Hospitalized Child & Scoliosis Flashcards
What is scoliosis ?
complex spinal deformity usually involving a lateral curvature of the spine, spinal rotation, and thoracic hypokyphosis
What are some risk factors for scoliosis ?
- familial inheritance
- age
- sex
- conditions like muscular dystrophy, cerebral palsy, spina bidida
What can scoliosis lead to ?
- deformity
- pain
- alteration in mobility
- respiratory compromise (can impact how much they expand their lungs)
- altered body image
What are some sign & symptoms of scoliosis ?
- difficulty fitting clothes
- uneven shoulder blades
- protruding scapula
- protruding hip
- unequal leg length
What is the gold standard for idiopathic scoliosis diagnosis ?
x-ray imaging
Is scoliosis screening meant to be diagnostic ?
it’s main purpose is to select children which high probability of occurrence of idiopathic scoliosis out of total population
- the # of kids positively screened should correspond to prevalence of idiopathic scoliosis in the population
What are some ways we screen for scoliosis ?
- Observer from posterior: shoulder height, scapular or flank shape, and hip height and alignment
- Adams test: forward bending position with the use of scoliometer which can be performed either in standing or in sitting position (controversial)
- radiographs (gold standard)
What is the treatment for mild scoliosis ?
up to 25 degree curvature
- no treatment
- follow up every 4-6 months
What is the treatment for moderate scoliosis ?
between 25-45 degree curvature
- bracing & physical therapy exercises
What is the treatment for severe scoliosis ?
angle greater then 45 degree curvature
- surgical intervention with spinal fusion and internal stabilization
What is the purpose of wearing a brace with scoliosis ?
to keep the curve from progression (worsening) as the child grows
- may not correct the curve permanently, but it may prevent it from increasing
How long do you wear the brace for each day ?
23 hrs each day
- until the team determines that the pt has reached skeletal maturity
- then they can wear it at night only
- then the pt is slowly weaned from the brace when its deemed appropriate
Successful brace wearing requires pt to ?
- wear for 23 hrs within 2-3 weeks of start of receiving brace
- take care of skin on daily basis
- wear an undershirt at all times under your brace (no side seem & girls wear bra under the undershirt)
- shirt must fit well without wrinkles
- apply brace properly
- do exercise daily
- gradually increase your brace wearing time daily until you reach goal
What is some post-op care for scoliosis ?
- IV fluids
- log roll patient
- physical therapy (active and passive ROM)
- pain management
- neurovascular checks of extremities
- NG tube
- foley catheter (will keep in until they are allowed to mobilize)
- monitor for swelling and bleeding
What is some possible complications of post-op scoliosis ?
- lowered self esteem (typically prior to interventions)
- breathing difficulties (with spinal curvature)
- spine or nerve damage
- post-operative infection
What are the ages of the different age groups ?
- infant: birth - 1 yr
- toddler: 1 yr - 3 yrs
- preschool: 3 yrs - 6 yrs
- school age: 6 yrs - 13 yrs
- adolescent: 13 yrs - 18 yrs
What are some common stress responses to hospitalization ?
- fear of the unknown
- separation anxiety
- stranger anxiety
- fear of pain or mutilation
- loss of control
- anger
- guilt
- regression
What are some fears/stressors of a infant ?
- about 6 months of age they are aware of absence of parents and become fearful of unfamiliar persons
- used to having basic needs met by parents and could result in issues with attachment
- can sense parents anxiety
- separation anxiety (with older infant)
What occurs in the protest phase ?
- screaming, crying, inconsolable
- clinging to parents, pleading for parents to stay
- agitated, temper tantrums, refuse to comply with care
- resists caregivers
What occurs in the despair phase ?
- child becomes inactive, withdrawn, lacks interest in environment, apathetic
- sadness, depression
- withdrawal or complaint behavior
- crying when parents appear
What occurs in the detachment phase ?
- lack of protest when parents leave
- increased interest in surroundings
- interacts with strangers or familiar caregivers
- forms new but superficial relationships
- if parents reappear, child may ignore
- resignation but not contentment
- possible serious effects on attachment to parent after separation
What is the role of a child life specialist ?
- know the importance of play as the work of children and is critical in their development
- teach positioning and comfort positions
- parental involvement
What are some fears/stressors for toddlers ?
- separation anxiety: even start in older infants
- loss of self control
- fear of injury and pain
- regressive behavior
- issues can arise with disruption of routine and separation from parents
What are some fears/stressors for preschoolers ?
- regression (highest age risk)
- separation anxiety and fear of abandonment: generally less than the toddler
- inability to distinguish fact/fiction
- unable to understand reason for hospitalization
- loss of self-control
- fear of dark
- fear of bodily injury
What age group has the highest risk for regression ?
preschoolers
What age group has the highest risk for stranger anxiety ?
infant
What are some fears/stressors for school-age children ?
- loss of control
- fear of pain
- fear of bodily injury and death
- loss of privacy
- separation not as much of an issue as toddlers and preschoolers (may already experienced when starting school)
- want to know reason for procedures (likes to be involved and make choices)
What are some fear/stressors for adolescents ?
- loss of control (give some control to avoid power struggle)
- loss of privacy
- concerned with appearance (fear of altered body image)
- separation from peer group (more important than separation from family)
- may act as though not afraid when they really are
