Habits (poor sitting position and not ergonomic, carry heavy

objects, frequent bending), congenital, neuromuscular

disease, and idiopathic
Weakens the nerves that provide
traction on the spine during
normal position

Scoliosi
s
Medical management
Braces. Underarm or low-profile
brace. This type of brace is
made of modern plastic
materials and is contoured to
conform to the body.

necrotic tissue

Pull the spine out of

balance

Diagnostic test

Magnetic
resonance
imaging (MRI).

Computerized
tomography
(CT)

Bone scan

Milwaukee brace. This full-torso

brace has a neck ring with rests for
the chin and for the back of the head

Curved lateral thoracic vertebra

with vertebral rotation

Nursing intervention
Damaging the spine
area
Disrupt the structure of
the spine area so as
disrupted flexibility in
the mobilization

Skoliometri showed abnormal

Instruct to express feelings
curvature of the corner, thorac scan
and problems.
showed the curvature of the
vertebrae, palpation palpable curved
Give supportive environment.
spine, and abnormalities cobb
Help the patient to identify
showed
positive coping styles.

unbalanced Mobilization and

pressing vertebra areas

Give realistic expectations

and goals for the short term
to facilitate the achievement.

Disrupted
body
coordination
Emphasis
on the
vertebral
area

Pressing
the nerve
cells

increases
energy

Decrease of
energy
supply

Difficulty of
movement

Stimulate
CNS

lack of
Nursing intervention
unbalance
Pain
input output
Occur
Assess the type, intensity,
and location of pain.
Fatigue
Acute
Adjust the position of which
pain
can increase the
sense of
Medical
managements
comfort.
aspirin and ibuprofen

Maintain a quiet environment

to improve comfort
Teach relaxation and
distraction techniques to
divert attention, thus
reducing pain.
Encourage regular postural

impaired Bone
growth

Impaired physical
mobility

Impaired
metabolism
disorders

Abnormal
bone
structure

Perception of body
shape is different
from that of normal
client
Disturb body
image

Impaired bone
growth and
development
Nursing intervention

Put the patient in

semi fowler position

Teach the patient

effective breathing
pattern

Assess respiratory

The ribs suppress

lung and heart
Decrease
lung

status every 4 hours.

Auscultation of the
chest

hyperventila
tion

pressure on
the abdomen

Decrease
intestinal
peristalsis

to listen for breath

sounds every 2 hours.

Ineffective
Breath
pattern

Constipation

Nursing intervention

Assess the level of physical

mobility.

Nursing intervention

Review medical/surgical/social
history

Review medications (new and

chronic use) for impact
on/effects of changes in bowel
function.

Instruct in/encourage balanced fiber

and bulk in diet (e.g.,
fruits, vegetables, and whole grains)
and fiber supplements
(e.g., wheat bran, psyllium) to
improve consistency of stool
and facilitate passage through colon.

Increase activity if pain is

reduced.

Teaching aids and active joint

range of motion exercises.

Involve the family in performing

self-care.

Increase return to normal

activity.

References:
http://www.mayoclinic.org/diseases-conditions/scoliosis/basics/treatment/con-20030140
http://nanda-nursing-diagnosis.blogspot.com/2014/09/scoliosis-5-nursing-diagnosis-and.html
http://www.mayoclinic.org/diseases-conditions/scoliosis/basics/treatment/con-20030140
http://www.mayoclinic.org/diseases-conditions/scoliosis/basics/treatment/con-20030140

Most children with scoliosis have mild curves and probably won't need treatment with a brace or surgery. Children who have mild scoliosis may
need checkups every four to six months to see if there have been changes in the curvature of their spines.

While there are guidelines for mild, moderate and severe curves, the decision to begin treatment is always made on an individual basis.
Factors to be considered include:

Sex. Girls have a much higher risk of progression than do boys.

Severity of curve. Larger curves are more likely to worsen with time.
Curve pattern. Double curves, also known as S-shaped curves, tend to worsen more often than do C-shaped curves.
Location of curve. Curves located in the center (thoracic) section of the spine worsen more often than do curves in the upper or lower sections
of the spine.
Maturity. If a child's bones have stopped growing, the risk of curve progression is low. That also means that braces have the most effect in
children whose bones are still growing.
Braces

If your child's bones are still growing and he or she has moderate scoliosis, your doctor may recommend a brace. Wearing a brace won't cure
scoliosis, or reverse the curve, but it usually prevents further progression of the curve.

