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.
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.
Patient will have optimal physical mobility; patient will have minimal pain; patient will have adequate breathing pattern
Perform physical assessment noting abnormalities of the legs, shoulders, hips. Assess physical mobility
Determine baseline for treatment and management of condition. Determine severity by looking at the degree of curvature.
Assess breathing pattern 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) and PQRST details
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
Non-pharmacological interventions are the first choice and often relieve pain well.
When necessary, administer anti-inflammatory meds and analgesics as appropriate.
Provide 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 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 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 plan for school and activities
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 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 brace or appliance to prevent injury to patient
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