Handout Orthopedic Nursing Scoliosis

Scoliosis  /sko-lee-oh-sus/ Greek word =crooked  

  

sideways curve of your backbone, or spine. often S- or C-shaped. Scoliosis is most common in growth spurts. Girls prone Hereditary

Cause: • Nonstructural, which is when the spine is structurally normal and the curve is temporary. •

Structural, which is when the spine has a fixed curve. The cause could be a disease, injury, infection, or birth defect.

Signs: *Idiopathic scoliosis can go unnoticed in a child because it is rarely painful in the formative years.Parents should watch for the following warning signs of scoliosis when their child is about 8 years of age: • • • • •

Uneven shoulders Prominent shoulder blade or shoulder blades Uneven waist Elevated hips Leaning to one side

Diagnosis:  medical and family history  physical exam  x ray -lets the doctor measure the curve in degrees (such as 25 degrees) and see its location, shape, and pattern. Treatment for scoliosis is based on:  The person's age  How much more he or she is likely to grow  The degree and pattern of the curve  The type of scoliosis. 1. Observation  check every 4 to 6 months to see if the curve is getting better or worse  Used for those who have a curve of less than 25 degrees and are still growing. 2. Bracing  The person is still growing and has a curve of more than 25 to 30 degrees.  The person is still growing and has a curve between 20 and 29 degrees that is getting worse.  The person has at least 2 years of growth remaining and has a curve that is between 20 and 29 degrees. If a girl, she should not have started having her monthly periods yet.

- two or more vertebrae are fused together, using bone grafts and metal rods and screws

Spinal fusion is used to treat: • •

• •

Injuries to spinal vertebrae Protrusion and degeneration of the cushioning disk between vertebrae (sometimes called slipped disk or herniated disk) Abnormal curvatures of the spine (such as scoliosis or kyphosis) Weak or unstable spine caused by infections or tumors

Spinal fusion  eliminates motion between vertebral segments, may cause pain.  stops the progress of spinal deformity, such as scoliosis.  will take away some spinal flexibility Technique: Bone Grafting  most commonly used material to help promote fusion of the vertebrae.  small pieces of bone are placed into the space between the vertebrae to be fused  larger solid pieces are used to provide immediate structural support.  The bone is either supplied by the patient (autogenous bone) or harvested from other individuals (allograft bone). *Autogenous bone is generally better at promoting fusion, but it requires extra surgery to remove bone from the patient's hip. Immobilization  Bones are immobile with metal rods and screws  External bracing or casting may also be used (can be both) The 4 Components Orthopaedic Evaluation 1. Medical history - information about pt’s general health and symptoms 2. Physical examination - to assess the stability, strength, alignment and motion of your back, as well as a neurologic evaluation 3. Diagnostic tests (radiography)

obtained to structure of

3. Surgery

 when the person is still growing  the curve is more than 45 degrees  the curve is getting worse Spinal Fusion

imaging) information uses no create images.

(X-rays), which may be evaluate the bones and your spine MRI (magnetic resonance to provide more detailed about the spine and radiation to

Myelography uses X-ray imaging and an injected dye to define bony and soft-tissue structures affecting the nerve root

and soft regular X-rays

CT (computed tomography) may also be arranged; CT provides details about the bones tissues not seen on

4. Discussion - findings

of the physical examination and diagnostic evaluation and the treatment for pt’s condition

Recovery at Home

 Arrange for transportation home that will allow the pt. to ride in a leaning back or lying down position

 Pt. may do as much for himself as you can as long as you maintain a balanced position of your spine

 Pt. should not stay in bed during the day  Teach the pt. not hesitate to ask for help from your family members or friends if it is needed

Pre-OP care 1. Medication- stop taking certain medicine  may interfere with or affect the results of surgery  may cause bleeding  may interfere with the effects of your anesthesia  aspirin and nonsteroidal anti-inflammatory drugs 2. Donating Blood  blood loss may occur during surgery  doctor may prescribe an iron supplement to help build up your blood before surgery Advance Nursing Plan:

Wound Care  stitches(sutures) or staples will be removed approximately 2 weeks after surgery  If the wound is clean and dry, no bandage is needed.

 If drainage continues after you are home, the wound should be covered with a bandage and a call made to pt’s surgeon Diet Some loss of appetite is common. Eating wellbalanced meals and drinking plenty of fluids are important

 The pt. will be able to walk after surgery

Activity Loss of energy is frequently experienced after major surgery, but this improves over time.

 Arrange for some help with washing,

Initially, pt should only participate in walking

dressing, and household activities, such as cleaning, laundry, and shopping, for a few days after your return home

 Do not drive a car for a period of time after

Later, swim or use an exercise bike or treadmill to improve pt’s general physical condition Avoiding Problems after Surgery

surgery. Nursing Considerations: 1. Immediate complications  urinary retention  temporary decreased or absent intestinal function 2. Major complications  Heart attack  Stroke  Infection & Blood clots- first few weeks after surgery  Recurrent disk herniations  nerve damage can result in pain and prolonged recovery time Rehabilitation  Pain medication will be given regularly, or PCA  The fused spine must be kept in proper alignment  Turn frequently using a "log rolling" technique-move the entire body as a unit, avoiding twisting of the spine.  Discharged from the hospital with a back brace or cast.

Warning signs of possible blood clots include the following: • • •

Swelling in the calf, ankle or foot Tenderness or redness, which may extend above or below the knee Pain in the calf

*a blood clot may travel through the blood stream and may settle in your lungs (Pulmonary embolism) Symptoms: sudden chest pain and shortness of breath or coughing Infection following spine surgery occurs very rarely Warning signs of infection include: • • • • •

Redness, tenderness, and swelling around the wound edges Drainage from the wound Pain or tenderness Shaking chills Elevated temperature, usually above 100°F if taken with an oral thermometer

After Recovery  Weight reduction Program

 Exercise programs have not been shown to keep scoliosis from getting worse.  Weight-bearing exercise, such as walking, running, soccer, and gymnastics, helps keep bones strong Alternative Treatments So far, the following treatments have not been shown to keep curves from getting worse in scoliosis: >Chiropractic treatment >Electrical stimulation >Nutritional supplements >Exercise