Nursing Care of the Child with a Neuromuscular Disorder

Nursing Care of the Child with a Neuromuscular Disorder

Cerebral Palsy

Chapter 44: Nursing Care of the Child with a Neuromuscular Disorder

Pamela is a six-year-old who was born with cerebral palsy. She has some health conditions related to cerebral palsy, which include mental impairment, hearing, and vision impairment, as well as spasticity. She is in the hospital for the diagnosis of her condition. NO she is ot.. you did not copy the case study as it is written.

Pamela Souza, 6 years old, was born with cerebral palsy. Pamela suffers from general spasticity, mental impairment, impaired vision and hearing, and hydrocephalus. She has been admitted to the pediatric unit for evaluation of intrathecal spasticity control. This is the focus of the case study and what you should have developed.

Cerebral palsy (CP) is among the groups of health disorders that have significant effects on the movement and coordination of body muscles (Ornoy, 2018). There other main areas that are affected by CP are the vison, sensation as well as hearing. However, the phrase cerebral is used to mean the brain. The word palsy is used to mean weakness or incapability of the body parts to move effectively. Through a lot of researches that has been done, it has been realized that CP is among the most common causes of childhood’s motor inabilities and disabilities. Across the world, about five children in 1000 are affected by cerebral palsy.

Signs and symptoms of CP

The signs of any symptoms of CP are different from one person to another and might range from minor or mild signs to acute and severe signs. Some patients might have challenges in walking while others might have problems sitting. On the other hand, some people who are affected by CP can have difficulties in grasping objects. Over time, the signs can worsen or become less severe, depending on the brain areas they have changed.

The most common signs are:

· Variations and differences in the muscle tone which include becoming very floppy or stiff.

· I was taking long to adapt some motor skill milestones, which include rolling over, crawling as well as sitting up.

· Difficulties in walking

· Delays in developing speech capabilities

· Stiffness of muscles or excessive flexibilities

· Tremors

· Problems during the process of swallowing

· Blindness and intellectual disabilities (Miller, 2018).

Some children are born with cerebral palsy, but the signs and symptoms do not present themselves until the children reach some months or even years. In most cases, the flags can present themselves at the age of three to four months.

Causes of cerebral palsy

The most common cause of CP is the abnormalities in the development of brain or brain injuries.  These damages affect the brain part that is used in controlling the movement of the body parts, their coordination, and posture. The cost on the brains most often happens before a child is born, but in other instances, it can occur during birth or in the first ten months after birth (Ornoy, 2018). There are other causes of CP, which include:

· Lack of adequate oxygen during the process of child delivery

· Gene mutations that can read to the development of the brain in an abnormal way

· Maternal infections which include herpes simplex

· Infections in the mind which might consist of meningitis

· Bleeding in the brain

· Head injuries can be caused by accidents, falls, or physical abuse.

The people who are at risk for cerebral palsy

Various factors put the children at high risk for CP. These factors include:

· Low birth weight

· Twins or triplet

· Premature birth

· Breech birth

· Rh incompatibility

· Maternal exposure to poisonous or poisonous substances during the pregnancy period

Potential Complications

Various complications are caused by cerebral palsy, which include spasticity as well as contractures.  Other complications include difficulties in feeding, fractures, challenges in communication, vomiting, osteopenia, constipation as well as bowel obstruction.

Head to Toe Assessment

General: difficulties in vision and communication due to brain damage.

Vital signs: Body temperature 86.5°F WHAT?

; heart rate, 98 bpm, blood pressure, 110/73 mm Hg; respiratory rate, 21 breaths/min


Head : the hair is black with no abnormalities

Eyes: Eye pain  Why?

and difficulties in seeing correctly,

has some discharge in the eyes. Why?

Pupil reactions?

Ears: Normal physical appearance of the ears.

Gross hearing?

Nose:  Has a dry nose with no growth or physical abnormalities.

Mouth/Throat:  the lips are moist, and the mouth has no lesions or sores. The throat has no wounds, and the gums are strong and healthy.

Respiratory her breath is clear with no difficulties and has no coughs or rhonchi.

Cardiovascular:  the patient has no history of cyanosis, syncope, or palpitations.

heart sounds and rhythm?

Gastrointestinal:  the patients admit having constipation occasionally. Parents are reporting and this is not part of you head to toe assessment

abdominal contour

Bowel sounds

bowel movements




Genitourinary :  the client has no odor in her vagina  She is 6 year old!

and no swelling nor virginal redness.

Urine output

Urine color


Skin : the skin is smooth with no scars, rashes, nor lesions.

Abdominal circumference:  the abdominal girth has average liquor  WHAT?

volume.  Wrong order

Musculoskeletal : the patients complain of back pain and have a history of fractures.

This is her problem area.. this is a very incomplete assessment






Neurologic : the patients have depression, which is making it difficult for her to sleep well.

Diagnostic and Lab Studies Expected Outcomes

What tests would be done at the present time in the present situation.. she is pre-operative.

She has been admitted to the pediatric unit for evaluation of intrathecal spasticity control. This is the focus of the case study and what you should have developed.

Cerebral palsy can affect any child either during birth or before the child is born. It can be seen as a natural health condition, and some people might also take it as part of life by accepting it. However, some advances have been made in the current diagnosis of CP.  The electroencephalogram can be used in the evaluation of the electrical activity of the patient’s brain (Miller, 2017).  This method can be used to evaluate the condition of Pamela. The CT scan can also be used in creating clear and cross-sectional images of the patient’s brain.

All Pamela Nursing Diagnosis

These are NOT NANDA nursing diagnosis.. You should know this by now.

1. Impaired vision and hearing related to brain damage

2. Mental impairment which makes the patient unable to make quick decisions.

3. Hydrocephalus

4. Spasticity

5. Difficulties in movement

6. Inability to speak

7. Constipation due to difficulties proper digestion.

3 Pamela Nursing Diagnosis, Goal Interventions, and Rationale

This pt is pre-operative 

1. Constipation which is caused by gastrointestinal muscles relation, which makes it difficult for the food to be properly digested.

Desired Outcomes

· To minimize and entirely do away with constipation

· Help the patient adapt to healthy eating


· Assessing the nature as well as the degree of constipation.

· I am advising the patient and the guardian on the proper ways of eating a healthy diet.


· Constipation is caused by the inability of the body to digest food properly.

· A lack of proper physical exercise might cause constipation.

0. Impaired vision and hearing related to brain damage

Desired outcome:

· Ensure that the client gets back her vision and hearing ability.

· Help the patient adapt to impaired vision and hearing.


· I was counseling the patient on how to positively adapt to the conditions related to impairment in vision and hearing.


· Counseling helps the patient and the guardians to live positively even when in impairment of vision and hearing.


The patient states that she can adapt to their condition and raise her self-esteem after the counseling section. Taking the medication and exercising has been received positively by the patient and her family.


Miller, F. (2017). Early-onset scoliosis in cerebral palsy. Cerebral Palsy, 1-14.

Miller, F. (2018). Knee flexion deformity in cerebral palsy. Cerebral Palsy, 1-22.

Ornoy, A. (2018). Animal models of cerebral palsy: What can we learn about cerebral palsy in humans. Cerebral Palsy, 1-12.

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