluation) i could supply a few more possible outcomes for you. however, i think this will fit the bill for you:

    patient will continue to maintain a happy demeanor and attitude as evidenced by[list some of patient's personal behaviors that indicate he is happy and contented]
  8. by   kimber1985
    Thank You, you have me on the right track.
    His mental age is minimal but hard to really determine, since he doesn't speak, but will be helpful when changing his diaper or he may squeeze my hand during Physical Assessment.
    I like Deficient Diversional Activity. I think I am going to go with that one.
    Thanks again.

close