Nursing Care Plan (NCP) for Scoliosis

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Outline

Pathophysiology

Scoliosis is an abnormal sideways curvature of the spine with a twisting that causes a “C” or “S” shape in the spine.  Treatment depends on the severity of the case and may range from exercises and a brace to surgery. Scoliosis most commonly presents between 10 – 12 years of age or during the teens. Severe cases may be present at birth.

Etiology

Congenital scoliosis is rare and is related to abnormal spine development during gestation and usually occurs with other congenital disorders such as cerebral palsy, Marfan syndrome, and muscular dystrophy. Functional scoliosis develops as a result of a problem elsewhere in the body, such as with unequal leg length or muscle spasms in the back. Injuries to the spine, bad posture, and connective tissue disorders can all cause scoliosis.

Desired Outcome

The patient will have optimal physical mobility; the patient will have minimal pain; the patient will have an adequate breathing pattern.

Scoliosis Nursing Care Plan

Subjective Data:

  • Shortness of Breath 
  • Hip pain
  • Back pain

Objective Data:

  • One leg longer than the other 
  • One hip higher than the other 
  • Uneven waist
  • Curvature of spine 
  • Uneven shoulders

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Perform physical assessment noting abnormalities of the legs, shoulders, hips. Assess physical mobility Determine a baseline for treatment and management of the condition. Determine severity by looking at the degree of curvature. 
Assess breathing patterns and auscultate breath sounds Encourage deep breathing exercises and administer oxygen as necessary.

 

Patients with altered posture may have less than adequate lung expansion because of changes in the shape of the thoracic cavity. That can lead to respiratory infection and decreased lung function. Deep breathing exercises help improve lung inflation. 

Assess pain level with appropriate scale (FACES or number scale) Help determine the best method for pain relief.  The curvature of the spine can cause pressure on muscles, nerves, and spinal discs that result in pain. 
Manage pain appropriately Massage

Heat / cold

Positioning

Medication

Non-pharmacological interventions are the first choice and often relieve pain well. When necessary, administer anti-inflammatory meds and analgesics as appropriate. 

Provide a range of motion exercises – AROM and PROM Encourage strengthening of the muscles and flexibility.  Promotes good posture. Prevent contractures and encourage mobility. 
Apply and educate patient parents in the use of braces Properly used, a back brace can help relieve pain and provide stability for the spine. Ideally, the brace can help slow down the progression of the spinal curve, but it typically cannot correct it.
Assess skin for breakdown with use of a brace Monitor for signs of skin breakdown or improper fit of brace that may cause sores, blisters, and excoriation. Preventing skin breakdown can help prevent infection. 
Reposition every 2 hours Promotes effective breathing and prevents skin breakdown. 
Assist patient and parents with the plan for school and activities The use of an appliance or brace may require certain changes to be made to activities.

Promote independence and self-care.

Develop a plan for school so that patients can move about and reposition frequently as needed to relieve pain and encourage mobility.

Encourage regular monitoring Patients with mild scoliosis may only require routine monitoring to make sure the condition is not getting worse.
Provide pre- and post-op instructions and care Patients with severe deformities may be eligible for surgery in which the spine is straightened with rods and screws.  Prevent infection at the surgical site and promote early ambulation and range of motion exercises. 
Educate patient and parents regarding activities that should be avoided during treatment Contact sports and high-risk activities should be avoided following surgery and while wearing a brace or appliance to prevent injury to the patient 

Writing a Nursing Care Plan (NCP) for Scoliosis

A Nursing Care Plan (NCP) for Scoliosis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

https://www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716

https://my.clevelandclinic.org/health/diseases/14521-pediatric-and-adolescent-scoliosis

https://orthoinfo.aaos.org/en/diseases–conditions/clubfoot/

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Transcript

Hi everyone. Today, we are going to be creating a nursing care plan for scoliosis. So let’s get started. First, we’re going to go over the pathophysiology. So scoliosis is an abnormal sideways curvature of the spine with a twisting that causes a C or an S shape in the spine. Nursing considerations. We want to assess vital signs, full head to toe assessment, pain management, range of motion exercises, brace care, surgical education, and any follow up care. Desired outcome. The patient will have optimal physical mobility. The patient will have minimal pain, and the patient will have an adequate breathing pattern. Here’s an example of scoliosis. So you’re going to notice in this picture, this curvature right here. You’re going to notice how it kind of has C shaped here right around here and kind of an S starting up here kind of goes down and around like an S. So this is what is known as scoliosis of the spine right here.

