1. Describe scoliosis including the different types.

Types of idiopathic scoliosis are categorized by both age at which the curve
is detected and by the type and location of the curve.
When grouped by age, scoliosis usually is categorized into three age groups:
Infantile scoliosis: from birth to 3 years old
Juvenile scoliosis: from 3 to 9 years old
Adolescent scoliosis: from 10 to 18 years old
Scoliosis curves are often described based on the direction and location of
the curve. Physicians have several detailed systems to classify specific
curves, but here are some common terms used to describe scoliosis:
Terms that describe the direction of the curve:
Dextroscoliosis describes a spinal curve to the right ("dextro" = right).
Usually occurring in the thoracic spine, this is the most common type of
curve. It can occur on its own (forming a "C" shape) or with another curve
bending the opposite way in the lower spine (forming an "S").
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Levoscoliosis describes a spinal curve to the left ("levo" = left). While
common in the lumbar spine, the rare occurrence of levoscoliosis in the
thoracic spine indicates a higher probability that the scoliosis may be
secondary to a spinal cord tumor. A physician will order an MRI for a
thorough diagnosis.
Terms that describes the location of the curve:
Thoracic scoliosis is curvature in the middle (thoracic) part of the spine. This
is the most common location for spinal curvature.
Lumbar scoliosis is curvature in the lower (lumbar) portion of the spine.
Thoracolumbar scoliosis is curvature that includes vertebrae in both the
lower thoracic portion and the upper lumbar portion of the spine.
2. Discuss the incidence and etiology of idiopathic scoliosis.
Idiopathic scoliosis (unknown cause) - in about 80% of cases the cause is
unknown. Neuromuscular conditions - these are conditions that affect the
nerves and muscles. About 20% of scoliosis cases are caused by
neuromuscular conditions, such as cerebral palsy or muscular dystrophy. It is
not caused by activity such as exercise, sports, or carrying heavy object; nor
does it come from sleeping position, posture, or minor differences in leg
length.
3. How might her diagnosis impact on her growth and development?

Spinal curvatures may become worse or emerge during growth spurts but
with proper treatment there is no long term impact on growth.
4. Describe the treatment.
Scoliosis treatment decisions are primarily based on two factors: The skeletal
maturity of the patient and the degree of spinal curvature. A small degree of
curvature in a patient nearing skeletal maturity is not likely to need
treatment; Conversely, a younger patient with a bigger curve is likely to have
a curve will continue to advance and will need treatment. There are three
main scoliosis treatment options for adolescents:
-Observation
-Back braces
-Scoliosis surgery
No exercises for scoliosis have proved to reduce or prevent curvature.
However, exercise is highly recommended for both scoliosis and non-scoliosis
patients alike to keep back muscles strong and flexible.
5. Discuss the teaching required for Kimberlli and her parents.
Because of her age and her curvature, Kimberlli will most likely need a brace.
Bracing does not straighten the curve that is already present. Instead, the
goal of a back brace is to stop the progression of the spinal curve as the child
continues to grow. The child will continue to wear the brace until he or she
reaches skeletal maturity. Once the individual stops growing, there is little
likelihood of progression of a curve. Working under the direction of an
orthopedic surgeon, an orthotist will fit a custom brace to the individual. The
braces usually are made of molded plastic and fit tightly around the body
and are worn under the clothes every day. Some are worn overnight; some
are worn 23 hours a day. Although braces for scoliosis are more comfortable
than ever before, they still have a low compliance rate for various reasons:
children and adolescents feel different from their peers when they have to
wear them, and some genuinely cause discomfort and perhaps difficulty
breathing. Support for children wearing back braces is key to their
effectiveness. Studies clearly show that the more closely patients follow their
prescribed bracing regimen, the less the scoliosis curve progresses.
6. After Kimberlis scoliosis does not respond to conservative treatment,
she is scheduled for a posterior spinal fusion. What are the priorities of
care?
Obtain consent and prepare the patient for surgery. The patient should be
kept NPO starting midnight before the procedure. Measurements of the
curvature should be reassessed before surgery.
7. What is a Harrington rod and how is it used?

The device itself was a stainless steel distraction rod fitted with hooks at
both ends and a ratchet and was implanted through an extensive posterior
spinal approach, the hooks being secured onto the vertebral laminae.
8.

Following her surgery, what are the post operative priorities?

Use logrollingto reposition the child every2 hoursto inhibit development
of pressure sores and to adequatelyinflate lungs.
Monitor vital signsfollowingsurgery.
Applyantiembolismstockings while the patient ison bed rest.
Remove the antiembolismstockingfor 1 hour three timesaday.
Assessthe patients pain level.
Assessfor Homan sign for signsof an embolism
Measure the circumference of the calf frequentlyif the calf is
swollen to determine if there are changesto the swelling.
Assessfor ischemia: Pain, pallor, pulselessness, paresthesia, paralysis.
Support the back, feet, and knees with pillowswhen the patient lieson
the side.
Performrange-of-motion exercisesto maintain muscle tone.
Avoid twistingor turningthe spine when movingthe patient.
Explain that spinal fusion surgerystabilizesthe spine byinsertingwiresand rodsinto the
spine to align the spine permanently.
Teach the parentsthe importance of performingordered exercisesand the need for the
patient to wear the brace.

9. Pulse oximetry reveals that Kimberlis pulse ox is 89% She is receiving

2 L of oxygen per nasal cannula. What should the nurse do?
Check to see if the pulse ox is on correctly and check to see if the oxygen is
attached and flowing. If yes, consider calling an RRT. Increase the oxygen
level, place the patient in high fowlers, get a set of vitals and contact the
physician.
10.
Discuss the importance of pain management and what agents
you anticipate will be prescribed.
Pain management is important to promote wound healing. The patient may
have been given prescriptions for several different pain medications.
Common medications include Percocet (oxycodone/ acetaminophen) for
severe pain; Lortab (hydrocodone/ acetaminophen) for moderate to severe
pain; and Darvocet (propoxyphene/ acetaminophen) for mild to moderate
pain. Sometimes patients will be sent home on a short course of long acting
narcotics (Oxycontin) to help will pain control for 10-14 days.
11.
Discuss nursing interventions to prevent complications of the
surgery.

Apply antiembolism stockings, assess the 5 ps q 30 mins for the first two
hours. Assess pain levels and treat pain. Monitor vital signs and watch for s/s
of bleeding.
12.
You are preparing to help Kimberli out of bed what interventions
are necessary?
Make sure to avoid twisting or turning the spine when moving the patient.
Log roll out of bed. Support the back, feet, and knees.
13.
Kimberli has not had a bowel movement what factors may have
precipitated the condition and which nursing interventions are
appropriate?
Pain medications and not moving are the largest factors that can contribute
to constipation. Administer Colace, promote fluid intake, promote increased
fiber, and exercises in bed and walking as tolerated can help relieve the
constipation.