Most braces are worn day and night. A brace's effectiveness increases with the number of hours a day it's worn. Children who wear braces can
usually participate in most activities and have few restrictions. If necessary, kids can take off the brace to participate in sports or other
physical activities.

Braces are discontinued after the bones stop growing. This typically occurs:

About two years after girls begin to menstruate

When boys need to shave daily
When there are no further changes in height
Braces are of two main types:

Underarm or low-profile brace. This type of brace is made of modern plastic materials and is contoured to conform to the body. Also called a
thoracolumbosacral orthosis, this close-fitting brace is almost invisible under the clothes, as it fits under the arms and around the rib cage,
lower back and hips. Underarm braces are not helpful for curves in the upper spine or neck.
Milwaukee brace. This full-torso brace has a neck ring with rests for the chin and for the back of the head. The brace has a flat bar in the front
and two flat bars in the back. Because they are more cumbersome, Milwaukee braces usually are used only in situations where an underarm
brace won't help.
Surgery

Severe scoliosis typically progresses with time, so your doctor might suggest scoliosis surgery to reduce the severity of the spinal curve and to
prevent it from getting worse. The most common type of scoliosis surgery is called spinal fusion.

In spinal fusion, surgeons connect two or more of the bones in the spine (vertebrae) together, so they can't move independently. Pieces of
bone or a bone-like material are placed between the vertebrae. Metal rods, hooks, screws or wires typically hold that part of the spine straight
and still while the old and new bone material fuses together.

Surgery is usually postponed until after a child's bones have stopped growing. If the scoliosis is progressing rapidly at a young age, surgeons
can install a rod that can adjust in length as the child grows. This growing rod is attached to the top and bottom sections of the spinal
curvature, and is usually lengthened every six months.

Complications of spinal surgery may include bleeding, infection, pain or nerve damage. Rarely, the bone fails to heal and another surgery may
be needed.

http://nanda-nursing-diagnosis.blogspot.com/2014/09/scoliosis-5-nursing-diagnosis-and.html

Scoliosis - 5 Nursing Diagnosis and Interventions

Scoliosis is a curvature, or lateralcurvature of the spine due to the rotation and vertebral deformity.
Three forms of structural scoliosis are:
1.
Idiopathic scoliosis is the most common form and classified into 3 groups: infantile, which arise from birth to age 3 years; children, who emerged
from the age of 3 years to 10 years; and adolescents, which appears after the age of 10 years (the age of the most common).
2.
Congenital scoliosis is scoliosis that causes malformation of one or more vertebral bodies.
3.
Neuromuscular scoliosis, children who suffer from neuromuscular diseases (such as brain paralysis, spina bifida, or muscular dystrophy) which
directly causes the deformity.

(Nettina, Sandra M.)

Clinical Symptoms
1.
Spine curves abnormally to the side.
2.
Shoulder or hip and the left and right are not the same height.
3.
Back pain.
4.
Fatigue in the spine after sitting or standing for long.
5.
Severe scoliosis (curvature greater than 60) can cause respiratory problems.
Nursing Diagnosis and Interventions for Scoliosis
1. Ineffective Breathing Pattern related to emphasis the lung.
Goal: effective breathing pattern.
Intervention:

Assess respiratory status every 4 hours.

Help and teach the patient to do deep breaths every 1 hour.

Set the semi-Fowler position bed to improve lung expansion.

Auscultation of the chest to listen for breath sounds every 2 hours.

Monitor vital signs every 4 hours.

2. Acute pain: back related to body position tilted laterally.
Goal: pain is reduced / lost.
Intervention:

Assess the type, intensity, and location of pain.

Adjust the position of which can increase the sense of comfort.

Maintain a quiet environment to improve comfort.

Teach relaxation and distraction techniques to divert attention, thus reducing pain.

Encourage regular postural exercises to improve posture.

Teach and encourage use of the brace to reduce pain during activity.

