| Scoliosis Posted: 04 Oct 2010 08:17 PM PDT 
 Scoliosis Scoliosis - A lateral curvature of the spine, may be found in thoracic, lumbar, or thoracolumbar spinal segment.
- The curve may be convex to the right (more common in lumbar curves) or to the left (more common in lumbar curves).
- Rotation of the vertebral column around its axis occurs and may cause rib cage deformity.
- It is often associated with kyposis (humpback) and lordocis (swayback).
Etiology And Pathophysiology - Idiopathic scoliosis – exact etiology is unknown. Accounts for 65% of cases. Possible causes include genetic factors, vertebral growth abnormality. Classified into three groups based on age at time of diagnosis.
- Infantile – birth to age 3.
- Juvenile – presentation between age 11 and 17.
- Congenital scoliosis – exact etiology unknown; represented as malformation of one or more vertebral bodies that results in asymmetric growth.
- Type I – failure of vertebral body formation e.g. isolated hemivertebra, wedged vertebra, multiple wedged vertebrae, and multiple hemivertebrae.
- Type II – failure of segmentation e.g. unilateral unsegmented bar, bilateral block vertebra.
- Commonly associated with other congenital anomalies.
- Paralytic or musculoskeletal scoliosis – develops several months after symmetrical paralysis of the trunk muscles from polio, cerebral palsy, or muscular dystrophy.
- Neuromascular scoliosis – child has a definite neuromascular condition that directly contributes to the deformity.
- Additional but less common causes of scoliosis are osteopathic conditions, such as fractures, bone disease, arthritic conditions, and infections.
- Miscellaneous factors that can cause scoliosis include spinal irradiation, endocrine disoders, postthoracotomy, and nerve root irritation.
- As the deformity progresses, changes in the thoracic cage increase. Respiratory and cardiovascular compromise can occur in cases of severe progression.
Assessment - Poor posture, uneven shoulder height.
- One hip more prominent than the other.
- Scapular prominence.
- Uneven waist line or hemline
- Spinal curve observable or palpable on both upright and bent forward.
- Back pain may be present but is not a routine finding in idiopathic scoliosis.
- Leg length discrepancy.
Nursing Diagnosis - Disturbed body image related to negative feelings about spinal deformity and appearance in brace.
- Risk for impaired skin integrity related to mechanical irritation to brace.
- Risk for injury related to postoperative complications.
Diagnostic Evaluation - X-ray of the spine in the upright position, preferably on one long 36-inch cassette, show characteristic curvature.
- MRI, myelograms, or CT scan with three dimensional reconstruction may be indicated for children with severe curvatures who have a known or suspected spinal column anomaly, before management decisions are made.
- Pulmonary function tests for compromised respiratory status.
- Evaluate for renal abnormalities in children with congenital scoliosis.
Nursing Interventions - Prepare the child for casting or immobilization procedure by showing materials to be used and describing procedure in age-appropriate terms.
- Promote comfort with proper fit of brace or cast.
- Provide opportunity for the child to express fears and ask questions about deformity and brace wear.
- Assess skin integrity under and around the brace or cast frequently.
- Provide good skin care to prevent breakdown around any pressure areas.
- Instruct the patient to examine brace daily for signs of loosening or breakage.
- Instruct patient to wear cotton shirt under brace to avoid rubbing.
- Instruct about which previous activities can be continued in the brace.
- Provide a peer support person when possible so the child can associate positive outcomes and experiences from others.
image from healthguide.howstuffworks.com Related posts: - Correction Of Scoliosis
- Osteoarthritis
- Cerebrospinal Fluid (CSF) Analysis
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| Osteoarthritis Posted: 04 Oct 2010 08:16 PM PDT 
 Osteoarthritis Osteoarthritis - The most common form of arthritis.
- It causes the deterioration of the joint cartilage and formation of reactive new bone at the margins and subchondral areas of the joint.
- This chronic degeneration results from a breakdown of chondrocytes, most often in the hips and knees.
- Osteoarthritis occurs equally in both sexes after age 40.
- The earliest symptoms appear in middle age and progress with advancing age.
- Depending on the site and severity of joint involvement, disability can range from minor limitation of the fingers to near immobility in persons with hip or knee disease.
- Progression rates vary; joints may remain stable for years in the early stage of deterioration.
Etiology And Pathophysiology - Changes in articular cartilage occur first; later, secondary soft tissue changes may occur.
- Progressive wear and tear on cartilage leads to thinning of joint surface and ulceration into bone.
- Leads to inflammation of the joint and increased blood flow and hypertrophy of subchondral bone.
- New cartilage and bone formation at joint margins results in osteophytosis, altering the size and shape of the bone.
- Generally affects adults ages 50 to 90; equal to males and females.
- Cause is unknown, but aging and obesity are contributing factors. Previous trauma cause secondary osteoarthritis.
