Scoliosis, Diagnosis of Scoliosis, Treatment of Scoliosis, Nursing Care Plans for Scoliosis, and 2 Nursing Care Plan Examples for Scoliosis
This guide is about Scoliosis, Diagnosis of Scoliosis, Treatment of Scoliosis, Nursing Care Plans for Scoliosis, and 2 Nursing Care Plan Examples for Scoliosis. It can be used to create educational nursing care plans for Scoliosis.
Scoliosis
What is Scoliosis?
Scoliosis is a lateral curving of the spine with the thoracic area being the most commonly affected. It can be classified as functional or structural. Functional scoliosis is the result of another deformity and is corrected by treating the underlying problem. Structural scoliosis is most often idiopathic although it may be congenital or secondary to another disorder. There is a growing body of evidence that idiopathic scoliosis is probably genetic but the etiology is not completely understood.
Structural scoliosis is more progressive and causes changes in supporting structures, such as the ribs. Management includes observation, bracing, and surgical fusion. Patients with idiopathic curves of less than 25 degrees are observed for progress until they have reached skeletal maturity. Bracing is recommended for adolescents with curves between 30 and 45 degrees, while curves greater than 45 degrees usually require surgery. The deformity may occur at any age, from infancy through adolescence, but the best prognosis belongs to those who are almost fully grown and whose curvature is of a mild degree. Idiopathic scoliosis most commonly occurs in adolescent girls.
What are the signs and symptoms of Scoliosis?
- An obvious curvature of the spine
- Leaning to one side
- Uneven shoulders
- Prominence of one shoulder blade over the other
- Uneven waist
- One hip is higher than the other
- Ribs on one side of the body may stick out farther compared to the other
- Clothes not fitting well
- Back pain
- The head is not centered
- Changes on the skin above the spine such as dimpling of the skin, hairy patches, changes in skin color
What causes scoliosis?
Scoliosis can occur secondary to an underlying congenital or neuromuscular condition. However, about 80% of cases are idiopathic and have no known cause.
- Idiopathic scoliosis – commonly diagnosed during puberty.
- Congenital scoliosis – malformation of the vertebrae during pregnancy can cause curvature of the spine due to the uneven development of the spinal column. Congenital scoliosis is often diagnosed at an earlier age compared to idiopathic scoliosis.
- Neuromuscular scoliosis – neurologic and muscular conditions can directly affect the natural curvature of the spine. This classification of scoliosis often requires surgery. Neuromuscular conditions that can cause scoliosis are the following:
- Cerebral palsy
- Spinal cord trauma
- Muscular dystrophy
- Spinal muscular atrophy
- Spina bifida
What will happen if scoliosis is not treated?
- Lung and Heart Damage. Severe scoliosis can affect pulmonary and therefore heart functions. The severe curvature of the spine can change the shape and size of the thorax that houses the lungs and the heart. The lung movements can be restricted causing an increase in tension to the organs.
- Back Problems. Back pain in scoliosis is commonly reported in adults rather than in children.
- Appearance. A disturbed body image is commonly associated with the effects of scoliosis on the person’s body appearance.
Diagnosis of Scoliosis
How do you diagnose scoliosis?
Scoliosis is diagnosed based on the results of physical exams and imaging studies.
Physical Examination:
- Cobb Method – a process of measuring the curvature of the spine. A positive diagnosis of scoliosis can be made with a curvature greater than 10 degrees. A curvature of the spine between 25-30 degrees is considered significant while curves greater than 45-50 degrees are severe and may require more intensive treatment.
- Adam’s Forward Bend Test – this standard screening tool is often used by pediatricians in grade school screenings. The test involves the person leaning forward at 90 degrees at the waist while keeping the feet together. The examiner can then easily assess for asymmetry of the spine.
Imaging Studies:
- X-ray – a simple x-ray imaging can identify spinal curvature.
- CT Scan or CAT scan – a CT scan image can show the size and shape of the spinal canal. This imaging technique gives more information about the spine and surrounding organs as compared to X-ray imaging.
- MRI Imaging – an MRI scan can produce three-dimensional images of the spinal structures.
Treatment of Scoliosis
How is scoliosis treated?
