Ch. 28: Scoliosis Flashcards
Scoliosis is a complex deformity of the spine that also affects the ___
Ribs
How is scoliosis characterized by?
A lateral curvature of the spine and spinal rotation that causes rib assymetry
A curve needs to be at least ___ for diagnosis and mild curves (less than ___) are monitored.
10 degree for diagnosis
Mild curves: less than 25 degrees are monitored
What is the most common form of scoliosis?
Idiopathic or structural scoliosis
What are the sub/obj data for scoliosis?
- Assymmetry in scapula, ribs, flanks, shoulders, and hips
- Improperly fitting clothing (one leg shorter than the others)
When is screening for scoliosis and how does it happen?
Preadolescence for B and G
- Child only wear underwear and observe child from back-
- Have child bend over at waist with arms hanging down and observe for symmetry of ribs and flank
How is truncal rotation measured?
Scoliometer
How do we determine the degree of curvature?
How do we determine the skeletal maturity?
Degree of curvature: Cobb technique
Skeletal maturity: Risser scale
Pre-op for surgical interventions we obtain routine lab studies, including a type and cross match for blood as prescribed. Why do we need to have blood labs studies done?
The adolescent may have self-donated blood available for transfusion—clients who have spinal instrumentation for scoliosis have a lengthy surgery with blood loss and require blood replacements
What slows the progression of the curve?
Bracing
What is the surgical intervention for scoliosis?
Spinal fusion with rod deplacement–used for curvatures greater than 45
Pre-op: Inform the adolescent to obtain ______ blood donations and assist them
Obtain autologous (self-donated)
Post-op: Do they get PCA pump?
Yes
Post op: How is pt turned?
Frequently by log rolling to prevent damage to the spinal fusion
Post-op: Why do we assess and monitor the bowel sounds?
Observing for paralytic ileus
Post-op: What do we monitor for decreases in?
Hgb and Hct–observe for indications of bleeding
Post-op: What do we preform frequently?
Neurovascular checks
What are indicators of changes when assessing neuromuscular status?
- Numbness
- Tingling
- Decreased mobility
- Sensation
- Cap. refill
What are some complications from scoliosis?
- Breathing difficulties (with severe curvatures)
- Lower self-esteem
- Infection following surgery (may be caused by bacteria like staph)
- Spine or nerve damage (uncorrected scoliosis)
If the child has an infection following surgery, what do we need to monitor, do about position, and nutrition?
Monitor: VS (changes in temp can be associated with complications and infection); changes in neuromuscular status
Position: reposition child frequently
Nutrition: High-fiber diet and adequate hydration
A nurse is completing prep teaching with an adolescent client who is going to receive spinal instrumentation for scoliosis. Which of the following information should the nurse include in the teaching?
A. You will go home same day of surgery
B. You will have minimal pain
C. You will need to receive blood
D. You will not be able to eat until the day after surgery
C
