Scoliosis NCLEX Review Care Plans
Nursing Study Guide on Scoliosis
Scoliosis is a medical condition that occurs when the spine curves and twists to the side. It affects people of all ages; however, it is most common in children aged 10 to 15 years.
Most cases of scoliosis are idiopathic, while some incidents occur secondary to other medical conditions, such as cerebral palsy and muscular dystrophy.
The curvature of the spine in scoliosis can be so mild that no treatment is necessary. Regular follow-up will be recommended to monitor the curvature closely and ensure the condition does not progress.
In moderate to severe cases, disabilities can occur, which may affect mobility and breathing. When this happens, the use of braces and surgery may be required.
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
Causes of 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:
Complications of Scoliosis
- 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
Scoliosis is diagnosed based on the results of physical exams and imaging studies.
- 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.
- 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
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
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.
|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.
|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.
|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.|
Other possible nursing diagnoses:
- Disturbed Body Image
- Activity Intolerance
- Deficient Knowledge
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. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
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. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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