Nursing 213

N213: Health Differences Across the Lifespan 3 Study Guide 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 • Teach patient to cough and deep breathe every twohours • Encourage patient to talk about feelings and body image • Encourage social activities with peers • Refer to a community support group Expected outcomes for scoliosis: • Demonstrates adequate coping skills regarding body image • Demonstrates compliance with brace wearing • Patient is free from respiratory complications • Verbalizes increased comfort • Patient remains free from skin breakdown • Patient and family verbalize understanding of brace use Legg-Calve-Perthes Disease This disease affects the femoral head in children aged four to ten years old. It is more common in boys than girls and is caused by a loss of blood supply to the epiphysis of the femur. After the vascular degeneration occurs, the bone begins to regenerate and recalcify. This can cause the acetabulum to misalign and cause complications. The femoral head begins to flatten and can eventually lead to premature arthritis or disability. There are four stages involved in Legg-Calve Perthes disease:

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