4 Scoliosis Nursing Care Plans

Most of your scoliosis patients are adolescents, often girls, facing bracing or surgery and the body-image fallout that comes with both. Your work centers on protecting breathing, keeping them mobile, supporting self-image, and teaching the family how to manage the curve and the appliance at home.

What is Scoliosis?

Scoliosis is a lateral curving of the spine, most often in the thoracic area. It is either functional or structural. Functional scoliosis results from another deformity and corrects when you treat the underlying problem. Structural scoliosis is usually idiopathic, though it can be congenital or secondary to another disorder. The evidence points to a genetic component in idiopathic scoliosis, but the cause is not fully understood. Structural scoliosis is more progressive and changes supporting structures such as the ribs.

Management is observation, bracing, or surgical fusion. Idiopathic curves of less than 25 degrees are observed until skeletal maturity. Bracing is recommended for adolescents with curves between 30 and 45 degrees, and curves greater than 45 degrees usually require surgery. The deformity can appear at any age from infancy through adolescence, but the best prognosis belongs to patients who are nearly fully grown with a mild curve. Idiopathic scoliosis most commonly appears in adolescent girls.

Nursing Care Plans and Management

For a pediatric patient with scoliosis, your goals are to restore normal breathing, improve mobility, address body image, promote comfort, teach the family, stop curve progression, and prevent deformity.

Nursing Problem Priorities

1. Determine the severity and progression of the scoliosis.
2. Manage pain with appropriate strategies.
3. Educate patient and family on the condition, causes, treatment options, and complications.
4. Support good posture and body mechanics to minimize discomfort and slow progression.
5. Help the patient cope with body image and psychological concerns.
6. Collaborate with the team on a plan that includes physical therapy, bracing, or surgery.
7. Promote compliance with treatment and long-term management.

Nursing Assessment

Assess for the following subjective and objective data:

• Back pain
• Abnormal spinal curvature on standing or forward bending
• Uneven shoulders
• Uneven waistline and hips
• Abnormal or protruding shoulder blade
• Rib prominence
• Limited movement or stiffness on bending or twisting
• Changes in posture or gait
• Increased work of breathing, use of accessory muscles

Assess for factors related to the cause:

• Musculoskeletal impairment
• Decreased lung expansion
• Hypoventilation syndrome
• Biophysical and psychosocial factors of spinal deformity

Nursing Diagnosis

After assessment, you form a diagnosis that fits the patient, based on your clinical judgment. Diagnostic labels organize care, but your judgment and the patient's priorities shape the plan more than the label does.

Nursing Goals

The child or patient will:

• Maintain an effective breathing pattern with relaxed breathing at a normal rate and depth and no shortness of breath.
• Maintain proper body alignment and progress with activity as ordered.
• Show increased acceptance of physical appearance, including the visible curvature.
• Use effective coping strategies for body-image concerns.
• Demonstrate understanding of scoliosis, its causes, progression, and impact on daily life.
• Gain the knowledge and skills to manage scoliosis day to day, including body mechanics, exercises, and comfort strategies.

Nursing Interventions and Actions

1. Promoting Effective Breathing Pattern

The abnormal curve restricts rib and chest movement, which decreases lung expansion and ventilation. That can produce an ineffective breathing pattern and hypoventilation, lowering blood oxygen and inviting complications.

Assess respiratory status every 4 hours, and more closely during activity or exertion. Limited rib movement weakens the respiratory muscles and increases work of breathing during rest, activity, and sleep, so frequent assessment catches changes early.

Auscultate breath sounds at least every 4 hours to detect decreased or adventitious sounds.

Monitor intake and output. Adequate hydration mobilizes secretions and prevents infection.

Assess oxygen saturation and pulse rate with pulse oximetry to catch changes in oxygenation.

Assist with deep breathing exercises to improve lung function.

Elevate the head of the bed or use pillows to support the chest and ease breathing.

Assist with incentive spirometry to improve lung expansion and alveolar aeration.

Administer bronchodilators if indicated. They relax airway muscle to widen the airways and ease breathing.

Administer oxygen as needed to keep peripheral oxygen saturation at 95% to 100%.