So we’re going to go ahead and get started on the care plan. We’re going to be writing down some of that subjective data and that objective data. So you’re going to see what the patient is complaining of or what you’re going to actually physically see of the patient. So they’re going to say they have some shortness of breath. It’s very common. And some hip pain. Some objective data that you might notice is that curvature. That is a very telltale sign. And you might notice as well that unevenness, that one of your hips is higher. So one hip might be higher than the other, or the opposite with the leg. One leg might be longer than another. They may also be complaining of some back pain, have an uneven waist, or even uneven shoulders. 

Some interventions that we want to do are a full assessment; you want to note any sort of abnormalities of the legs, the shoulders, and hips. You want to assess their physical mobility. You want to determine the severity by just looking at the degree of that curvature. You’re going to assess those vital signs, breathing patterns, And you want to auscultate those breath sounds. You want to make sure you’re encouraging deep breathing exercises and administering any oxygen as necessary. Patients with altered posture may have less than adequate lung expansion because of changes in the shape of the thoracic cavity that can lead to respiratory infections and decrease lung function. Deep breathing exercises help improve lung inflation. We’re also going to assess pain as pain is big for these patients because that curvature of the spine can cause pressure on muscles, nerves, and spinal discs that result in pain for those patients. We can do non-pharmaceutical interventions; that’s the first choice to relieve pain. So that could be some heat or cold compresses. You can do some massage, Maybe it’s changing their position. So repositioning the patient, making sure you’re doing that every two hours and, when necessary, giving medication. So you want to administer any sort of anti-inflammatory medications, analgesics as appropriate. Other interventions are we want to provide range of motion exercises. So any active range of motion or passive range of motion, you want to encourage strengthening of those muscles and flexibility. It promotes good posture and it prevents contractors and encourages mobility for those patients. Another intervention. We want to make sure that we’re educating the patient and or the parents on braces; how to properly use a back brace, and that will help relieve the pain and it’ll provide stability for the patient and the spine. Ideally, the brace can help slow down the progression of the spine curve, but it typically can’t correct it. You also want to make sure you’re assessing for any sort of skin breakdown with using the braces. You want to make sure it’s fitted properly and you want to make sure you’re monitoring for any sort of signs of skin breakdown and proper fit. Any blisters, any sores, you want to make sure you’re looking for that. Another intervention is we want to make sure we’re providing any sort of pre- and post-op instruction. So, if any of these treatments don’t work, they may end up doing surgery to surgically correct the spine. So any patients that have severe deformities in the spine will be eligible for surgery. And that is when the physician’s going to end up strengthening or straightening that spine with rods and screws. So you want to make sure we’re preventing infection at the surgical site. And we want to promote early ambulation and range of motion exercises, post-op for these patients. You want to make sure we’re educating the patient and parents regarding physical activities after surgery. 

Especially for kids, any contact sports in general are high risk activities. These should be avoided following surgery and while they’re wearing a brace, because you want to make sure you’re preventing any sort of further injury to the spine for the patient. You want to encourage regular monitoring. So follow up appointments; you want to make sure that they’re having those follow up appointments to make sure that the condition is not getting any worse than what they were previously by seeing the physician, 

Okay, we’re going to go into some of those key points. So scoliosis; it’s an abnormal sideways curve of the spine with that twisting that causes that C or that S shape in the spine injuries to the spine. Bad posture and connective tissue disorders are all causes of scoliosis. Some subjective objective data that you’ll see with the patient. They’ll complain of shortness of breath. Some hip pain and back pain. One leg might be longer than the other one. Hip might be higher than the other, uneven waist, curvature of that spine. That is the hallmark of this – uneven shoulders. We’re going to be doing vital signs assessments, and working on those range of motion exercises. So we’re going to make sure we’re checking those vital signs, noting the severity of that spine curvature in these patients, managing their pain, and providing the range of motion exercises. So that’s going to be your active range of motion and your passive range of motion. We’re going to be doing brace education, surgery, reeducation, and follow-up. So you want to make sure that you have a proper brace that fits well. You’re looking for any sort of skin breakdown. You want to educate them about activities to avoid to prevent any further damage, and provide education about pre- and post-surgical care, making sure they’re following up with the physician. You want to make sure that this condition is not getting any worse 

And there you have it. That completed care plan. You guys did wonderful. We absolutely love you guys. Go out and be your best self today and, as always, happy nursing.

 

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