Scoliosis

Data Base A. Lateral curvature of the spine usually associated with a rotary deformity that eventually causes cosmetic and physiologic alterations in the spine, chest, and pelvis B. Cause in 70% of cases is "idiopathic"; probably transmitted as an autosomal dominant trait with incomplete penetrance C. Most common spinal deformity D. More frequent in adolescent girls during growth spurt E. Classification 1. Nonstructural scoliosis: curve is flexible and corrects by bending 2. Structural scoliosis: curve fails to straighten on side-bending: characterized by changes in the spine and its supporting structures F. Clinical findings 1. Prominence of one hip 2. Deformity of the rib cage 3. Prominence of one scapula 4. Difference in shoulder or scapular height 5. Curve in the vertebral spinous process alignment 6. Breasts appear unequal in size 7. Other clues a. Clothes do not fit right b. Skirt hems are uneven G. Therapeutic interventions 1. Screening for scoliosis 2. Diagnosis: confirmed by x-ray examination 3. Interventions depend on severity of the curvature a. Exercise such as swimming can be used in nonstructural scoliosis b. Mild to moderate curvature (1) Braces (a) Milwaukee brace, an individually adapted steel and leather brace that extends from a chin cup and neck pads to the pelvis, where lumbar pads rest on the hips (b) Low profile or underarm brace (2) Treatment (a) Worn 23 hours a day (b) The child is gradually weaned from the brace over a 1- to 2-year period (c) Brace then worn only at night until the spine is mature (d) Electrical stimulation to the convex side of the curvature may prevent progression of the scoliosis c. More severe curves usually require surgery: techniques consist of spinal realignment and straightening by way of external or internal fixation and instrumentation combined with bony fusion (arthrodesis) of the realigned spine (1) Harrington rods (2) Luque segmental instrumentation (3) Dwyer instrumentation (4) Texas Scottish Rite Hospital (TSRH) system d. Most severe scoliotic curvatures require traction devices and exercises for a time before spinal fusion to provide partial Mosby 1998 Section 118, Chapter 5

correction and more flexibility Nursing Care of Adolescents with Scoliosis A. Assessment 1. Have the child stand erect, clothed only in underpants (and bra if older girl) and observe from behind; note asymmetry of the shoulders and hips (Figure 5-53) 2. Have the child bend forward so the back is parallel with the floor; observe from the side, noting asymmetry or prominence of the rib (Figure 5-54) B. Analysis/Nursing Diagnoses 1. Body image disturbance related to: a. Perceived alteration in body structure b. Altered appearance when using supportive devices 2. Altered family processes related to situational crisis (child with a structural defect) 3. Altered growth and development related to disease process 4. Risk for injury related to use of supportive devices 5. Knowledge deficit related to disorder 6. Impaired physical mobility related to use of supportive devices 7. Risk for impaired skin integrity related to: a. Presence of brace b. Use of electrical stimulation 8. Pain related to medical/surgical therapies 9. See General Nursing Diagnoses for Adolescents with Health Problems 10. See General Nursing Diagnoses for the Family of a Child with Special Needs C. Planning/Implementation 1. Check spinal alignment 2. Reinforce and clarify explanations provided by the orthopedist in regard to: a. Appliance b. Plan of care c. Activities allowed or restricted d. Child's and parents' responsibilities in therapy 3. Examine skin surfaces in contact with the brace or electrical stimulator for signs of irritation; implement corrective action to treat or prevent skin breakdown 4. Help in selection of the appropriate wearing apparel to wear over the brace to minimize altered appearance and footwear to maintain proper balance 5. Prepare for surgery if required 6. See General Nursing Care of Adolescents with Health Problems D. Evaluation/Outcomes 1. Family members demonstrate appropriate care and support of child 2. Child demonstrates proper use of brace 3. Parent/child verbalize understanding of disorder and treatment plan 4. Child verbalizes feelings and concerns 5. Skin does not break down 6. Child engages in activities appropriate to limitations and developmental level 7. Child reports minimal pain

Mosby 1998 Section 118, Chapter 5