Treatments
Up to 20-degree curvature: Exercise to enhance muscle tone and posture.
Between 20 and 40 degree curvature: Apply a brace to maintain curva-
ture.
Greater than 40 degree curvature: Spinal fusion surgery.Nursing Interventions
If spinal fusion surgery is performed:- Use log rolling to reposition the child every 2 hours to inhibit devel-
opment of pressure sores and to adequately inflate lungs. - Monitor vital signs following surgery.
- Apply antiembolism stockings while the patient is on bed rest.
Remove the antiembolism stocking for 1 hour three times a day. - Assess the patient’s pain level.
- Assess for Homan sign for signs of an embolism.
- Measure the circumference of the calf frequently if the calf is
swollen to determine if there are changes to the swelling. - Assess for ischemia: Pain, pallor, pulselessness, paresthesia, paral-
ysis.
Support the back, feet, and knees with pillows when the patient lies on
the side.
Perform range-of-motion exercises to maintain muscle tone.
Avoid twisting or turning the spine when moving the patient.
Explain that spinal fusion surgery stabilizes the spine by inserting wires
and rods into the spine to align the spine permanently.
Teach the parents the importance of performing ordered exercises and
the need for the patient to wear the brace.
Slipped Capital Femoral Epiphysis
What Went Wrong?
The upper end of the femur becomes dislocated during the onset of puberty
due to weakness of the epiphysis and a growth spurt. There are four types of
slipped capital femoral epiphysis:
Acute: Caused by trauma.
Chronic: Caused by a growth spurt.
Stable: The patient can walk.
Unstable: The patient is unable to walk.Signs and Symptoms
Visible limp.
Groin pain.
Knee, hip, or thigh pain.
Patient holds hip in the external rotation while at rest.(^290) Pediatric Nursing Demystified