Nursing Care Plan (NCP) for Scoliosis
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Study Tools For Nursing Care Plan (NCP) for Scoliosis
Outline
Lesson Objective for Scoliosis Nursing Care Plan
- Understanding Scoliosis:
- Gain a comprehensive understanding of scoliosis, including its pathophysiology, types, and impact on the musculoskeletal system. This knowledge forms the foundation for effective nursing interventions.
- Assessment and Diagnosis:
- Develop proficiency in assessing and diagnosing scoliosis through thorough physical examinations, including spinal curvature assessments and the use of imaging studies. Identify key indicators that guide the formulation of an individualized care plan.
- Patient Education:
- Equip healthcare professionals with the skills to educate patients and their families about scoliosis, explaining the condition, potential causes, progression, and available treatment options. Foster open communication to address concerns and promote collaboration in care.
- Management Strategies:
- Learn evidence-based nursing interventions and management strategies for scoliosis, encompassing both conservative approaches (e.g., bracing, physical therapy) and surgical interventions. Understand the nuances of patient care across different age groups and severity levels.
- Holistic Patient Support:
- Develop a holistic approach to supporting individuals with scoliosis, considering the physical, emotional, and psychosocial aspects of their well-being. Emphasize patient empowerment, self-care, and adherence to treatment plans for optimal outcomes.
Pathophysiology of Scoliosis
- Abnormal Spinal Curvature:
- Scoliosis is characterized by an abnormal lateral curvature of the spine, creating a three-dimensional deformity. The spine may curve to the left or right, resembling an “S” or “C” shape, instead of maintaining its normal vertical alignment.
- Structural Changes in Vertebrae:
- The condition involves structural changes in the vertebrae, causing them to rotate or tilt. This alteration in vertebral alignment contributes to the curvature of the spine and can affect the surrounding muscles, ligaments, and other supporting structures.
- Three Types of Scoliosis:
- Scoliosis can be categorized into three main types: idiopathic, congenital, and neuromuscular. Idiopathic scoliosis, the most common type, has no identifiable cause. Congenital scoliosis results from spinal malformations present at birth, while neuromuscular scoliosis is associated with conditions affecting the muscles or nerves.
- Growth-Related Progression:
- In idiopathic scoliosis, the condition often manifests during periods of rapid growth, such as adolescence. The progression of the curvature may be influenced by growth spurts, and early detection is crucial for implementing interventions to prevent further deformity.
Etiology of Scoliosis
- Idiopathic Causes:
- Adolescent Idiopathic Scoliosis (AIS): The most common form, AIS occurs without a known cause and typically manifests during periods of rapid growth in adolescence. Genetics may play a role, as there is often a familial predisposition.
- Congenital Factors:
- Congenital Scoliosis: Some individuals are born with abnormalities in the development of the spine, leading to scoliosis. Malformations in vertebrae or other spinal structures can contribute to curvature present at birth or detected early in life.
- Neuromuscular Influences:
- Neuromuscular Conditions: Scoliosis can be secondary to neuromuscular disorders such as cerebral palsy, muscular dystrophy, or spinal cord abnormalities. Muscular imbalances and weakness may contribute to spinal curvature in these cases.
- Degenerative Changes:
- Degenerative Scoliosis: This type occurs later in life and is associated with the degeneration of spinal discs and joints. Aging-related changes, such as disc thinning and arthritis, can contribute to the development of scoliosis in adulthood.
- Connective Tissue Disorders:
- Syndromic Scoliosis: Some genetic syndromes and connective tissue disorders, such as Marfan syndrome or Ehlers-Danlos syndrome, can be associated with scoliosis. The connective tissue abnormalities may impact the stability of spinal structures.
Desired Outcome for Scoliosis Management
- Prevention of Progression:
- Objective: Halt or minimize the progression of spinal curvature.
- Measurement: Monitoring the degree of curvature through regular imaging (X-rays) to assess stability.
- Improvement in Quality of Life:
- Objective: Enhance the individual’s overall quality of life and functionality.