The treatment for scoliosis depends on several factors which are as follows:
- Spinal maturity – the spine is assessed whether it is still growing and changing.
- Degree and extent of curvature – the degree of curvature and how it affects the person’s life is also taken into consideration when deciding the treatment.
- Location of the curve – scoliosis can occur in any area of the spine. However, some areas are more at risk of progressing compared to other areas.
- Possibility of curve progression – it is noted that those with large curves before their growth spurts are at higher risk of curve progression.
Once the above-mentioned variables are assessed and considered, the following treatment may be recommended:
- Observation. Mild cases of scoliosis do not interfere with body functions and lifestyle therefore they do not require treatment. If progression is a concern, regular monitoring and radiologic imaging may be recommended to keep a close eye on the condition.
- Bracing. The use of braces is not suitable for every case of scoliosis. It is most useful in curvature in people who have not reached skeletal maturity yet. There are several types of braces available in the market. Studies suggest that there is an 80% success in stopping curve progression in fully compliant people. A brace needs to be worn around 16-23 hours a day and must properly fit the user.
- Surgery. Surgical treatment is commonly recommended in scoliosis with a curvature greater than 40 degrees. This treatment is used to fully stop the progression of the curvature and to reduce spinal deformity.
Nursing Care Plans for Scoliosis
What are some of the available nursing care plans for Scoliosis?
Nursing care planning goals for a pediatric client with scoliosis may include restoration of normal breathing pattern, relief of pain, improved physical mobility, enhanced learning, stop the progression of the curve and prevent deformity.
Here are four (4) nursing care plans (NCP) and nursing diagnosis (NDx) for scoliosis:
- Ineffective Breathing Pattern
- Impaired Physical Mobility
- Disturbed Body Image
- Deficient Knowledge
Nursing Diagnosis
- Ineffective Breathing Pattern
May be related to
- Musculoskeletal impairment
- Decreased lung expansion
- Hypoventilation syndrome
Possibly evidenced by
- Changes in respiratory rate and depth
- Fatigue
- Increased work of breathing, use of accessory muscles
- Shortness of breath
Desired Outcomes
- Client will maintain an effective breathing pattern, as evidenced by relaxed breathing at normal rate and depth and absence of shortness of breath.
| Nursing Interventions | Rationale |
|---|---|
| Assess respiratory status every 4 hours. | Scoliosis hinders the movement of the ribs, therefore weakens the respiratory muscles causing an increase in the work of breathing during, rest, activity or at sleep. |
| Auscultate breath sounds at least every 4 hours. | This is to detect decreased or adventitious breath sounds. |
| Monitor intake and output. | Adequate hydration mobilizes secretions and prevents infection. |
| Assess oxygen saturation and pulse rate by using pulse oximetry. | Pulse oximetry is a helpful tool to detect alterations in oxygenation. |
| Assist the child in doing deep breathing exercises. | Deep breathing exercises are initiated to improve lung function. |
| Place the client in a semi-Fowler position. | Facilitates expansion of the lungs. |
| Frequently reposition the child every 2 hours. | Promotes lung field inflation. |
| Assist the child in using an incentive spirometry. | Improves lung expansion and aeration of the alveoli. |
| Administer oxygen as needed. | Oxygen increases peripheral oxygen saturation by 95%–100% |
2. Impaired Physical Mobility
Nursing Diagnosis
- Impaired Physical Mobility
May be related to
- Musculoskeletal impairment, pain, and discomfort
Possibly evidenced by
- Reluctance to attempt movement
- Limited range of motion
- Imposed restrictions of movement by medical protocol, resting or immobilization of joint by splinting and positioning
- Fatigue
- Malaise
Desired Outcomes
- Child will maintain proper body alignment and progress with activity as ordered by the physician.
