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need nursing care plan for adult with cerebral palsy

Posted

I am beginning a part time job with a homebound ADULT with cerebral palsy; mild mental retardation; aggressive behavior. Need help with a nursing care plan.

Thanks,

Margaret Rivers LPN

NotReady4PrimeTime, RN

Specializes in NICU, PICU, PCVICU and peds oncology. Has 25 years experience.

Hello and welcome to allnurses.com. Please take this in the spirit intended... you might want to reconsider using your real name as your user name. At some point in the future your posts here could be used against you, no matter how harmless they seem. Just a thought.

Now, on to caring for adults with CP, mild developmental delay and aggressive behaviour. It would be helpful to know what type of CP he has, but not essential. I'll be making many assumptions about him that may or may not be correct. Your focus for care will be safety, ADLs, hygiene, mobility and behaviour. This man will probably have a well-developed care plan unless he's newly admitted to home health services. Daily routine is vital for people with developmental disabilities; they do best when they're able to predict what's going to happen next. Knowing what his schedule looks like will provide the structure for and help you organize your care. His parents or current caregivers will be able to give you detailed information about his abilities, which will also assist in planning care. They should also show you how his assistive devices work.

Your day will probably look like this:

Get him cleaned up, changed and dressed for the day. While you're doing this you can do your assessment, which will be less involved than those performed in acute or long-term care. People with athetoid and/or spastic CP are often very thin because of continuous muscle activity. Pay special attention to potential pressure areas, such as the coccyx, scapulae, back of the head, elbows, heels and areas where positioning devices such as AFOs and clamshell vests come in contact with skin. This is a good opportunity to do range of motion. Your client my require chest physio if there are lots of poorly-controlled oral secretions and/or scoliosis. I'd suggest doing this before giving meds or feeds. Give any a.m. meds (many - but certainly not all - people with CP have seizure disorders, and those with spasticity are given meds to treat it) via the prescribed route. Check his briefs or ask him if he needs the toilet, then transfer him to his chair, if he uses one. Next would be breakfast. Feeding instructions will be provided for you. This doesn't sound like a lot but it will take you several hours, especially at first. If he's verbal he should be able to help you know what order things are usually done.

He may have a few routine activities he does after breakfast, such as watching TV, reading or being read the newspaper, listening to music... that sort of thing. It may be possible to take him outdoors for a walk or to the mall to window shop. Social opportunities are important for people with mild developmental disability. Once you're more comfortable in your role, you'll have more options. Around lunchtime (or sooner) check his briefs again and change him if needed. The rest of your day would be similar to the morning, unless he has specific activities arranged. There may be noon or afternoon meds. You'll get into a rhythm fairly quickly.

Safety is paramount when someone isn't able to do for himself. Many brain-injured people are at high risk for aspiration due to poor control of oral secretions and reflux of stomach contents. This is probably your biggest duty, maintaining a patent airway and good gas exchange. He may have portable suction to use when secretions get out of hand. You don't indicate what types of aggressive behaviour he exhibits, but biting is highly possible. Distinguishing between reflexive biting (any oral stimulus may elicit biting in some people) and deliberate biting is not always easy. So suctioning may best be done with a tonsil suction rather than a suction catheter. If he hits, kicks or pinches, you might want to approach him from one side and slightly behind him so he can't swing or grab. (Physically restraining him shouldn't be the first thing tried.) He's only mildly delayed so he should have some reasoning ability and should understand consequences. Learn from his caregivers what kinds of sanctions and rewards they use so you can be consistent.

Falls are also a potential risk. Make sure you know how to use his lift, if there is one, and that you secure his wheelchair straps and belts as soon as physically possible. One patient I remember used to sit very calmly in her chair when first transferred into it but every time I went to do up her harness she'd arch her back, extend her arms and legs and nearly slide out of the chair. I'd have to scramble to get a hand on her so she couldn't fall. After awhile I figured it out. Be very aware of how he reacts and what he does with everything you do for him. If he grabs for things all the time, put something in his hand and ask him to hold it for you. (I do this with my son when we're in the car so he'll leave the gearshift alone!) If he's prone to seizures he may wear a helmet. Check the strap frequently to be sure it's not too tight or too loose.

I think I've covered everything that comes to mind. If I think of anything else, or YOU do, we can chat again.