- Measurement: Assessing improvements in pain levels, mobility, and participation in daily activities.
- Respiratory Function Optimization:
- Objective: Ensure optimal respiratory function, especially in cases of severe curvature.
- Measurement: Monitoring lung capacity through pulmonary function tests and assessing any improvements in breathing patterns.
- Psychosocial Well-being:
- Objective: Address psychological and social aspects related to scoliosis, reducing any negative impact on mental health.
- Measurement: Evaluating emotional well-being, self-esteem, and the impact on social interactions.
- Patient Education and Empowerment:
- Objective: Provide education and support to empower individuals with scoliosis to actively participate in their care.
- Measurement: Assessing the patient’s understanding of the condition, adherence to treatment plans, and ability to manage scoliosis-related challenges independently.
Scoliosis Nursing Care Plan
Subjective Data:
- Shortness of Breath
- Hip pain
- Back pain
Objective Data:
- One leg longer than the other
- One hip higher than the other
- Uneven waist
- Curvature of spine
- Uneven shoulders
Nursing Assessment for Scoliosis
- Detailed Health History:
- Objective: Obtain a comprehensive health history, including any family history of scoliosis, developmental milestones, and any previous treatments or surgeries.
- Physical Examination:
- Objective: Perform a thorough physical examination, focusing on spine inspection, palpation for asymmetry, and assessing for any signs of spinal deformity.
- Neurological Assessment:
- Objective: Evaluate neurological function by assessing motor strength, sensation, and reflexes to identify any signs of neuromuscular involvement.
- Assessment of Pain:
- Objective: Assess the patient’s experience of pain, its location, intensity, and any factors that exacerbate or alleviate it.
- Functional Assessment:
- Objective: Evaluate the impact of scoliosis on the patient’s daily functioning, including mobility, activities of daily living (ADLs), and participation in recreational activities.
- Respiratory Assessment:
- Objective: Evaluate respiratory function, especially in cases of severe curvature, by assessing lung capacity and observing any signs of respiratory distress.
- Psychosocial Assessment:
- Objective: Assess the patient’s emotional well-being, self-esteem, and any psychosocial factors that may impact their experience of scoliosis.
- Radiographic Studies:
- Objective: Review and interpret X-rays or other imaging studies to determine the degree and pattern of spinal curvature, aiding in diagnosis and treatment planning.
- Patient and Family Education Needs:
- Objective: Identify the educational needs of the patient and their family regarding scoliosis, its management, and the importance of treatment adherence.
Implementation for Scoliosis
- Collaborative Care Planning:
- Objective: Develop a collaborative care plan involving healthcare providers, physical therapists, and other specialists to address the unique needs of the patient with scoliosis.
- Orthotic Management:
- Objective: Implement orthotic interventions, such as braces, as prescribed by the healthcare provider to help manage and slow the progression of the spinal curvature.
- Physical Therapy:
- Objective: Initiate a structured physical therapy program aimed at improving muscle strength, flexibility, and postural control to support the spine and enhance overall function.
- Pain Management:
- Objective: Implement pain management strategies, including pharmacological interventions and non-pharmacological approaches such as heat therapy, to address any discomfort associated with scoliosis.
- Educational Support:
- Objective: Provide education to the patient and their family on scoliosis management, including the importance of adherence to prescribed treatments, exercises, and lifestyle modifications.
Nursing Interventions and Rationales
| Nursing Intervention (ADPIE) | Rationale |
| Perform physical assessment noting abnormalities of the legs, shoulders, hips. Assess physical mobility | Determine a baseline for treatment and management of the condition. Determine severity by looking at the degree of curvature. |
| Assess breathing patterns and auscultate breath sounds | Encourage deep breathing exercises and administer oxygen as necessary.
