Scoliosis is a condition characterized by an abnormal lateral curvature of the spine. This nursing diagnosis is crucial for healthcare professionals to understand as it can significantly impact a patient’s quality of life and require comprehensive care planning.
Causes (Related to)
Scoliosis can result from various factors that affect the spine’s normal development or structure. Common causes include:
- Congenital spine deformities
- Neuromuscular conditions (cerebral palsy, muscular dystrophy)
- Degenerative diseases of the spine
- Leg length discrepancy
- Poor posture
- Injury or trauma to the spine
- Idiopathic factors (cause unknown, most common in adolescents)
Signs and Symptoms (As evidenced by)
Scoliosis can manifest with a variety of signs and symptoms. During a physical assessment, a patient with scoliosis may present with one or more of the following:
Subjective: (Patient reports)
- Back pain, especially in adults
- Fatigue after standing or sitting for long periods
- Breathing difficulties in severe cases
- Self-consciousness about appearance
Objective: (Nurse assesses)
- Visible curve in the spine
- Uneven shoulders
- One hip higher than the other
- Uneven waist
- Rib prominence on one side
- Clothes not hanging properly
- Reduced range of motion in the spine
- Abnormal gait or walking pattern
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for scoliosis:
- The patient will report reduced back pain
- The patient will demonstrate improved posture
- The patient will show an increased range of motion in the spine
- The patient will exhibit improved respiratory function
- The patient will report increased comfort during daily activities
- The patient will demonstrate proper use of prescribed braces or supports
- The patient will show improved self-image and body awareness
Nursing Assessment
The nursing assessment is crucial in developing an effective care plan for patients with scoliosis. Here are important assessment steps:
- Conduct a thorough physical examination
Assess the patient’s spine for visible curvature, shoulder and hip alignment, and trunk asymmetry. - Perform Adam’s forward bend test.
This test helps identify the rotation of the spine and rib cage prominence. - Measure the Cobb angle.
Work with the healthcare team to interpret X-ray results and determine the severity of the curve using the Cobb angle measurement. - Assess pain levels
Use a pain scale to evaluate the patient’s discomfort and its impact on daily activities. - Evaluate respiratory function
Assess breathing patterns, lung sounds, and oxygen saturation, especially in severe cases. - Check for neurological symptoms.
Assess for any signs of nerve compression, such as numbness, weakness, or altered reflexes. - Assess psychological impact
Evaluate the patient’s emotional state, body image concerns, and social interactions. - Review medical history
Look for any underlying conditions or family history that may contribute to scoliosis. - Assess daily activities and lifestyle.
Evaluate how scoliosis affects the patient’s ability to perform daily tasks, participate in sports, or maintain posture during work or school. - Monitor growth and development.
For adolescent patients, track growth patterns as rapid growth can influence curve progression.
Nursing Interventions
Effective nursing interventions are essential for managing scoliosis and improving patient outcomes. Here are key interventions:
- Provide education on scoliosis
Explain the condition, treatment options, and the importance of adherence to the treatment plan. - Assist with pain management.
Administer prescribed medications and teach non-pharmacological pain relief techniques. - Promote proper posture
Teach and reinforce good posture habits during various activities. - Assist with brace management.
If prescribed, help the patient with proper brace application, care, and adherence to the wearing schedule. - Encourage exercise and physical therapy.
Support the patient in following prescribed exercise regimens and attending physical therapy sessions. - Monitor for complications
Regularly assess for signs of curve progression, respiratory issues, or neurological symptoms. - Provide emotional support
Offer counseling or referrals to support groups to address psychological aspects of living with scoliosis. - Collaborate with the healthcare team.
Work closely with physicians, physical therapists, and orthotists to ensure comprehensive care. - Assist with activities of daily living.
Help patients modify daily activities to accommodate their condition and promote independence. - Prepare for surgical interventions if needed.
Provide pre and post-operative care for patients undergoing surgical correction of scoliosis.
Nursing Care Plans
Here are five nursing care plans for patients with scoliosis:
Care Plan 1: Chronic Pain
Nursing Diagnosis: Chronic Pain related to spinal curvature and muscle imbalance secondary to scoliosis as evidenced by the patient’s report of back pain rated 6/10 and decreased participation in daily activities.
Related factors/causes:
- Spinal curvature causing muscle strain
- Altered body mechanics
- Pressure on nerves and surrounding tissues
Nursing Interventions and Rationales:
- Assess pain characteristics (location, intensity, duration, aggravating/alleviating factors)
Rationale: Provides a baseline for pain management and helps identify effective interventions - Administer prescribed pain medications as ordered
Rationale: Helps manage pain and improve comfort - Teach and encourage non-pharmacological pain management techniques (e.g., relaxation, heat/cold therapy)
Rationale: Provides additional pain relief options and promotes patient autonomy in pain management - Assist patient in finding comfortable positions and using supportive devices
Rationale: Reduces strain on affected areas and improves comfort - Encourage adherence to prescribed physical therapy exercises
Rationale: Strengthens supporting muscles and improves flexibility, potentially reducing pain
Desired Outcomes:
- The patient will report pain reduction to 3/10 or less within one week
- The patient will demonstrate the use of at least two non-pharmacological pain management techniques by discharge
- The patient will show increased participation in daily activities within two weeks
Care Plan 2: Impaired Physical Mobility
Nursing Diagnosis: Impaired Physical Mobility related to spinal deformity and discomfort secondary to scoliosis as evidenced by difficulty in bending, reduced range of motion, and reluctance to engage in physical activities.
