Nursing Care Plans for Medical Diagnoses: Scoliosis, pediatric

Scoliosis, pediatric

Revised: April 5, 2019

Anxiety
Goal
The child will display decreased signs and symptoms of anxiety.
Other:

Interventions
Assess for signs and symptoms of anxiety.
Encourage the child to verbalize anxieties, concerns, and fears.
Explain all tests and procedures to the child and family using clear, simple explanations.
Help the child identify coping strategies that have worked in the past, and support the use of them, as
age-appropriate.
Help the child identify factors that increase anxiety, as age-appropriate.
Provide care in a calm and reassuring manner.
Provide quiet time, and decrease environmental stimulation.
Teach stress-reduction and relaxation techniques, as age-appropriate.
Use therapeutic communication skills to develop a trusting relationship with the child.
Administer medications, as prescribed, and monitor for effect.
Allow the family to remain with the child, as appropriate.
Encourage the family to bring in items of comfort from home, such as a favorite blanket or toy.
Maintain the child's routine as much as possible.
Provide for consistency in staffing assignments as indicated.
Other:

Body Dysmorphia
Goal
The child will express a realistic, positive body image.
Other:

Interventions
Allow the child uninterrupted quiet time to process feelings and emotions through writing or journaling.
Allow the child and family to verbalize their feelings and concerns related to the child's condition and
planned treatment, including concerns about body image and wearing a brace. Provide clear explanations
about care and treatment measures, and offer emotional support.
Encourage the child to verbalize skills and functioning that have NOT changed; assist in identifying
personal strengths and weaknesses.
Provide suggestions to the child regarding clothing, such as ways to minimize the appearance of the
brace by wearing loose clothing, along with instruction on use of the brace.
Role-play with the child to explore feelings of disturbed body image.
Teach coping mechanisms to deal with body changes.
Obtain a consult with a child life therapist as needed.
Obtain a social services consult as needed.
Obtain a psychiatric consult, if indicated.
Refer the child and family to a local support group.
Other:

Chronic Pain
Goal
 The child will state that pain is relieved or controlled.
Other:

Interventions
Determine the child's and family's knowledge and beliefs about pain.
Encourage verbalization of feelings concerning pain issues.
Explore age-appropriate diversional activities.
Explore factors that relieve, worsen, or precipitate pain.
Instruct the child to notify the caregiver of all episodes of pain.
Perform a pain assessment using an age-appropriate pain scale.
Observe for nonverbal cues of discomfort.
Provide emotional support as indicated.
Provide nonpharmacologic comfort measures, such as relaxation, meditation, and yoga.
Provide uninterrupted periods of rest.
Schedule care activities to allow frequent rest periods.
Administer medications, as prescribed, and monitor for effect.
Obtain a consult with a pediatric pain management specialist.
Obtain a consult with the child life therapist as needed.
Obtain an orthopedic and neurologic consult as needed.
Prepare the child and family for ordered surgical procedures or treatments; provide preoperative and
postoperative teaching as appropriate.
Other:

Fear
Goal
The child will verbalize a cessation or decrease of fear.
Other:

Interventions
Assist the child in identifying the specific cause of fear; allay fears as appropriate.
Provide information that addresses the cause of fear.
Provide active listening.
Provide support to the child and family.
Teach relaxation techniques, such as deep breathing and muscle relaxation, as age-appropriate.
Administer medications, as prescribed, and monitor for effect.
Allow the family to remain with the child, as appropriate.
Encourage the family to bring in items of comfort from home, such as a favorite blanket or toy.
Maintain the child's routine as much as possible.
Provide for consistency in staffing assignments as indicated.
Other:

Impaired Comfort
Goal
The child will verbalize feelings of comfort.
Other:

Interventions
Acknowledge the child's feelings of discomfort. Observe for nonverbal cues of discomfort, such as
restlessness, muscle tension, and altered vital signs.
Assess the child's discomfort (characteristics, severity, location, onset, type, precipitating factors, and
duration).
Assist the child in identifying the causation of the discomfort and factors that relieve or worsen it. Assess
the child as well as the environment for contributing factors.
Educate the child on ways to decrease factors that precipitate the discomfort, as appropriate. Assist the
child in developing a plan to reduce discomfort, and include the child in care measures to facilitate
independence and control.
 Instruct the child and family to notify the practitioner if comfort measures are inadequate. Modify comfort
measures based on the child's response.
Encourage the child to participate in distraction activities, as appropriate.
Provide nonpharmacologic comfort measures. Adjust the environment as necessary, and position the
child for comfort.
Schedule care activities to provide the child with uninterrupted periods of rest.
Administer medications, as prescribed, and monitor for effect.
Apply heat or cold therapy, as ordered, and monitor for effect.
Encourage the family to spend time with the child and assist in providing comfort measures, as
appropriate.
Explore complementary therapies with the child, such as massage therapy, relaxation therapy, and guided
imagery.
Other:

