Issues Identified From Case Study of Cerebral Palsy and Gastroesophageal Reflux Disease

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University of California, Santa Barbara
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Case study
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Michael suffers from both cerebral palsy and gastroesophageal reflux disease (GERD). The two conditions are attributable to his having been born prematurely and suffered anoxia at birth. Due to anoxia which results from insufficient oxygen supply in the fetal body, his brain muscles underwent an abnormal development. In any other cases, cerebral palsy arises from the lack of oxygen during early development stages of the victim thus causing the inability of the victim to control the nervous functioning of the body. The occurrence of anoxic injuries occurs at different stages of the development of the fetus and after birth. The case of an anoxic injury that Michael sustained was as a result of premature birth which caused the deformation in development of his central nervous system, especially the brain. From a nursing perspective, any child who is born before 37 weeks of pregnancy is at risk of sustaining congenital cerebral palsy (Crump, Winkleby, Sundquist, & Sundquist, 2012 p.234). Therefore, the fact that Michael was born prematurely at 23 weeks of gestation was a critical risk factor for the intermittent development of congenital palsy.

Premature birth also resulted in Michael developing gastroesophageal reflux disease (GERD). there is a high correlation between the period of gestation and risk of developing gastroesophageal reflux disease (GERD) at infancy (Vaezi, 2015 p.78). Despite the fact that research has explicitly determined the cause of this correlation, it is arguable that the immature epithelium of the patient suffered the carcinogenic effects of gastric acid which increased the risk of suffering from GERD (Crump, Winkleby, Sundquist, & Sundquist, 2012 p.233). An intervention to reduce the effects of GERD entails teaching the patient to avoid conditions that reduce the lower esophageal sphincter pressure or contribute to the irritation of the esophagus. GERD and cerebral palsy have associated risk factors; they require distinct interventions (Vaezi, 2015 p.113).

Cerebral palsy is a permanent disorder hence Michael has to contend with the resultant continuous developmental challenges in movement, cognitive development, posture and general activity defectiveness (Fuhrman, 2011 p.76). Most of these defects in the functioning of body tissues and organs occurred at Michaels early development stages since his brain remained poorly aerated due to anoxia and premature birth (Marshall Cavendish Corporation, 2010 p.69). Other developmental problems that must be addressed in the intervention plan for Michael include potential epilepsy, impaired visual and auditory systems, changes in behavior patterns and intellectual disabilities (Marshall Cavendish Corporation, 2010 p.142). Gastroesophageal Reflux disease has various signs in adults which must be deliberately addressed to improve Michaels resilience. Some of these signs and symptoms include poor appetite, wheezing, abdominal or chest pain, chronic cough, recurrent pneumonitis, regurgitation and halitosis (Fuhrman, 2011 p.152). Therefore, the adopted intervention must adequately alleviate these symptoms.

Being an adult, episodes of gastroesophageal reflux disease (GERD) in Michael inevitably presents as heartburn caused by the backing up of hydrochloric acid in the stomach Vela, Richter, & Pandolfino, 2013 p.136). Mental retardation from infancy means that the patient is unable to utter complaints of heartburn. Therefore, the plan should involve care professionals with knowledge of detecting a possible event of reflux arising from GERD (Vela, Richter, & Pandolfino, 2013 p.65). In essence, care professional involved in the plan must be sensitive to all signals which are indicative of GERD. If the presenting conditions of GERD are not proactively addressed, there are various risks that they may arise including inflammation of the inner lining of the esophagus, relapsing pneumonia, cancer, and bronchitis.

Care plan for Michaels Condition

Michael should be provided with individualized based care which is based on his presentation and requires a multidisciplinary approach. The fact that he has lived with the cerebral palsy and gastroesophageal reflux disease means that he cannot be subjected to the entirety of interventions for a child suffering from the same condition. For instance, surgery to enhance muscular movement may not result in practical outcomes (Miller & Bachrach, 2017 p.132). The entire process should be rehabilitation which is comprehensive intervention aimed at facilitating the patients adaptation to his condition. In this rehabilitative process, the neurologists and physiatrists must play a critical role. The responsibility of the physician will be to closely monitor and manage the many medical complications that result from management of cerebral palsy (Miller & Bachrach, 2017 p.134). The plan is multifaceted and involves five systematic interventions. The steps are aimed at improving physical ability, nurturing the mental development and motivating the patient to take active measures towards self-care.

