Scoliosis
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Outline
Overview
- Three dimensional deviation of the spine
- Abnormal curving and rotating
- S-Shaped, deformity of thoracic and lumbar vertebrae
- Most common is right thoracic
Nursing Points
General
- Cause- unknown
- Diagnosed during adolescent growth spurt
- Girls 10-12 years
- Boys 13-14 years
- Measured in degrees
- 10-25 degrees = mild
- 26-45 degrees = moderate
- >45 degrees = severe
- Severe scoliosis can affect breathing or growth of internal organs
Assessment
- Assess child from behind with the child standing straight with their back exposed.
- Assess for asymmetry
- Shoulder & scapula height
- Hip and pelvic height
- Assess for asymmetry
- Have the child bend forward at the waist. Keep trunk parallel to the floor and let arms hang free.
- Assess for asymmetry
- Ribs and flanks
- Assess for asymmetry
- Assess for other spinal anomalies
- Sacral dimple
- Hairy patches
- Abnormal reflexes
- Bladder & bowel incontinence
- Pain
- Assess for breathing difficulties in severe cases
Therapeutic Management
- Observation
- Monitoring every 4-6 months
- Bracing
- Slow progression
- Worn up to 23 hours a day
- Assess skin and keep dry
- Surgery
- If curve is >45 degrees
- Rods and pins to force spine into alignment
- Often requires multiple revisions
- Post-Op Care
- Pain management
- PCA pump
- Mobility
- Avoid twisting
- Use log roll when turning
- Assist patient in moving from side-lying to standing position
- Involve PT
- Skin & wound care
- Assess under braces
- Monitor for complications
- Spinal cord damage
- Paralysis
- Incontinence
- Hemorrhage
- Spinal cord damage
- Pain management
- Emotional support
- May struggle with body image
- May feel alone and isolated if unable to participate in activities
Nursing Concepts
- Mobility
- Comfort
Patient Education
- Ensure safe environment for ambulation
- Use assistive devices if necessary
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Transcript
Hey! In this lesson we are going to be talking about scoliosis. It’s a pretty straightforward diagnosis so we will be able to cover this diagnosis pretty quickly.
Scoliosis is when there is a abnormal curvature and twisting of the thoracic spine. It’s usually diagnosed and during the adolescent growth spurt. So for girls this is between the years 10 and 12 and for boys it’s more like 13 – 14 years.
Scoliosis is measured in degrees and so you can have 10 to 25°, which is a mild case of scoliosis. Then 26 to 45 degrees is considered moderate and greater than 45° is considered a severe case of scoliosis.
When you are assessing for scoliosis it’s important that the patient has their shirt off so that you can see their shoulders, back and all the way down to their hips. You also need to look at the back in two different positions. The first position is to simply have them stand in front of you, facing away from you with their arms down to their side. For the second position have have them bend over with their torso parallel to the floor with their arms hanging down.
Pretty much what you’re looking for in both positions is asymmetry. You need to assess shoulders, scapula, ribs and hips to see if the left and right side are aligned. In the second position, here you really want to see if one side of their back is raised higher than the other. The right side is more commonly affected than the left.
Scoliosis is sometimes associated with other diagnosis like spina bifida and Marfan syndrome so you make sure to look for any signs of spinal deformity or other syndromes.
And then lastly you want to think about some of the things that could be problematic for kids who have more severe cases of scoliosis. If the scoliosis is bad enough it can actually affect their pulmonary function because the lungs can’t expand properly resulting in frequent respiratory infections. And then the other thing that can affect when it’s severe is their gait. They may actually have a limp because of it.
So as I mentioned earlier kids with moderate scoliosis are probably going to be treated with a brace. And you can see in the photo here what a scoliosis brace looks like. It’s no small thing to wear and patients actually have to wear it for 23 hours a day. As you can imagine compliance can be an issue because it’s such a slow process.
Surgery is indicated for patients with >45° or more of scoliosis. The surgery is no small thing because pins and rods are placed in the spine to help straighten it. Patients can be admitted for 5 to 7 days and it tends to be a pretty painful recovery. PCA pumps are the commonly used so it’s important to educate patients on how their pain will be managed by using one. Physical therapy will be very involved with these cases, helping them ambulate. And until notified otherwise, these kids need to be moved using a log roll technique.
The major complications to be on the lookout for are spinal cord injury (so looking for things like, paralysis and bowel and bladder incontinence) and bleeding (there tends to be a lot of blood loss with spinal surgeries).
Your priority nursing concepts for a patient with scoliosis are mobility and comfort.
Scoliosis is curving and twisting of the thoracic spine. It varies in severity with > 45 degree being considered the most severe.
When assessing for scoliosis the main thing to look for is asymmetry of shoulders, scapulas, ribs and hips.
Moderate scoliosis (which is 26-45 degree) is treated with a brace that is worn for 23 hours a day.
Severe scoliosis requires surgery where pins and rods are placed in the spine to straighten it.
It’s a very painful surgery so most patients will have a PCA pump. They need to be moved using the log roll technique. Be on the lookout for complications like a spinal cord injury from the surgery and bleeding.
That’s it for our lesson on Scoliosis. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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