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Health, Medicine, Nursing
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Case Study
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English (U.S.)
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Topic:
Scoliosis: How does the nursing care shape up? Discussion post.
Case Study Instructions:
I am submitting two individual post and I need two individual responses. In your responses I need you to provide constructive and insightful comments that go beyond that of agree or disagree.
1)This post is from Joseph:
Progressive curves due to the effects of scoliosis are more prevalent in females than males, and is greatest during pre-adolescence growth spur, just before the onset of menses. Clinical manifestations of scoliosis might include pain, poor posture, shoulder asymmetry, S-shaped spinal appearance, leg length discrepancy, uneven hips, scapular prominence, lump (rib hump) on back, and uneven breast size. The choice of treatment for scoliosis will depend on the cause and degree of the postural defect. One treatment option for scoliosis is brace management, with the goal of slowing down the curvature process. Bracing is recommended for skeletally immature children whose spinal curvature from scoliosis is at about 25 to 40 degrees.
A brace is usually recommended to be worn by affected children for 23 hours per day. One of such brace is the Milwaukee brace, which is a commonly used device that extends from the chin to the hips. The device would be specially fitted to the affected child, and would be regularly adjusted as the child grows. Another option is the Boston orthosis, which is an underarm fitted device. It is used for the management of thoracic and thoracolumbar curves. Charleston bending brace is another option that could be recommended for nighttime use by patients, though considered effective, the use is yet to receive widespread acceptance.
Surgical correction for the stabilization of the spinal column, could become an option after more conservative treatment of the defect is unsuccessful. This is usually accomplished with a spinal fusion and with the use of a spinal device such as the Harrington rod, which is actually secured to the vertebral bones following spinal fusion. In other to minimize the growth arresting nature of such a procedure, surgery with an expandable rod could be used. Issues that may arise from the mode of treatment for scoliosis might include (1) impaired physical mobility due to presence of brace, traction, or casts, (2) risk for injury due to restricted movements, (3) risk for impaired skin integrity due to presence of brace, (4) body image disturbance due to chronic skeletal deformity or the use of body brace, and (5) family members ineffective coping due to the chronicity and complexity of treatment regimen.
Therefore, the plan of care should be designed to accommodate and effectively address the specific needs of the affected child with considerations for the developmental stage, the degree of postural defect, the adopted treatment option, and the effectiveness of family and peer support. For instance, the plan of care for pre-adolescence girls who are most often affected by scoliosis (and who are more apt to be concerned with body image issues) should include consideration for promoting positive body image.
To that effect, such category of children should be encouraged to express their feelings and concerns about body image, and to also express their concerns about the prospect of wearing a brace. Wearing baggy clothes for convenience, and disclosing condition and need for brace wear to peers and classmates might be a way to enhance such children's social function and interactions. Providing a peer support person so an affected child can associate positive outcomes and expressions from others is also a way of enhancing self-image and self-esteem.
In addition, the RN can be of help to affected children and their family by providing adequate information about scoliosis and treatment options in an understandable way both to the affected child and family, by promoting compliance with treatment and explaining possible outcome with non-compliance, and by encouraging feedback from child and family as regards to their concerns and questions in respect to scoliosis and the prescribed treatment.
Assisting with ADLs as much as possible, preventing postoperative complications, teaching family members to examine brace for fit or breakage and to inspect skin for irritation under brace, encouraging family to promptly report any device malfunction or complications to the healthcare provider, and promoting the child's independence as much as possible, are some of the other ways the RN can further be of help.
Caring for a child with scoliosis who has to be in a brace or body cast, or who has to undergo corrective surgery could be physically, socially, financially, and emotionally challenging for the parents and family. It is therefore essential that the RN provide the family with the needed emotional support, and referrals for appropriate social services and to support groups that can enhance their coping ability.
2)This post is from Jamie: Scoliosis affects a young person within the first 20 years of life and can be structural, non-structural or idiopathic. Depending on the type of scoliosis the child has, other diseases might accompany it (cerebral palsy, muscular dystrophy, rheumatic diseases). If the child has nonstructural scoliosis, a cause should be sought (inflammatory, compensatory, and postural). The right treatment at the right time may prevent major deformities. Prevention of progression and preservation of pulmonary and cardiac functions are the primary goals in the treatment of scoliosis regardless of the child's age.
The Academy of Orthopedic surgeons, the American Academy of Pediatrics and the Scoliosis Research Society all endorse and recommend screening and bracing children who have a >10 degree curvature in the spine. Nurses can assist with these screenings in schools, community events, sports arenas and fields and urgent care centers.
Since there is such a wide age range for scoliosis, I will focus my discussion on the teenage/adolescent that is affected. The nurse and parents can allow the child to make realistic choices and encourage independence in his/her activities and activities of daily living. This will allow the child to feel powerful and in some sense in control of their life. Of course Erikson's psychosocial developmental stages and Freud's psychosexual stages will have to be considered by the RN. Teens will be at the identity vs. role confusion stage. Having scoliosis and receiving treatment might make them feel that their identity is the disease. It would be important for the RN to speak with the parents and help them realize that the teen should be allowed to make the “normal” mistakes all other teens do. The teen will be in Freud's stage of exploring girls/boys and relationships. Experimentation with their own body is normal but if the child is ashamed or embarrassed because of the disease, this could put strain on the teen or cause them to avoid those interactions. The RN should warn the parents of a teen to watch for signs of depression and isolation. If surgery is going to take place for the child/teen pre-operative and post-operative teaching and care will be part of the RNs responsibility.
The parent or parents of the teen will have to make adjustments with their schedules because of the medical appointments and physical therapy appointments that are necessary. A brace needs to be worn for 23 hours/day and the parents/caregivers will need to be available to assist the child with different tasks when and if needed. Pain control and medication administration will be something that the parent can oversee and assist the teen with also.
Allowing the teen independence and the freedom, not force, to discuss their feelings about the disease and how it is affecting their life will be one of the best things that the RN can instruct the family about.
Case Study Sample Content Preview:
Scoliosis
Name:
Institution: Joseph
The post by Joseph starts off with the introduction of the disease, and the various stages and genders where it has been seen to be most prevalent. In the account, Joseph brings out that the condition is common between the teenage girls just before the menses, but it is rather rare in the boys at the same age. Then he goes on to show the signs and the symptoms that are common in the patients that may have the condition.
The post goes on to mention in some of the different types of the braces , although in great detail ,which have been recommended for use in the children that have more than 25% and below 40% of the spinal cord curvatures (National Institute of Arthritis and Musculoskeletal and Skin Diseases (U.S.), & National Institutes of Health (U.S.), 2001). When the braces and other common interventions do not work as effectively as is expected, surgical options are considered. Some of the most common side effects of the braces and the surgical process range from, injuries, body image disturbance, as well as the social, economic and the emotional turmoil that the families endure.
The post then goes on correctly state some of the interventions that may help reduce the burden on the child and the family (Lyons, Adjei, Podzius & Podzius, 1999).
Jamie
The post starts off by highlighting the condition prevalence and some of the main causes. Then goes on to state the various methods such as the brace...
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