family case presentation
DESCRIPTION
Family Case Presentation. Abad.Imperial.Javate.Palma.Uy.Valencia. To discuss the family profile of Remocaldo family To establish the family diagnosis using family assessment tools To present a case of a child with cerebral palsy - PowerPoint PPT PresentationTRANSCRIPT
Family Case Presentation
Abad.Imperial.Javate.Palma.Uy.Valencia
Objectives
• To discuss the family profile of Remocaldo familyo To establish the family diagnosis using family
assessment tools• To present a case of a child with cerebral palsy
o To briefly discuss the etiology, pathophysiology and management of cerebral palsy
The Index Case
Index Case Profile
• A.R.• 10 y/o• Female• Filipino• Born Again Christian• Angono, Rizal
Chief Complaint and HPI
• Hip dislocationosustained 3 yrs PTC while her
mother was stretching her legsoconsulted with a GP
advised othropedic consult: cant afford
ono medications taken
Past Medical History
• Diagnosed case of cerebral palsy with microcephalyo Confirmed at 3 moso Underwent EEG showing “holes in the brain” o Was recommended to have CT Scan but cannot afford ito Quadriplegic
Physical therapy till 5 y/oo Cannot swallow on her own or expectorate phlegmo Meds: phenobarbital, I grain
• Has asthma• Frequently have cough, colds, constipation, and UTI
o Bronchopneumonia at 5 y/o Confined for 1 week in a local hospital
Cerebral Palsy
• also known as congenital cerebral diplegia, static encephalopathy, Little’s disease
• a comprehensive diagnostic term used to designate to a group of nonprogressive disorders resulting from malfunction of the motor centers and pathways of the brain
• occurs while the brain is under development ( at most 5 years old)
• permanent• muscles are not defective
Types of Cerebral Palsy
Spastic Athetoid Ataxia
Characterized by:
Tension in muscles;
presence of stretch or
myotatic reflex, contractures
Involuntary, uncoordinated, uncontrollable movements
Difficulties in coordination and
balance
Damaged area: Cortical motor area; pyramidal
tract;
Extrapyramidal tract; basal
ganglia area
cerebellum
Occurrence: 70% 20% 10%
Types of Cerebral Palsy
• Monoplegia – one limb• Hemiplegia – one leg and corresponding arm• Diplegia – similar parts on both sides of the body;
lower limbs more affected• Paraplegia – lower limbs• Quadriplegia – tetraplegia
- both arms and legs- muscles of trunk, face and mouth
Types of Cerebral Palsy
Additional:
• Hearing loss• Poor sight• Speech defects• Learning disabilities• Visual or Auditory Agnosia
Causes
• Damage can occur during prenatal, natal, and postnatal period• Insufficient oxygen• Premature birth• Infections in the mother such as:
- rubella = German measles- cytomegalovirus = viral infection- toxoplasmosis = parasitic infection• Rh disease- incompatibility between blood of
mother and fetus
Causes
• Severe jaundice – yellowing of skin and whites of the eye because of bilirubin
• Brain infections such as :- encephalitis = inflammation of brain- meningitis = inflammation of the membranes covering the brain and spinal cord• Physical brain injuries• the cause of many individual cases of cerebral palsy is unknown!
