N213: Health Differences Across the Life Span 3

N213: Health Differences Across the Lifespan 3 Study Guide Nursing assessment for scoliosis: • Check respirations: respiratory muscle use, depth, breath sounds, and character • Inquire about history of pain: location, severity, and duration • Have patient ambulate; check gait, mobility, ability to bend over, and range ofmotion • Visualize the spine for deformity (C or S curve in spine) • Review radiology reports: o X-ray: Will show curvature o Pulmonary testing: Checks lung function o MRI: Can show even small abnormalities in the spine o Clinical photography: Keep photo documentation on the patient from each visit to watch for changes Nursing diagnosis for scoliosis: • Impaired physical mobility related to spinal curvature • Pain related to abnormal spinal structure • Risk for ineffective breathing pattern related to abnormal thoracic structure • Risk for body image disturbance related to curvature or wearing of brace • Risk for impaired skin integrity related to pressure from the brace or surgical wounds Nursing interventions for scoliosis: • Assess for pain frequently and offer pain medication per MDorder • Assist with applying a brace and perform patient and family teaching on correct placement: o Milwaukee brace: This brace works well for double major curves and thoracic curves o Charleston brace: Not commonly used, but can be used at night during sleep o Boston brace: This type is used for thoracolumbar curves and the lower thoracic area o Thoracolumbo orthosis brace (TLSO): This brace fits like a jacket, is made of plastic, and is custom fitted to help reshape the area or give support to the deformed area • Teach patient and family that brace wearing will commence shortly after diagnosis and the patient must commit to wearing the brace for up to 23 hours a day • Physical therapy may use a TENS unit (transcutaneous electrical nerve stimulation) in order to stimulate the muscles into a proper position to pull the curvature straight • Prepare patient for surgical intervention if necessary (if curvature is over 40 degrees); Harrington Rod, spinal fusion, or both in combination with each other may be used • Post-op care includes pain control, checking brace for placement, range of motion exercises, wound care, and good skin care • Turn patient with the “log roll” technique every two hours • Suggest cotton clothing under the brace to prevent skinbreakdown ©2017 Achieve Test Prep Page 125 of 204