Step1: Nutrition and Diet Counseling

About 93% of people suffering from cerebral palsy experience multiple feeding difficulties which also impair the general nourishment of the brain muscles. Therefore, it is important to take Michael through nutritional and diet counseling in which he will be taught in the ways of attaining optimal feeding (Lancioni & Singh, 2014 p.164). The fact that palsy results in the impairment of facial muscles which are always actively involved during chewing skills that Michael has reduced the ability to chew or swallow food. Through nutrition and diet therapies, the patient will be trained on self-feeding approaches (Lancioni & Singh, 2014 p.138). These skills include training on how to use adaptive equipment and embracing the role of caregivers in assisting him in feeding. Adequate time in between serving and ingesting should be enough to enable natural swallowing (Lancioni & Singh, 2014 p.119). Some of the assistive devices that the patient should be trained include feeding tube for partial or complete intake of foods.

Step 2: Physical and Psychological Therapy

Before the commencement of the physical therapy, Michael requires a comprehensive assessment of motor capabilities. Through this evaluation, it will be possible to determine the extent of muscular damage attributable to the cerebral palsy (Dodd, Imms, & Taylor, 2010 p.186). Furthermore, initial evaluation of the motor function will be helpful in identifying the specific movement problems that the patient is undergoing thus an initial step in designing the most appropriate correction (Miller, 2007 p.97).

After evaluation, a professional physical therapist should be involved in preserving the best strength training workouts, muscle relaxing techniques, and stretches (Miller, 2007 p152). Through the physical therapy, the patient will be able to improve on his strength, mobility, balance, flexibility, and posture. Some of the equipment to be used in physical activity include weights, resistance bands and stability balls (Miller, 2007 p195). Physical therapy will be necessary for treating some common movement and posture challenges associated with cerebral palsy such as scoliosis and shortened Achilles tendons. The nature of physical therapy must take into account the patients history of physical activity. More rigorous physical therapies are more recommended if the patient has a history of physical therapy (Fisichella, 2017 p. 47). It is important for the trainer to avoid prescribing treatments that may strain muscles and tendons.

Cerebral palsy results in occasional sensational pain in the muscles. When this condition compounds with the challenges of GERD, the collectively undermine the quality of life (Pasero, & Mccaffery, 2011 p.176). Therefore, through psychotherapy. Michael will interact with a psychotherapist who is a trained professional to enhance his feeling of wellbeing, improve his coping skills as well as communication abilities. The fact that these two conditions are long-term and pose many health challenges implies the need to nurture in the patient-relevant life coping strategies (Pasero, & Mccaffery, 2011 p.105). Psychotherapy deals specifically with restructuring the patients mindset to embrace the sense of self-worth. This intervention results in mental stability which is critical in achieving positive outcomes in virtually all the other spheres of medication.

Step 3: Speech Pathology and Conductive Education

Speech is an important aspect of cognitive development as it facilitates the ability of the patient to communicate ideas, thoughts, and opinions as well as get feedback. Cerebral palsy adversely affects the speech ability of victims thus the need for speech pathology (Workinger, 2005 p.97). Speech pathology involves training the patient on alternative ways of understanding what is being said and learning how to use a wide array of words within given contexts. There are multiple interventions that speech pathologists can recommend for Michael. These include the use of argumentative or alternative systems of communications including communication boards, signing and various speech generating equipment.

Other recommendations in speech pathology are communicative partner training. The use of eye gaze technology, and conductive teaching (Workinger, 2005 p.123). Despite the fact that Michael is an adult, cerebral palsy resulting from fetal developmental challenges resulted in severe cognitive retardation hence conductive education model is more appropriate in enhancing his learning capabilities. Conductive education is an evidence-based teaching model which takes into account the motor and cognitive difficulties that learners undergo (Tatlow, 2005 p.112). It integrates various aspects into the education delivery process including fun and play which increase the independence of the leaner as well as other life skills. Michael should be actively involved in drafting his achievable goals and practice on them until he attains perfection at school, home, and the wider community.

Having been placed in a critical care center for intellectual disability people implies that Michael can engage with others within such a setting and follow at least some instructions. Through conductive education, the patient is subjected to a structured program which is appropriate to his age and that critically improve his motor functioning, mobility, and life skills (Gage, 2009 p.172). This intervention is a supportive and group intervention with the potential of increasing the patients self-esteem, psyche and activity levels. Cerebral palsy is a permanent disability that can only be managed but not adequately treated specially at advanced stages hence conductive education will increase Michaels resilience and encourage him to actively take part in overcoming the barriers to his activities including communication and social skills (Gage, 2009 p.127).

Step 4: Lifestyle Modifications

The management of GERD in adults requires various changes in an individuals lifestyle that Michael must embrace through persistent training for positive health outcomes (Vaezi, 2015 p.143). Some of these lifestyle changes or practices recommended for Michael include losing weight if he is overweight, avoiding the use of substances which are likely to increase the acid content in his body. Some of these substances include citrus juice, alcohol, and peppermint. He should also not indulge in eating large meals. After eating he should only lie down at least 3 hours later (Levitt & Pickering, 2010 p.72). When sleeping, Michael should ensure that he maintains an appropriate posture by raising his head by around 8 i...

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