Scoliosis Screening Case Study

Sonja is resting in the side-lying position after her first log roll. What nursing assessment is most critical when completing this procedure?

Assess nuerovasulcar status Neurovascular should be assessed before and after log rolling. Any neurovascular compromise must be treated immediately to prevent paralysis.

Sonja complains of pain at the insertion site. She rates her pain as 6/10. What is the nurse's first responsiblity?

Assess respiratory status. There is a risk of respiratory depression with morphine, especially when administered by the intrathecal route.

Scoliometric findings for Sonja are: 8˚ thoracic curve and 4˚ lumbar curve. What is the correct nursing intervention the school nurse must complete?

Document the finding and recommend a rescreen at age 12 years The 10-year-old has not completed growing. Curves are most pronounced at the end of the adolescent growth spurt. Curves 10° and greater are referred for confirmation via x-ray.

How should the nurse address the parents' concerns about blood transfusions?

Educate the parents about options such as autologous blood transfusions. The client can donate her own blood prior to surgery. Other options include intraoperative blood salvage, hemodilution, or erythropoietin administration.

Which question is most relevant for the school nurse to ask Sonja, when assessing the effect of growth on potential future curve progression?

Have you started your period? Spinal curves progress most rapidly during the period of rapid growth. Girls grow rapidly until the time of their first menses. Growth then continues, but slows over the next 18 to 24 months.

The HCP prescribes preoperative laboratory orders. Which orders would the nurse consider a priority for this client?

Hemoglobin and hematocrit. Due to gender and age, the client is at risk of iron deficiency anemia. Scoliosis surgery results in significant blood loss making her highly susceptible to anemia.

What is the most appropriate response for the nurse to tell Sonja?

I will show you ways to decorate the brace similar to current fashions

The school nurse rescreens 15-year-old Sonja. The findings include a noticeable rib hump, as well as waist and hip asymmetries, and a thoracic curve of 32˚. What is the most appropriate nursing interventoin?

Refer for x-rays and bracing. X-rays are confirmatory and curves less than 40° respond to bracing.

The nurse clarifies the purpose of pulmonary function tests. Which of the following statements is correct?

Scoliosis restricts movement of the ribs. Mechanical function of respiratory muscles is also affected.

Which of the following meals would best meet this goal?

Supplement meals with 8 ounces of Ensure(R) 3 times a day. Each 8 ounce serving contains 220 calories, 9 grams of protein and 26 essential vitamins and minerals.

Did you learn about scoliosis from Sonja and her nurses through this case study?

True

Sonja begins ambulation on her third post-operative day. What factor must the nurse consider unique to ambulation post scoliosis surgery? (Select all that apply.)

A distorted sense of balance Potential orthostatic hypotension. Correction of the spinal curve results in a 2 inch increase in height. The adolescent is not accustomed to this and experiences fear and balance issues when first ambulating. The client has been supine for 3 days and she has experienced blood loss during surgery.

What critical observations to detect curvature are included in the screening process? (Select all that apply.)

Asymmetry of shoulder and hip height. Rib humps. Prominent scapula. This asymmetry is characteristic of scoliosis. A rib hump signifies presence of a rotational deformity, in addition to the lateral curve. This is a characteristic of scoliosis.

Sonja continues to have body image concerns. She visits the school nurse and asks the nurse if there are any exercises she could do to improve the curvature of her spine

Exercises can help maintain musculature of the trunk during bracing Stretching exercises can increase mobility of the spine and breathing exercises cause temporary improvement in rotational deformities.

The nurse reviews the pathophysiology of scoliosis with the student nurses. What concepts should the school nurse include? (Select all that apply.)

Intraspinal abnormalities can cause scoliosis. Most causes of adolescent scoliosis are ideopathic Scoliosis can be classified according to age of onset Scoliosis occurring: in the first 3 years of life is termed infantile; between 4-10 years is termed juvenile, and at age 10 or later is termed adolescent scoliosis. Spinal abnormalities such as tethered cord, syringomyelia, or diastematomyelia can cause scoliosis. For most cases of scoliosis occurring after age 10 years, no cause can be detected, although there is growing evidence of a genetic relationship.

Sonja's nurse provides instructions to the team members for the log rolling procedure. What instructions must the nurse provide to assure safe turning.

Place a pillow between the client's legs. Ask the first assistant to stand at the client's shoulder with the second assistant at the client's hips, reach over and pull the draw sheet in one smooth motion. Spinal alignment is maintained at all times, pillows are placed behind the client to maintain a 30° to 45° angle in the side lying position.

Six days after surgery, Sonja complains of abdominal pain and nausea. She initially vomits small amounts but progresses to vomiting copious amounts. Her pain is worse in the spine position. Which prescription should the nurse anticipate?

Placement of a nasogastric tube and begin parenteral feeding This complication is superior mesenteric artery syndrome, or compression of the duodenum by the aorta and superior mesenteric artery. The obstruction is treated by gastric decompression. Parenteral nutrition is needed to rest the gut.

Sonja is eager to resume her physical activities including participation in sports. She also wishes to know of risks the spinal instrumentation might cause for pregnancy in the future. How should the nurse counsel Sonja?

Resume regular activities of daily living, including school in 3 to 4 weeks

The nurse informs the student nurses to observe for which signs that would rule out disease processes that can cause scoliosis?

Sacral dimpling or hairy patches. These findings along with abnormal reflexes, vascular changes in the skin, or bladder and bowel incontinence may indicate spinal abnormalities.

A mother informs the school nurse that she does not want her daughter to be screened at school. What is the appropriate response from the school nurse?

School screening is voluntary. She may have screening done at the pediatrician's office. This statement is supportive of the parent's preference and gives guidance for appropriate follow up.

What is the school nurse's explanation as to the purpose of scoliosis screening in this population?

Target high prevalence age groups. Idiopathic adolescent scoliosis is the most common form of scoliosis and is most frequently found in girls following the adolescent growth spurt.

What is the correct method of assessment with the scoliometer?

The student bends over with arms dangling, and the scoliometer is placed on the thoracic curve, then on the lumbar curve It is recommended that measurements be repeated twice with the child returning to a standing position between measurements.

What topics must the nurse include in the teaching with Sonja and her parents? (Select all that apply.)

The use of incentive spirometry. The need for log rolling when turning postoperative. Presence of a Foley catheter and frequent Operation of a PCA pump.

The school nurse provides education to Sonja and her mother about the diagnostic procedures for scoliosis. Which response provides accurate information?

X-rays will be taken in several positions including a side view The client will be asked to bend to either side to assess spinal flexibility and traction will be placed on extremities to stretch the spine. Lateral views assess presence of kyphosis.