Patients with altered posture may have less than adequate lung expansion because of changes in the shape of the thoracic cavity. That can lead to respiratory infection and decreased lung function. Deep breathing exercises help improve lung inflation. |
| Assess pain level with appropriate scale (FACES or number scale) | Help determine the best method for pain relief. The curvature of the spine can cause pressure on muscles, nerves, and spinal discs that result in pain. |
| Manage pain appropriately | Massage
Heat / cold Positioning Medication Non-pharmacological interventions are the first choice and often relieve pain well. When necessary, administer anti-inflammatory meds and analgesics as appropriate. |
| Provide a range of motion exercises – AROM and PROM | Encourage strengthening of the muscles and flexibility. Promotes good posture. Prevent contractures and encourage mobility. |
| Apply and educate patient parents in the use of braces | Properly used, a back brace can help relieve pain and provide stability for the spine. Ideally, the brace can help slow down the progression of the spinal curve, but it typically cannot correct it. |
| Assess skin for breakdown with use of a brace | Monitor for signs of skin breakdown or improper fit of brace that may cause sores, blisters, and excoriation. Preventing skin breakdown can help prevent infection. |
| Reposition every 2 hours | Promotes effective breathing and prevents skin breakdown. |
| Assist patient and parents with the plan for school and activities | The use of an appliance or brace may require certain changes to be made to activities.
Promote independence and self-care. Develop a plan for school so that patients can move about and reposition frequently as needed to relieve pain and encourage mobility. |
| Encourage regular monitoring | Patients with mild scoliosis may only require routine monitoring to make sure the condition is not getting worse. |
| Provide pre- and post-op instructions and care | Patients with severe deformities may be eligible for surgery in which the spine is straightened with rods and screws. Prevent infection at the surgical site and promote early ambulation and range of motion exercises. |
| Educate patient and parents regarding activities that should be avoided during treatment | Contact sports and high-risk activities should be avoided following surgery and while wearing a brace or appliance to prevent injury to the patient |
Evaluation for Scoliosis
- Assessment of Spinal Curvature Progression:
- Objective: Regularly monitor and compare X-rays or other imaging studies to evaluate changes in spinal curvature over time, assessing the effectiveness of interventions in preventing or slowing progression.
- Functional Improvement:
- Objective: Assess improvements in the patient’s functional abilities, including mobility, posture, and activities of daily living, to determine the impact of treatment on daily life.
- Pain Management Effectiveness:
- Objective: Evaluate the effectiveness of pain management strategies by assessing changes in pain levels, frequency, and impact on the patient’s overall well-being.
- Orthotic Compliance:
- Objective: Assess the patient’s adherence to prescribed orthotic interventions, such as brace wear, to determine the impact on spinal stability and curvature control.
- Patient and Family Satisfaction:
- Objective: Gather feedback from the patient and their family regarding their satisfaction with the overall management plan, including communication, education, and the impact on their quality of life.
References
https://www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716
https://my.clevelandclinic.org/health/diseases/14521-pediatric-and-adolescent-scoliosis
https://orthoinfo.aaos.org/en/diseases–conditions/clubfoot/
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Transcript
Hi everyone. Today, we are going to be creating a nursing care plan for scoliosis. So let’s get started. First, we’re going to go over the pathophysiology. So scoliosis is an abnormal sideways curvature of the spine with a twisting that causes a C or an S shape in the spine. Nursing considerations. We want to assess vital signs, full head to toe assessment, pain management, range of motion exercises, brace care, surgical education, and any follow up care. Desired outcome. The patient will have optimal physical mobility. The patient will have minimal pain, and the patient will have an adequate breathing pattern. Here’s an example of scoliosis. So you’re going to notice in this picture, this curvature right here. You’re going to notice how it kind of has C shaped here right around here and kind of an S starting up here kind of goes down and around like an S. So this is what is known as scoliosis of the spine right here.
So we’re going to go ahead and get started on the care plan. We’re going to be writing down some of that subjective data and that objective data. So you’re going to see what the patient is complaining of or what you’re going to actually physically see of the patient. So they’re going to say they have some shortness of breath. It’s very common. And some hip pain. Some objective data that you might notice is that curvature. That is a very telltale sign. And you might notice as well that unevenness, that one of your hips is higher. So one hip might be higher than the other, or the opposite with the leg. One leg might be longer than another. They may also be complaining of some back pain, have an uneven waist, or even uneven shoulders.