Collaboration in providing analgesic to relieve pain.

3. Impaired physical mobility related to an unbalanced posture.

Objective: To improve physical mobility.
Intervention:

Assess the level of physical mobility.

Increase activity if pain is reduced.

Teaching aids and active joint range of motion exercises.

Involve the family in performing self-care.

Increase return to normal activity.

4. Disturbed Body Image or Self-concept disturbance related to kelateral tilted posture.
Objective: To enhance the image of the body.
Intervention:

Instruct to express feelings and problems.

Give supportive environment.

Help the patient to identify positive coping styles.

Give realistic expectations and goals for the short term to facilitate the achievement.

Give rewards for tasks performed.

Encourage communication with people nearby and need socialization with family and friends.

Give encouragement to care for themselves as tolerated.

5. Knowledge Deficit related to lack of information about the disease.
Goal: understanding of the treatment program.
Intervention:

Explain about the state of the disease.

Emphasize the importance and benefits of maintaining the recommended exercise program.

Tell us about the treatment of: name, schedule, purpose, dosage, and side effects.

Demonstrate the installation and maintenance brace or corset.

http://www.mayoclinic.org/diseases-conditions/scoliosis/basics/treatment/con-20030140

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By Mayo Clinic Staf

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Learn more. Request an appointment.

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Most children with scoliosis have mild curves and probably won't need treatment with a brace or surgery. Children who
have mild scoliosis may need checkups every four to six months to see if there have been changes in the curvature of
their spines.

While there are guidelines for mild, moderate and severe curves, the decision to begin treatment is always made on an
individual basis. Factors to be considered include:

Sex. Girls have a much higher risk of progression than do boys.

Severity of curve. Larger curves are more likely to worsen with time.
Curve pattern. Double curves, also known as S-shaped curves, tend to worsen more often than do C-shaped
curves.
Location of curve. Curves located in the center (thoracic) section of the spine worsen more often than do curves
in the upper or lower sections of the spine.
Maturity. If a child's bones have stopped growing, the risk of curve progression is low. That also means that
braces have the most efect in children whose bones are still growing.

Braces
If your child's bones are still growing and he or she has moderate scoliosis, your doctor may recommend a brace.
Wearing a brace won't cure scoliosis, or reverse the curve, but it usually prevents further progression of the curve.
Most braces are worn day and night. A brace's efectiveness increases with the number of hours a day it's worn.
Children who wear braces can usually participate in most activities and have few restrictions. If necessary, kids can
take of the brace to participate in sports or other physical activities.
Braces are discontinued after the bones stop growing. This typically occurs:

About two years after girls begin to menstruate

When boys need to shave daily

When there are no further changes in height

Braces are of two main types:

Underarm or low-profile brace. This type of brace is made of modern plastic materials and is contoured to
conform to the body. Also called a thoracolumbosacral orthosis, this close-fitting brace is almost invisible under the
clothes, as it fits under the arms and around the rib cage, lower back and hips. Underarm braces are not helpful for
curves in the upper spine or neck.
Milwaukee brace. This full-torso brace has a neck ring with rests for the chin and for the back of the head. The
brace has a flat bar in the front and two flat bars in the back. Because they are more cumbersome, Milwaukee
braces usually are used only in situations where an underarm brace won't help.

Surgery
Severe scoliosis typically progresses with time, so your doctor might suggest scoliosis surgery to reduce the severity of
the spinal curve and to prevent it from getting worse. The most common type of scoliosis surgery is called spinal fusion.
In spinal fusion, surgeons connect two or more of the bones in the spine (vertebrae) together, so they can't move
independently. Pieces of bone or a bone-like material are placed between the vertebrae. Metal rods, hooks, screws or
wires typically hold that part of the spine straight and still while the old and new bone material fuses together.

Surgery is usually postponed until after a child's bones have stopped growing. If the scoliosis is progressing rapidly at a
young age, surgeons can install a rod that can adjust in length as the child grows. This growing rod is attached to the
top and bottom sections of the spinal curvature, and is usually lengthened every six months.
Complications of spinal surgery may include bleeding, infection, pain or nerve damage. Rarely, the bone fails to heal
and another surgery may be needed.