Teach the child and family proper breathing techniques, the value of good posture, and the need to report respiratory symptoms promptly. Poor posture further limits chest and lung movement. Report shortness of breath, wheezing, or coughing right away, since these can signal worsening or a complication.

2. Enhancing Physical Mobility

Maintaining mobility lets the patient perform daily activities with more ease and independence, supports musculoskeletal health, and lowers the risk of secondary complications.

Assess the level of physical mobility to guide the management plan.

Assess pain by type, location, and intensity. A severe curve stresses the spinal discs, muscles, nerves, and ligaments and produces pain.

Teach nonpharmacologic pain management such as imagery, relaxation, touch, and music to divert attention and decrease pain.

Encourage active range-of-motion exercises to promote circulation and maintain strength and muscle tone.

Encourage regular postural exercises to help correct posture and manage the effects of scoliosis.

Teach and encourage brace use as indicated. The brace prevents or slows progression of the curve.

Collaborate with physical therapy, which uses corrective techniques to prevent progression and maintain quality of life.

3. Enhancing Body Image and Self-Esteem

A visible spinal curve makes patients self-conscious, which feeds negative emotions and lowers self-esteem. Supporting body image builds a positive sense of self and helps the patient cope with the physical and social challenges of the condition.

Assess the child's feelings about wearing a brace, long-term treatment, restricted movement, and not keeping up with peers. This tells you where self-concept stands.

Encourage the child to talk about feelings and concerns, and support communication with family and peers, to limit negative feelings about appearance and prolonged appliance use.

Help the child adjust to self-perception of a short leg, appliance use, and effect on appearance to build a realistic, positive self-image.

Plan for independence in ADLs, applying and removing appliances, and choosing shoes and clothing, to support adjustment to the appliance.

Maintain a positive environment and encourage age-appropriate activities to build body image, confidence, and trust.

Reassure parents and child that most activities are permitted with the appliance, which promotes positive feelings about the treatment.

Help the child find ways to tell others about wearing an appliance so they can handle questions and curiosity about the deformity.

Help the child choose clothing that covers the appliance and has peer acceptance to improve appearance and body image.

Teach activity restrictions after surgery, progressing from quiet activities and avoiding contact sports, bike riding, driving, skating, or anything with fall risk, to prevent injury following surgical correction.

4. Promoting Health Education

Scoliosis patients often know little about the condition, which breeds confusion and misconceptions that hinder effective management.

Assess knowledge of the deformity, its cause, and treatments to identify teaching needs.

Teach parents and child about functional versus structural defects and treatment modalities appropriate to the child's age and the severity of the deformity. Functional scoliosis corrects when you treat the underlying problem; structural scoliosis is treated with long-term bracing and exercise or with surgical fixation to straighten and realign the spine.

Teach proper posture, shoe lifts, exercises, and other prescribed treatments for functional scoliosis, which is usually caused by poor posture or unequal leg length.

Teach the application, care, and removal of the brace or Orthoplast jacket, and that the appliance must be worn 23 hours per day, removed only for bathing and exercise. Higher curves are treated with the Milwaukee brace and lower curves with the TLSO brace, both worn until growth is complete.

Teach exercises to perform in and out of the brace daily to prevent atrophy of the spine and abdominal muscles.

Teach parents and child to use electrical stimulation at night, including electrode application, skin protection, lead connection, and machine operation, to stimulate the muscles and prevent curve progression.

Teach the planned operative procedure and preoperative preparation, reinforcing the physician's information and using pictures, models, and drawings. Internal surgical instrumentation is used for curves over 45 degrees or those rapidly progressing toward 45 degrees.

Prepare parents and child for postoperative care: activity restrictions, log rolling, progression to ambulation, pillows for support, maintaining a flat position, and possible use of a special bed such as a Stryker frame.

Teach the use of a safety belt and walker when ambulating, and safety precautions for a child in a brace, such as clear pathways, handrails, and using aids for ADLs. This prevents falls from postoperative weakness, unassisted ambulation, or the awkwardness of bracing.

Reassure parents and child that physical and occupational therapy will be prescribed after surgery to support recovery and optimal activity.