| Nursing Interventions | Rationale |
|---|---|
| Assess the level of physical mobility. | Understanding the particular level, guides the design of best possible management plan. |
| Assess client’s description of pain including the type, location, and intensity. | Severe curvature of the spine creates stress and pressure on the spinal discs, muscles, nerves, and ligaments that can lead to pain. |
| Instruct with the use of nonpharmacologic pain management techniques, such as imagery, relaxation, touch, music. |
Use of these techniques will divert attention, therefore decreasing the pain. |
| Encourage the child to perform active range-of-motion exercises. |
Promotes good circulation; helps maintain strength and muscle tone |
| Encourage regular postural exercises. | These exercises may help in correcting the posture and managing the effects of scoliosis. |
| Teach and encourage use of brace as indicated. | The primary purpose of utilizing a brace is to prevent or slow down the progression of the spinal curve. |
| Collaborate with the physical therapist as indicated. | Physical therapy uses corrective techniques in order to prevent curve progression that enables continued maintenance and improvement of quality of life. |
3. Disturbed Body Image
Nursing Diagnosis
- Disturbed Body Image
May be related to
- Biophysical and psychosocial factors of spinal deformity
Possibly evidenced by
- Verbal response to actual change in structure of spine
- Negative feelings about body
- Dependence on long-term use of brace
- feeling of rejection by peers, inability to participate in some activities.)
Desired Outcomes
- Child will experience improved body image.
| Nursing Interventions | Rationale |
|---|---|
| Assess child’s feelings on wearing brace, long-term treatments, restricted movements, and inability to keep up with peers and participate in activities. |
Provides information about the status of self-concept and changes in appearance. |
| Encourage verbalization of feelings and concerns and support child’s communications with significant others and peers. |
Provides an opportunity to verbalize and limit negative feelings on changes in appearance and prolong wearing of an appliance. |
| Assist child to adjust to self-perception of short leg, use of appliance and effect on appearance. | Promotes realistic perception of appearance and positive self-image. |
| Assist with the plan for independence in performing ADL, application and removal of appliance, choice of shoes and clothing to wear. | Promotes independence and adjustment to the appliance. |
| Maintain positive environment and encourage activities appropriate to the child. | Enhances body image and confidence, and promotes trust and respect of the child. |
| Reassure parents and child that most activities are permitted with use of appliance. |
Promotes positive feelings about the treatment and restrictions created by the deformity. |
| Assist the child find ways to inform others about wearing appliance. |
Assist child in dealing with questions and curiosity of others about differences caused by deformity. |
| Assist child to the type of clothing to cover appliance that is stylish and has peer acceptance. | Improves appearance and body image. |
| Educate child about activity restrictions that include progression from quiet activities to involvement in those to avoid: contact sports, bike riding, driving, skating, or those that may result in a fall if surgery has been done. |
Prevents injury following surgical correction of the deformity. |
4. Deficient Knowledge
Nursing Diagnosis
- Deficient Knowledge
May be related to
- Lack of information about correction of functional or structural scoliosis
Possibly evidenced by
- request for information about treatments for scoliosis, application of brace and surgical procedure to correct scoliosis
Desired Outcomes
- Clients verbalize understanding of scoliosis and the treatment plan.
| Nursing Interventions | Rationale |
|---|---|
| Assess knowledge of deformity, cause, and treatments. |
Provides information about teaching needs. |
| Teach parents and child about a functional or structural defect and methods of treatment modalities specific to the age of child severity of the deformity. | Promotes understanding of type of defect and treatment protocol to relieve anxiety; functional and scoliosis is corrected by treating the underlying problem, and structural scoliosis is treated with long-term bracing and exercising or surgical fixation to straighten and realign spine. |
| Teach child to maintain proper posture, use shoe lifts, exercises, and other prescribed treatments for functional scoliosis. | Corrects functional scoliosis which is usually caused by poor posture or unequal length of legs. |
| Teach parents and child about application, care, and removal of brace or orthoplast jacket, and inform that appliance must be worn for 23 hours/day and may be removed for bathing and exercise. | Provides nonoperative bracing to prevent progressive curvatures; higher curves are treated with the Milwaukee brace and lower curves with the TLSO brace and both are worn until growth is complete. |
| Teach child exercises to be performed in and out of the brace or other appliance and to perform them daily. |
Prevents atrophy of muscle of spine and abdomen. |
| Teach parents and child to use electrical stimulation, application of electrodes, skin protection, connection of leads, operation of machine to be used at night. |
Provides stimulation to the muscles to prevent progression of curvature. |
| Teach parents and child of operative procedure planned and preoperative preparation required; reinforce physician information and use pictures, models and drawings to aid in teaching. |
Provides information about option for internal surgical instrumentation of curves over 45 degrees or those which are rapidly progressing to 45 degrees. |
| Prepare parents and child for postoperative care, especially activity restrictions, log rolling, on progression to ambulation, use of pillows for proper support, maintaining flat position, and possible use of special bed such as Stryker frame. |
Provides information about what to expect following surgery depending the type of procedure. |
| Teach parents and child of use of safety belt and walker when ambulating; instruct in safety precautions to take for child wearing brace [clear pathways, handrails, performing ADL using aids]. |
Prevents trauma caused by fall from postoperative weakness, unassisted ambulation, or wearing of brace causing awkwardness in ambulation and ADL performance. |
| Reassure parents and child that physical and occupational therapy will be prescribed after surgery. | Provides information and support services. Promotes optimal physical activity. |
2 Nursing Care Plan Examples for Scoliosis
Nursing Care Plan 1
Impaired physical mobility related to musculoskeletal impairment secondary to scoliosis as evidenced generalized weakness, back pain, inability to do activities of daily living (ADLs) as normal, fatigue, and verbalization of overwhelming tiredness
Desired Outcome: The patient will be able to perform activities of daily living within the limits of the condition.