Some interventions that we want to do are a full assessment; you want to note any sort of abnormalities of the legs, the shoulders, and hips. You want to assess their physical mobility. You want to determine the severity by just looking at the degree of that curvature. You’re going to assess those vital signs, breathing patterns, And you want to auscultate those breath sounds. You want to make sure you’re encouraging deep breathing exercises and administering any oxygen as necessary. Patients with altered posture may have less than adequate lung expansion because of changes in the shape of the thoracic cavity that can lead to respiratory infections and decrease lung function. Deep breathing exercises help improve lung inflation. We’re also going to assess pain as pain is big for these patients because that curvature of the spine can cause pressure on muscles, nerves, and spinal discs that result in pain for those patients. We can do non-pharmaceutical interventions; that’s the first choice to relieve pain. So that could be some heat or cold compresses. You can do some massage, Maybe it’s changing their position. So repositioning the patient, making sure you’re doing that every two hours and, when necessary, giving medication. So you want to administer any sort of anti-inflammatory medications, analgesics as appropriate. Other interventions are we want to provide range of motion exercises. So any active range of motion or passive range of motion, you want to encourage strengthening of those muscles and flexibility. It promotes good posture and it prevents contractors and encourages mobility for those patients. Another intervention. We want to make sure that we’re educating the patient and or the parents on braces; how to properly use a back brace, and that will help relieve the pain and it’ll provide stability for the patient and the spine. Ideally, the brace can help slow down the progression of the spine curve, but it typically can’t correct it. You also want to make sure you’re assessing for any sort of skin breakdown with using the braces. You want to make sure it’s fitted properly and you want to make sure you’re monitoring for any sort of signs of skin breakdown and proper fit. Any blisters, any sores, you want to make sure you’re looking for that. Another intervention is we want to make sure we’re providing any sort of pre- and post-op instruction. So, if any of these treatments don’t work, they may end up doing surgery to surgically correct the spine. So any patients that have severe deformities in the spine will be eligible for surgery. And that is when the physician’s going to end up strengthening or straightening that spine with rods and screws. So you want to make sure we’re preventing infection at the surgical site. And we want to promote early ambulation and range of motion exercises, post-op for these patients. You want to make sure we’re educating the patient and parents regarding physical activities after surgery.
Especially for kids, any contact sports in general are high risk activities. These should be avoided following surgery and while they’re wearing a brace, because you want to make sure you’re preventing any sort of further injury to the spine for the patient. You want to encourage regular monitoring. So follow up appointments; you want to make sure that they’re having those follow up appointments to make sure that the condition is not getting any worse than what they were previously by seeing the physician,
Okay, we’re going to go into some of those key points. So scoliosis; it’s an abnormal sideways curve of the spine with that twisting that causes that C or that S shape in the spine injuries to the spine. Bad posture and connective tissue disorders are all causes of scoliosis. Some subjective objective data that you’ll see with the patient. They’ll complain of shortness of breath. Some hip pain and back pain. One leg might be longer than the other one. Hip might be higher than the other, uneven waist, curvature of that spine. That is the hallmark of this – uneven shoulders. We’re going to be doing vital signs assessments, and working on those range of motion exercises. So we’re going to make sure we’re checking those vital signs, noting the severity of that spine curvature in these patients, managing their pain, and providing the range of motion exercises. So that’s going to be your active range of motion and your passive range of motion. We’re going to be doing brace education, surgery, reeducation, and follow-up. So you want to make sure that you have a proper brace that fits well. You’re looking for any sort of skin breakdown. You want to educate them about activities to avoid to prevent any further damage, and provide education about pre- and post-surgical care, making sure they’re following up with the physician. You want to make sure that this condition is not getting any worse
And there you have it. That completed care plan. You guys did wonderful. We absolutely love you guys. Go out and be your best self today and, as always, happy nursing.
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