Scoliosis

  1. General information
    1. Lateral curvature of the spine
    2. Most commonly occurs in adolescent girls
    3. Disorder has a familial pattern; associated with other neuromuscular disorders
    4. Majority of the time (75% of cases) disorder is idiopathic; others causes include congenital abnormality of vertebrae, neuromuscular disorders, and trauma
    5. May be functional or structural
      1. Nonstructural/functional: "C" curve of spine
        1. due to posture, can be corrected voluntarily and disappears when child lies down
        2. not progressive
        3. treated with posture exercises
      2. Structural/progressive: "S" curve of spine
        1. usually idiopathic
        2. structural change in spine, does not disappear with position changes
        3. more aggressive intervention needed
  2. Medical management
    1. Stretching exercises of the spine for nonstructural changes
    2. Milwaukee brace worn for 23 hours/day for 3 years
    3. Plaster jacket cast
    4. Halo-pelvic or halo-femoral traction
    5. Spinal fusion with insertion of Harrington rod
  3. Assessment findings (structural scoliosis)
    1. Failure of curve to straighten when child bends forward with knees straight and arms hanging down to feet (curve disappears with functional scoliosis)
    2. Uneven bra strap marks
    3. Uneven hips
    4. Uneven shoulders
    5. Asymmetry of rib cage
    6. Diagnostic test: x-ray reveals curvature
  4. Nursing interventions
    1. Teach/encourage exercises as ordered.
    2. Provide care for child with Milwaukee brace
      1. Child wears brace 23 hours/day; is removed once a day for bathing.
      2. Monitor pressure points, adjustments may be needed to accommodate increase in height or weight.
      3. Promote positive body image with brace.
    3. Provide cast/traction care.
    4. Assist with modifying clothing for immobilization devices.
    5. Adjust diet for decreased activity.
    6. Provide diversional activities.
    7. Provide care for child with Harrington rod insertion (see below).
    8. Provide client teaching and discharge planning concerning
      1. Exercises
      2. Brace/traction/cast care
      3. Correct body mechanics
      4. Alternative education for long-term hospitalization/home care
      5. Availability of community agencies

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