CASE STUDY

Dr. amaal
Amjad alanazi
Khawlah abdulaziz
Hind almubarki
Maha alhzazi
Ahlam almajrashi

OUT LINE :
Definition
case components
background in formation
HEALTH HISTORY
PHYSICAL ASSESSMENT
diagnostic procedure
Medication
Management
Nursing Interventions
health education :

Definition
"Cerebral palsy" is a general term for a group of disorders that appear during the first few
years of life and affect a child's ability to coordinate body movements. Cerebral palsy can
cause muscles to be weak and floppy, or rigid and stiff . In Europe and the United States,
cerebral palsy occurs in about two to four out of every 1,000 births. Babies born
prematurely or at low birth weights are at higher risk The disorder is usually caused by
brain injuries that occur early in the course of development Cerebral palsy isn't curable.
However, getting the right therapy for your child can make a big difference

CASE COMPONENTS :

NAME: rifal ali albishi

AGE: 4 years old
sex : female
nationality : Saudi
Diagnosis : CPMR , near miss sids , ventilator dependent .
Date Admitted :20-1-1432
Time : 15:00 h

BACKGROUND IN FORMATION
Subjective :
Diarrhea
Vomiting
Objective :
Vital sign, Bb 103 50 mmhg , puls 98 b/min , RR 18 cycle/mint , Temp 36,9 , O2 98%
He breathing by dependent ventilator ,
If a that hand on the eye responds
The leg is supported by pillow between legs

Stiffer right arm or legs .

HEALTH HISTORY:
6 months old ,baby presented 2 days ago to our ER with history of twice diarrhea with blood streaks at
last one , she was afebrile ,well hydrated ,active , breast feeding , admitted to our pedia ward for
investigations and observation .
24 hours after admission , after feeding baby was flaccid , cyanosis and not breathing , resuscitated by
o2 , ambu bagging picked up rapidly transferred to close observation , kept NPO , all her investigations
came normal (CBC , UE , chest x-ray ).
24 hours later mother notice that baby is flaccid, seen immediately by on-call team when she found to
be cyanosis , apnea and severely bradycardia .
Active resuscitation was done with intubation , adrenaline , atropine was given .
After 3-4 minutes patients picked with resumed HR and attached to mechanical ventilator , shifted to
PICU .

PHYSICAL ASSESSMENT
GENERAL APPEARANCE:

conscious, stuporous
Activity : quit , crying

SKIN
Poor hygiene , dry skin color: pink
HEAD, NECK :
Exterior abnormal / Difficulty moving the neck
EYE : pupils right / size 2 reaction normal
left /size 2 reaction normal
EAR : Hearing impairment
MOUTH: Problem in the growth of teeth in the upper 2 , Lower 4
Secretions from the mouth continuous .
ABDOMEN
dry skin noted / Sound soft , absent
MUSCULOSKELETAL :
unable to respond
unable to walk
Muscle stiffness

Muscle weakness

DIAGNOSTIC PROCEDURE :
A definitive test for cerebral palsy -- or CP -- does not exist at this time. The diagnosis is
based on a child's medical history and a physical exam.
Doctors diagnose CP by testing the infant's motor skills, looking for characteristic
symptoms, and considering the child's medical history. They also may use computed
tomography (CT) scans or magnetic resonance imaging (MRI) scans to look for
abnormalities in the infant's brain. Certain lab tests may help rule out various
progressive biochemical disorders that involve the motor system, such as Tay-Sachs
disease.

MEDICATION :
I.phenobarbitonc 30 mg

NGT BID

I Nexium 10 mg
I bacloth 5mg

Sup. kepra 60 mg
Badoten 10 mg

not PRN

Sup paracetamol 10 mg not PEN

MANAGEMENT:
Strategies, treatments, and therapies that can help your loved one with cerebral palsy.
Cerebral palsy cannot be cured, but treatment can often improve a persons capabilities. In fact, many
patients can enjoy near-normal lives if their neurological problems are properly managed. There is no
standard therapy that works for all patients. Instead, the doctor must work with a team of health care
professionals to identify your loved ones unique needs and create an individual treatment plan to address
them.
Approaches that can be incorporated in this plan include:

Drugs to control seizures and muscle spasms

Special braces to compensate for muscle imbalance
Surgery
Mechanical aids to help overcome impairments
Counseling for emotional and psychological needs
Physical, occupational, speech, and/or behavioral therapy.

Management is aimed at minimising the progressive deformity, improving the child's functional
outcome and managing the associated problems.
Physical rehabilitation
Physiotherapy

Physiotherapy is the mainstay of treat-ment for the majority of children with CP. The role of
physiotherapy in improving the outcome (e.g. improving a spastic quadriplegics mobility to enable
them to walk) is controversial . However, there is clearly no doubt about the role of physiotherapy
in maintaining the current function of the child and reducing the incidence and severity of further
complications like joint contractures, deformities and dis-locations. The success of medical and
surgical interventions for CP is also highly dependent on rehabilitative exercises to optimise
results.
4
Physiotherapy is not just stretching exercises. It is oriented towards activities of daily living by
improving important components of movement,e.g. improving trunk control to improve a childs
walking ability.

Severe spastic quadriplegia

Supine lying should be avoided if possible as this reinforces the abnormal extended
position, with the child star-ing at the ceiling. Windswept position in supine should also be
avoided to prevent scoliosis and dislocated hip . Encourage the caregiver to place the
child on its side, lying with a pillow between the legs. This will also bring the hands to the
midline to play with atopy . Prone lying over a longitudinal pillow with weight bearing on
the forearms should alternate with side lying . Never lose the feet. Always teach a
caregiver to maintain 90 degrees of ankle dorsiflexion so that even a severely affected
child can be placed in the standing position, if only for transfer from bed to chair.

NURSING INTERVENTIONS
do suction.

the provision of anti-seizure in the event of a seizure.

Improve the physical mobility

examine the movement of the joints and muscle tone.

do physical therapy.

do repositioning every 2 hours.

Improve the nutritional status needs

examine the diet of children.
Weigh weight every day.

provide adequate nutrition , lots of protein, minerals and vitamins.

do immediately when there is suction secretions.

provide an upright position or semi-sitting while eating and drinking.

examine the pattern of breathing

examine the area that is attached ancillary equipment.

use a skin lotion to prevent dry skin.

do the massage in a depressed area.

provide a comfortable position and provide support with pillows.

ensure that ancillary equipment or dressing appropriately and fixed.

HEALTH EDUCATION :
Early identification of cerebral palsy can lessen developmental problems by placing a child in
a special education for cerebral palsy patients program sooner. Special education for
cerebral palsy patients includes early intervention programs (EIPs) that are family-centered
in which professionals and families work together with the child in specific activities.

Special education for cerebral palsy patients can consist of many different programs. These
programs can include speech and language therapy, occupational therapy, assistive
technology, physical therapy, as well as medical intervention. Educators, occupational and
physical therapists, social workers, speech-language pathologists, psychologists, and
physicians can assist families by providing information and education.

Thank you