Symptoms
• Feeble cry • Difficulty in sucking and swallowing• Listlessness or irritability• Failure to follow normal pattern of motor development
( delayed)
Symptoms
• Apparent preference for one hand before the infant is 12-15 months old
• Persistence of infantile/ primitive reflexes• evidence of mental retardation
Family History
• Hypertension• Asthma• No history of cerebral palsy
Birth History
• 25 y/o mother G1P1(1001)• Full term• NSD, local hospital• Attended by an OB-Gyne• Complications:
o Difficult birth: mother slipped during 9 mos, baby shifted position
o Mother had ecclampsiao Convulsions while giving birth
Nutritional History
• Breastfed until 1 y/0• Cannot ingest solid food
o Mashed vegetables, rice, sometimes meat
Immunization
• Local Health Centero BCG – 1 dose o DPT – 3 dose o OPV – 3 dose o Hep B – 3 doseo Measles – 1 dose
Growth and Development
• Not at par with ageo Cannot moveo Cannot talko Mom claims AR can understand
Physical Examination
• General Surveyo conscious, not in cardio-respiratory distress
• Vital Signs:o HR – 110/min o RR – 22/mino Temp – 37.2o C
Physical Examination
• Skin: no cyanosis, rashes on dependent areas, particularly in the buttocks
• HEENT: normocephalic, pink palpebral conjunctivae, anicteric sclerae, no alar flaring, no nasal discharge, intact tympanic membrane, no tonsillopharyngeal congestion
• Neck: supple, no cervical lymphadenopathy
• Thorax/Lungs: symmetrical chest expansion, no retraction, resonant, clear breath sounds, no rales, no wheezes
Physical Examination
• Cardiovascular: adynamic precordium, apex beat at 5th LICS MCL, tachycardic with regular rhythm, no murmur
• Abdomen: flat, normoactive bowel sounds, no organomegaly, soft,, no mass
• Genitourinary: not done
• Extremities: full and equal pulses, no edema, Motor 0/5 on all extremities, Sensory and cerebellars cannot be tested
Family Assessment Tools
Family Lifeline
AR was born and was later
confirmed to have CP
AR’s mother gave birth to AR’s
youngest sibling
AR’s father decided to work
for five days without going
home
AR’s house was struck by a recent
typhoon
AR’s parents accepted her
condition and tried to give her
everything she needs
The whole family welcomed the
baby and worked harder in order to
provide each other’s needs; 2nd child sometimes
feels jealous
Everyone became accustomed to
seeing the head of the family during weekends only
AR’s family moved to AR’s paternal grandparents’ house and are staying there indefinitely
Family Profile
Family Member Age/ Sex Relation to Patient Occupation
MR 64M Grandfather Unemployed
NR 63F Grandmother Unemployed, Occasional Laundry
Washer
BR 34M Father Parking Attendant
MAR 35F Mother Unemployed
KR 9M Brother Student
JR 1M Brother -
Family Genogram
Family Life Cycle
• Family with young children (nuclear family)
APGAR
APGAR SCORE REASON
Adaptation 1 / 2 M: cannot rely on family for everything
Partnership 2 / 2 No problems in terms of communication
Growth 1 / 1 B: Family supportive but there are a lot of restrictions because of their responsibilities
Affection 2 / 2 Everyone feels loved and respected
Resolve 2 / 1 G: wants better life for his family
SCREEM
Resource Pathology
Social Good relationship within the family and within their community: neighbors
supportive and helpful
(-)
Cultural Proud of who they are and where they came from
(-)
Religious Born Again: not very religious but follows basic teachings
(-)
Economic Manages to get by with the income of the family
Frequent cause of conflict between AR’s parents, esp. about medications
Education Has clear idea on how problems arise and their solution
HS graduates only, thus have a hard time looking for high-paying jobs
Medical Very patient and diligent in going to health centers and medical missions
to avail of free services
Heavily relies on health center in their barangay and municipality; these
centers are problematic on their own
Discussion
Impact of Illness
• Stage I- Onset of Illness• Stage II- Reaction to Diagnosis• Stage III- Major Therapeutic Efforts• Stage IV- Early Adjustment to Outcome• Stage V- Adjustment to the Permanency of the
Outcome
Interventions
• Primary Caregiver• Diet modification• Consult with attending pediatric neurologist• Consult with pediatric orthopedic specialist• Linking with new health resources in the community
(KHVs/barangay)• Persistent attendance in medical missions, DSWD,
governor’s office• Make time for other children• Make time for self to avoid caregiver fatigue
Interventions
• Father• Use time at home to care for AR and support mother• Mediate with extended family if needed
• Family• Help with the day-to-day care of AR• Achieve a better diet plan for the family• Provide financial support if possible
Thank
You