Professional Documents
Culture Documents
COLLEGE OF NURSING
Scoliosis
Treatment:
1. Milwaukee brace
This apparatus exerts pressure on the chin, pelvis and convex (curved) side the spine.
Worn approximately 23 hours a day and is worn over a t-shirt to protect the skin
Indicated for curves between 20-40 degrees
2. Boston Brace
An underarm modification of the brace
Effective for patients with low curvature
3. Spinal fusion
Indicated for curves more than 40 degrees and for patient with unsuccessful conservative
treatment
Halo traction- used when there is associated weakness or paralysis of the neck and truk
muscle
Note: Curves up to 20 degrees do not require treatment.
Fracture
Break in the bone and is mainly caused by accidents.
Characterized by pain, tenderness and swelling, discoloration, limited movement and numbness
Types
o Simple- bone is broken but skin is intact
o Compound- a wound in the skin accompanies the broken bone
o Greenstick- incomplete fracture in which one side of the bone is broken and the other
side is bent.
Treatment:
o Bryant’s traction- weights and pulleys extend the limbs as in the Buck’s extension;
however the legs are suspended vertically. The weight of the child supplies the
countertraction
o Buck’s Skin Traction- type of skin traction used in fractures of the femur and in hip and
knee contractures.
o Russel Traction- similar to Buck’s traction but a sling is positioned under the knee, whch
suspends the distal thigh above the bed. Skin traction is applied to the lower
extremities.
Nursing consideration for patients with traction
o Neurovascular check to ensure adequate tissue perfusion
Peripheral pulse rate and quality
Color
Capilliary refill time
Warmth
Movement and sensation
pain
o Maintain body alignment
o Skin integrity monitored regularly
o Pain relief as ordered
o Antiembolism stocking or foot pumps in place as ordered
Treatments
o Prostaglandin Inhibitor drugs such as Ibuprofen or Naproxen
o Heat application to the ower abdomen or back
o Oral contraceptives which reduce the aount of endometrium build up each month and
therefore reduce prostaglandin secretions.
o Low fat and vegetarian diet
o Vitamins B and E and high level of omega 3 fatty acids
Obesity
Excessive weight in childhood is related to obesity in adulthood
Can lead to increase cholesterol, orthopedic problems, sleep apnea, high blood pressure and
diabetes
It can lead to social isolation which may lead to depression
BMI- 22-24 in adolescents indicates obesity
Nursing interventions:
o Monitoring of weight regularly
o Counseling on diet and lifestyle
o Encouraging exercise
Anorexia Nervosa
Is a form of self starvation seen mostly in adolescent girls
Characteristics
o Failure to maintain minimum body weight for age and height
o An intense fear of gaining weight
o Excess influence of body weight upon evaluation
o Amenorrhea
Risk factors
o Genetics
o Average to superior intelligence and overachievers usually perfectionist
o Dysfunctional family- controlling, rigid and imposing
o Social standards of weight such as being thinner
Manifestation
o Weight loss
o Dry skin
o Amenorrhea
o Lanugo hair over back and extremities
o Cold intolerance
o Low blood pressre
o Abdominal pain
o Constipation
o Helplessness
o Lack of control
o Low self-esteem
o Depression
o Lack of self- identity
o Although eating less, anorexic patients are preoccupied with food but hunger is denied
o They feel bloated when ingesting even small amount of food
Treatment
o A brief period of hospitalization may be necessary to correct severe malnutrition and
electrolyte imbalance
o Stabilization of patient’s weight
o Individual and family psychotherapy
o Antidepressant medications as ordered
o Provide comfortable and relaxed atmosphere
Bulimia
It is characterized by recurrent episodes of uncontrolled binge eatig followed by self-induced
vomiting and misused of laxative and/ or diuretics
Characteristics
o Dysfunctional family may cause the problem
o Depression and alcoholism in the family
o The binge-purge cycle if thought to be a coping mechanism for dealing with guilt,
depression, and low self-esteem
Manifestations
o Persistent vomiting
o Erosion of tooth enamel and eventual tooth loss
o Electrolyte imbalance due to excess use of laxatives and diuretics
o Muscle weakness
Nursing management
o Educate the adolescent on the condition
o Involve adolescent in meal planning
o Stay with the adolescent while she is eating until 30 minutes after eating to ensure that
there is no vomiting or purging
o Encourage verbalization of feelings
o Maintain nutritional requirements
Suicide is more successful in males than in women, although there are more attempts in women
than in male
Most often happens during school year, reflecting school stress, and between the time of 3 PM
and midnight, which reflects depression that increases with the dark.
Ranks third as cause of death in the age group of 15 years old to 19 years old.
Causes of Depression:
Anger
Manipulation (psychological black mail)
Loss of a parent
Loss of a girlfriend or a boyfriend
Loss of a community
Loss of self-esteem
ASSESSMENT
Adolescents need to have thorough physical examinations at health maintenance visits to assure
them they are in good physical health.Assess (signs of depression):
o Anorexia
o Insomnia
o Excessive fatigue
o Weight loss
Disobedience
Temper tantrums
Truancy
Running away from home
Self-destructive behavior
Accident proneness
Difficulty in school
Acting out with chemicals, alcohol, or sexual promiscuity
trouble with legal authorities
Occasionally, depressed adolescents find it so hard to be alone they seek constant activity as a
means of escape. Others may withdraw from contact with other persons and become
completely isolated
1. Loners and those who have difficulty expressing their feelings to others, therefore, do not receive
emotional support from friends.
4. Adolescents who have a family member or close friend who committed suicide.
5. An adolescent who have a school mate who committed suicide.6. Students who have internet
contacts who arranged a group suicide.
Suicide warning signs:
• Organ donation questions, such as “How do you leave your body to a medical school?”
• Sudden, unexplained elevation of mood. Mood elevation may indicate that the individual has reached
a decision about the suicide and feels relief.
• A statement such as, “This is the last time you will see me.”
• Previous attempt (80% of all completed suicides have been preceded by a failed attempt)
• Asking for information (supposedly for a friend) about suicide prevention and intervention
Nursing Diagnosis: Risk for violence, self-directed, related to symptoms of depression or expressed
desire to hurt oneself
Outcome Evaluation:
1. Client expresses feelings of depression to health care providers or other adults, saying she will
contact support person should the desire to commit suicide become overwhelming
2. Intervention for adolescents who are contemplating suicide includes trying to alleviate their pain and
depression and counseling them to help them change their perspective on the value of life.
3. Try to find out the things in the child’s life that are still viewed as important.
4. Since adolescent resort to suicide as a method of solving their problems, helping them in this area can
be an intervention strategy.
5. Help adolescents speak honestly about thoughts of suicide and the problems that have led them to
think that death is a solution.
6. A period of observation in a hospital setting is desirable after a suicide attempt to prevent the
adolescent from inflicting personal injury again and to allow assessment in a neutral setting, away from
the stress that precipitated the attempt.
8. Continuing evaluation by both history taking and physical examination is necessary, because the
young person who has attempted suicide may attempt it again if support people and better problem-
solving ability are not available at another time
Achieving a sense of identity may be difficult for adolescents who have a chronic illness or other
challenge.
It is important, for such individuals to learn to look past their particular condition to their real
selves.
Some of the biggest problems of chronically ill adolescents are likely to be:
o difficulties in being as independent as they would like to be
o achieving in school
o establishing intimate relationships
The loss of many hours of school because of illness or frequent hospitalization may result in the
inability to pursue a desired career, at least without a delay
Chronic hospitalization or the realization they will never be free of symptoms can cause
depression in adolescents, placing them at high risk for substance abuse or suicide.