Related factors/causes:
- Spinal curvature limiting movement
- Pain and discomfort during movement
- Muscular imbalance
Nursing Interventions and Rationales:
- Assess the patient’s current mobility status and limitations
Rationale: Provides a baseline for planning interventions and measuring progress - Assist patient with prescribed range of motion exercises
Rationale: Maintains joint flexibility and muscle strength - Teach proper body mechanics for daily activities
Rationale: Reduces strain on the spine and prevents worsening of symptoms - Encourage use of assistive devices as prescribed (e.g., back brace)
Rationale: Provides support and promotes proper alignment during activities - Collaborate with a physical therapist to implement an individualized exercise program
Rationale: Improves strength, flexibility, and overall mobility
Desired Outcomes:
- The patient will demonstrate an increased range of motion in the spine within two weeks.
- The patient will report reduced discomfort during daily activities within one week.
- The patient will consistently use proper body mechanics during activities by discharge.
Care Plan 3: Disturbed Body Image
Nursing Diagnosis: Disturbed Body Image related to visible spinal deformity and use of orthotic devices secondary to scoliosis as evidenced by verbal expressions of dissatisfaction with appearance and reluctance to participate in social activities.
Related factors/causes:
- Visible curvature of the spine
- Need for visible orthotic devices (e.g., back brace)
- Alterations in clothing fit
Nursing Interventions and Rationales:
- Assess patient’s perception of body image and emotional response to scoliosis
Rationale: Provides insight into the psychological impact of the condition - Provide emotional support and active listening
Rationale: Helps patient feel understood and validated in their concerns - Educate patient on the purpose and benefits of orthotic devices
Rationale: Increases understanding and may improve acceptance of necessary treatments - Refer to support groups or counseling services as appropriate
Rationale: Provides additional emotional support and coping strategies - Assist in finding adaptive clothing options if needed
Rationale: Helps maintain a sense of normalcy and improves self-esteem
Desired Outcomes:
- The patient will verbalize improved acceptance of body image within two weeks
- The patient will demonstrate increased participation in social activities by discharge
- The patient will express an understanding of the importance of orthotic devices within one week
Care Plan 4: Risk for Impaired Respiratory Function
Nursing Diagnosis: Risk for Impaired Respiratory Function related to severe spinal curvature affecting lung expansion secondary to advanced scoliosis.
Related factors/causes:
- Restricted chest wall movement due to spinal deformity
- Decreased lung capacity
- Potential for progression of spinal curvature
Nursing Interventions and Rationales:
- Assess respiratory rate, depth, and pattern regularly
Rationale: Allows early detection of respiratory compromise - Teach and encourage deep breathing and coughing exercises
Rationale: Promotes lung expansion and clearance of secretions - Position the patient to maximize lung expansion (e.g., semi-Fowler’s position)
Rationale: Facilitates easier breathing and improved oxygenation - Monitor oxygen saturation levels
Rationale: Provides objective data on oxygenation status - Collaborate with respiratory therapy for pulmonary function tests and interventions
Rationale: Helps track lung function and implement specialized respiratory care
Desired Outcomes:
- The patient will maintain oxygen saturation above 95% on room air
- The patient will demonstrate effective use of deep breathing exercises by discharge
- The patient will show improved or stable pulmonary function test results within three months
Care Plan 5: Deficient Knowledge
Nursing Diagnosis: Deficient Knowledge related to scoliosis management and treatment options as evidenced by patient’s verbalization of misconceptions about the condition and expressed uncertainty about self-care measures.
Related factors/causes:
- Lack of exposure to accurate information about scoliosis
- Complexity of treatment options
- Misunderstandings about long-term prognosis
Nursing Interventions and Rationales:
- Assess the patient’s current knowledge and understanding of scoliosis
Rationale: Identifies gaps in knowledge and areas needing focus - Provide comprehensive education on scoliosis, its progression, and treatment options
Rationale: Increases patient’s understanding and ability to make informed decisions - Demonstrate and teach proper brace application and care (if prescribed)
Rationale: Ensures correct use of orthotic devices for maximum benefit - Discuss the importance of regular follow-ups and monitoring
Rationale: Emphasizes the need for ongoing care and early intervention if needed - Provide written materials and reliable online resources for further learning
Rationale: Offers additional sources of information for reinforcement and reference
Desired Outcomes:
- The patient will verbalize an accurate understanding of scoliosis and its management within one week.
- The patient will demonstrate proper brace application (if applicable) before discharge.
- The patient will express confidence in the ability to adhere to treatment plan by discharge.
References
- Negrini, S., Donzelli, S., Aulisa, A. G., Czaprowski, D., Schreiber, S., de Mauroy, J. C., … & Zaina, F. (2018). 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis and spinal disorders, 13(1), 3.
- Horne, J. P., Flannery, R., & Usman, S. (2014). Adolescent idiopathic scoliosis: diagnosis and management. American family physician, 89(3), 193-198.
- Weinstein, S. L., Dolan, L. A., Wright, J. G., & Dobbs, M. B. (2013). Effects of bracing in adolescents with idiopathic scoliosis. New England Journal of Medicine, 369(16), 1512-1521.
- Kakar, R. S., Simpson, K. J., Das, B. M., & Brown, C. N. (2017). Review of physical activity benefits and potential considerations for individuals with scoliosis. International journal of exercise science, 10(3), 324.
- Reichel, D., & Schanz, J. (2003). Developmental psychological aspects of scoliosis treatment. Pediatric Rehabilitation, 6(3-4), 221-225.
- Romano, M., Minozzi, S., Bettany‐Saltikov, J., Zaina, F., Chockalingam, N., Kotwicki, T., … & Negrini, S. (2012). Exercises for adolescent idiopathic scoliosis. Cochrane Database of Systematic Reviews, (8).