Impaired Mobility
Goal
The child will be free of complications of immobility.
Other:

Interventions
Assess the child for complications of immobility:
every 1 hour
every 2 hours
every 4 hours
every 6 hours
every 8 hours
as ordered
other: _________________________________________.
Assess the child's strength/mobility.
Assist with activities of daily living, as appropriate.
Encourage a gradual increase in activity; promote self-care, and allow adequate time for completion of
tasks.
Encourage verbalization of feelings about impaired mobility.
Explain potential complications of immobility.
Place the call bell within reach; instruct the child in its use; and verify that it's used properly.
Place the child's belongings within reach.
Reinforce the proper use of ambulatory assistive devices. Teach the child and family about the use and
care of all equipment, and have them perform return demonstrations, as indicated.
Turn and reposition the immobile child frequently.
Assist with application of a spinal brace as ordered; monitor the child's response.
Obtain physical and occupational therapy consults as needed.
Prepare the child and family for surgery as ordered; perform preoperative and postoperative teaching as
indicated.
Provide prophylaxis for deep vein thrombosis as ordered, and monitor response.
Review with the child and family the prescribed exercise regimen and activity limitations (for example, no
vigorous sports; swimming but no diving).
Other:

Injury Risk
Goal
The child will remain free of injury.
Other:

Interventions
Assist with mobility (getting out of bed, ambulation), as appropriate.
Encourage frequent rest periods to prevent overtiring.
 Inspect the skin around and under the brace; provide suggestions for appropriate skin care, including
wearing a cotton shirt under the brace.
Monitor neurologic status:
every 1 hour
every 2 hours
every 4 hours
every 6 hours
every 8 hours
as ordered
other: _________________________________________.
Provide continual surveillance as indicated by the child's condition.
Reinforce the plan for use of the brace, including the number of hours per day that it needs to be worn.
Review environmental or lifestyle changes that the child and family can make in the home environment to
decrease the risk of injury and promote health.
Review safe body mechanics.
Assist with application of the spinal brace as ordered; ensure padding of the brace edges to minimize the
risk of skin irritation and breakdown; monitor the child's response; provide teaching related to the brace;
and ensure that the child and family perform brace application appropriately.
Encourage deep-breathing exercises and incentive spirometry, as ordered.
Obtain a physical therapy consult as needed.
Obtain a social services consult as indicated.
Review strengthening exercises; postoperative activity restrictions, as appropriate; and the importance of
adhering to the recommended follow-up care, especially if observation is the mode of treatment.
Other:

Selected References
1. Auerbach, J. D., et al. (2014). Body image in patients with adolescent idiopathic scoliosis: Validation of the
Body Image Disturbance Questionnaire—Scoliosis Version. Journal of Bone & Joint Surgery (American), 96(8),
e61. (Level IV)
2. Bowden, V. R., & Greenberg, C. S. (2016). Pediatric nursing procedures (4th ed.).Philadelphia, PA: Wolters
Kluwer.
3. Fong, D. Y., et al. (2015). An alternative to a randomised control design for assessing the efficacy and
effectiveness of bracing in adolescent idiopathic scoliosis. Bone & Joint Journal, 97-B(7), 973-981. (Level II)
4. Helenius, I., et al. (2016). Gelatine matrix with human thrombin decreases blood loss in adolescents
undergoing posterior spinal fusion for idiopathic scoliosis: A multicentre, randomised clinical trial. Bone Joint
Journal, 98-B(3), 395-401. (Level II)
5. Hockenberry, M. J., & Wilson, D. (2016). Wong's essentials of pediatric nursing (10th ed.).St. Louis, MO: Mosby.
6. Luo, M., et al. (2017). Pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis: A
systematic review and meta-analysis with emphasis on complications and reoperations. Medicine (Baltimore),
96(27), e7337. (Level I)