| Interventions | Rationales |
| Assess the patient’s level of functional mobility and ability to perform ADLs. | To assist in creating an accurate diagnosis and monitor effectiveness of treatment and therapy. |
| Assist the patient during exercises and when performing activities of daily living. | To encourage the patient to perform muscle-strengthening exercises and promote dignity by allowing the patient to perform their ADLs while maintaining safety. |
| Encourage the use of the prescribed braces at the appointed hours of the day. | The prescribed braces can help the patient perform ADLs while preventing the progression of spinal curvature. |
| Ensure the safety of the environment. Check that the call bell is within reach, the bed rails are up when the patient is on the bed, the bed is in the lowest level, the room is well-lit, the floor is not slippery, and that important things like phone and eyeglasses are easy to reach. | To maintain patient safety and reduce the risk of falls. |
| Encourage the patient to perform range of motion (ROM) exercises in all extremities. | To improve venous return, muscle strength, and stamina while preventing stiffness and contracture deformation. |
| Refer to the physiotherapy and occupational therapy team. | To provide a specialized care for the patient to gain physical and mental support in performing ADLs and mobilizing. |
Nursing Care Plan 2
Nursing Diagnosis: Fatigue related to muscular impairment secondary to scoliosis as evidenced by generalized weakness, irritability, and verbalization of overwhelming tiredness
Desired Outcome: The patient will demonstrate active participation in necessary and desired activities and demonstrate increase in activity levels.
| Interventions | Rationales |
| Assess the patient’s degree of fatigability by asking to rate his/her fatigue level (mild, moderate, or severe). Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try. | To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance. |
| Encourage activity through self-care and exercise as tolerated Alternate periods of physical activity with rest and sleep. Encourage enough rest and sleep, and provide comfort measures. | To help the patient balance his/her physical activity and rest periods. To reserve energy levels and provide optimal comfort and relaxation. |
| Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room. | To allow the patient to relax while at rest. To allow enough oxygenation in the room. |
| Refer the patient to physiotherapy / occupational therapy team as required. | To provide a more specialized care for the patient in terms of helping him/her build confidence in balancing daily physical activity and rest periods. |
Nursing Care Plan 3
Nursing Diagnosis: Risk for Ineffective Breathing Pattern secondary to severe scoliosis
Desired Outcome: The patient will maintain effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within the target range, and verbalize ease of breathing.
| Interventions | Rationales |
| Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. | To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. |
| If oxygen levels drop, administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician. | To increase the oxygen level and achieve and SpO2 value within the target range. |
| Administer the prescribed medications. | Bronchodilators: To dilate or relax the muscles on the airways. Steroids: To reduce the inflammation in the lungs. Cholinesterase inhibitors: To improve muscle strength and contractility by enhancing the communication between the nerves and muscles. |
| Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position. | Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively. |
| Educate the patient about proper breathing techniques such as pursed lip breathing, deep breathing exercises, and diaphragmatic breathing. | To help the patient improve his/her lung function. |
| When in bed, encourage the patient to turn every 2 hours. | Frequent turning and changes in positions help promote lung field inflation. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
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