Assessment - Deep, aching pain; pronounced after weight bearing or exercise, usually relieved by rest.
- Joint swelling or deformity.
- Joint stiffness on awakening, usually lasting less than 30 minutes.
- Hard nodes on distal or proximal interphalangeal joints on the fingers; known as Heberden's nodes when present on distal interphalangeal joints and Bouchard's nodes when present on proximal interphalangeal joints.
Nursing Diagnosis - Chronic pain related to joint deterioration.
Diagnostic Evaluation - X-rays of affected joints show joint space narrowing and sclerosis.
- Radionuclide imaging (bone scan) may show increased uptake in affected bones.
- Synovial fluid analysis will differentiate osteoarthritis from rheumatoid arthritis by low cell count.
Nursing Interventions - Provide rest for involved joints. Excessive use aggravates the symptoms and accelerates degeneration.
- Advise the patient to avoid activities that precipitate pain.
- Apply heat as directed to relieve muscle pain and stiffness.
- Teach the patient correct posture and body mechanics.
- Advise the patient to sleep with rolled terry cloth towel under the neck to relieve cervical pain.
- Provide patient with crutches, braces, or cane when indicated to reduce-weight bearing stress on hips and knees.
- Encourage patient to wear corrective shoes and metatarsal support for foot disorders.
- Encourage patient to lose weight to decrease stress on weight-bearing joints.
- Teach the patient range-of-motion exercises to maintain join mobility.
- Refer patient to physical and occupational therapy.
Complications - Osteoarthritis may cause flexion contractures, subluxation and deformity, ankylosis, bony cysts, gross bony overgrowth, central cord syndrome, nerve root compression, and cauda equine syndrome.
image from healthguide.howstuffworks.com Related posts: - Hodgkin's Disease
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| Traumatic Brain Injury Posted: 04 Oct 2010 08:14 PM PDT 
Traumatic Brain Injury - Also known as head injury.
- Is the disruption of normal brain function due to trauma-related injury resulting in compromised neurologic function resulting in focal or diffuse symptoms.
- Motor vehicle accidents are the most common etiology of injury.
Etiology And Pathophysiology Types of Traumatic Brain Injury - Concussion – transient interruption in brain activity; no constructural injury noted on radiographics.
- Cerebral contusion – bruising of brain with associated swelling.
- Intracerebral hematoma – bleeding into the brain tissue commonly associated with edema.
- Epidural hematoma – blood between the inner table of the skull and dura.
- Subdural hematoma – blood between the dura and arachnoid caused by bleeding commonly associated with additional brain injury.
- Diffuse axonal injury – axonal tears within the white matter of the brain.
Assessment - Disturbance in level of consciousness from slightly drowsy to unconscious.
- Headache, vertigo, agitation, and restlessness.
- Cerebrospinal fluid leakage at ears and nose, which may indicate skull fracture.
- Contusions about eyes and ears indicating skull fractures.
- Irregular respirations
- Cognitive deficit
- Pupillary abnormality
- Sudden onset of neurologic deficits
- Otorrhea indicating posterior fossa skull fracture
- Rhinorrhea indicating anterior fossa skul fracture.
Nursing Diagnosis - Risk for injury related to complications of head injury.
- Acute pain related to altered brain or skull tissue.
Diagnostic Evaluation - CT identifies and localizes lesions, cerebral edema, and bleeding.
- Skull and cervical spine X-ray identify fracture and displacement.
- Complete blood count, coagulation profile, electrolyte levels, serum osmolarity, arterial blood gases, and other laboratory tests monitor for complications.
- Neuropsychological test during rehabilitation phase determine cognitive deficits.
Nursing Interventions - Maintain ICP monitoring, as indicated, and report abnormalities.
- Maintain patent airway; assist with intubation and ventilatory assistance is needed.
- Turn the patient every 2 hours and encourage coughing and deep breathing.
- Apply firm pressure over puncture site for subdural trap, and observe for drainage and dressing.
- Suction the patient as needed.
- Institute measures to prevent increased ICP or other neurovascular compromise.
- Feed the patient as soon as possible after a head injury and administer histamine-2 blockers to prevent gastric ulceration and hemorrhage from gastric acid hypersecretion.
- If the patient is unable to swallow, provide enteral feedings after bowel sounds have returned.
- Elevate the head of the bed after feedings, and check residuals to prevent aspiration.
- Monitor respiratory rate, depth, and pattern of respirations.
Complications - Infections
- Increased intracranial pressure
- Posttraumatic seizure disorder
- Permanent neurologic deficits
- Persistent sympathetic storming
- SIADH
- Death
Related posts: - Spinal Cord Injury (SCI)
- Nursing Care Plan – Spinal Cord Injury
- Arteriovenous Malformation (AVM)
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