Scoliosis

a lateral curvature of the spine

five times more common in girls and

has peak incidence at 8 to 15yrs

Majority (75%) - idiopathic

has a familial pattern
(30% of children with
scoliosis)
associated with other
neuromuscular disorders
 Forms
1. Structural / Progressive form
“S” curve of the spine
usually idiopathic
does not disappear with position changes
needs more aggressive treatment

2. Functional/ Postural/Non structural

“C” curve of the spine
cause by poor posture, muscle spasm
due to trauma, or unequal length of legs

disappears when child lies down

can be treated with posture exercise
Assessment findings

1. Uneven shoulders

2. Uneven hips

3. Asymmetry of rib cage

4. Unequal length of bra strap

5. bump or rib hump on one

side of the spine
 Diagnosis
Forward bend test/ Adam’s bend test
a test used most often in schools
and doctor's offices to screen for scoliosis
Scoliometer – a commercial
device used to document
the extent of spinal curve
Cobb angle
standard method
for assessing the
curvature
quantitatively
Radiograph (X-ray) assess the angle of the curve
and determine extent of
deformity
 Using a Scoliometer

1. Ask the child to slowly bend

forward until the shoulders
are level with the hips

2. Adjust the bending position

height so the deformity of the
spine is most pronounced.

General Rule: 3. Gently lay the scoliometer

Refer to a physician with across the deformity at right
angles to the body, with the
a scoliometer reading of
marking centered over the
seven degrees or greater curve.
Management
Depends on the maturity of the skeleton
and on the degree of curvature

Spinal curve of less 20 degree

no therapy
observation until 18years of age

Spinal curve greater than 20 degree

conservative, nonsurgical approach
braces
traction
Plaster jacket cast

Spinal curve of more than 40 degree

surgery
Spinal fusion with insertion of Harrington rod
23 hours/day
for 3 years

Boston brace
 THE CHARLESTON
BENDING BRACE
For Part-time Wearing

THE BOSTON BRACE

For Full-time Wearing
 Traction

Halo-pelvic traction

Halo-femoral traction
 HALO-FEMORAL TRACTION
WITH ELECTRIC ROTATING BED
Electrical stimulation
Use as an alternative for braces
Electrodes are applied to the skin
or surgically implanted
Electrical stimulation is usually employed
at night, during sleeping hours
To stimulate muscle to contract to
straighten the spine

Stretching exercises of the spine

for non structural changes
 Nursing intervention

Provide care for child with brace

Teach the child to wear it constantly, except when

bathing
wear over a t-shirt to protect the skin
report if there is rubbing
encourage exercise as prescribed

Provide cast or traction care

Frequent cleansing on the pin sites
Provide diversional activities
Monitor for signs of complications
 Nursing intervention
Provide preoperative and post operative nursing care
Deep breathing exercise
Use of incentive spirometry
Log roll; do not raise the head of the bed

Stress correct body mechanics

Promoting mobility, positive body image and

compliance with therapy

Preventing injury and

Preventing skin irritation

Bone tumors
Sarcoma – tumors arising from connective tissue,
such bones and cartilage, muscle, blood vessels
or lymphoid tissue
common neoplasm in adolescent
Arise during adolescent because of rapid bone growth

Two most frequently occuring

types of bone cancer:

Osteogenic Sarcoma

Ewing’s Sarcoma
 Osteogenic Sarcoma
A malignant tumor tumor of long bone involving rapidly
growing bone tissue ( mesenchymal matrix forming cells)

characterized by formation of osteoid (immature bones)

Common sites of occurrence

distal femur – 50%
Proximal tibia – 20%
Proximal humerus – 10 to 15%

High incidence in children expose

to radiation and with retinoblastoma

Lungs – common site of metastasis

 Assessment
pain
Swelling, redness
Tender mass, warm to touch
Limitation of movement
Pathologic fracture

Diagnosis
Bone Biopsy
Ct scan
Bone scan
Management
Surgery
Limb salvage procedures
Bone or skin grafts
Amputation
Reconstructions
Resections of metastases
Radiation therapy
Chemotherapy

Rehabilitation
physical and occupational therapy
psychosocial adapting
prosthesis fitting and training
 Nursing management
1. Provide routine preoperative care

2. Offer support or encouragement and

accept client’s response of anger and grief

3. Discuss to patient and family

rehabilatation program and use of prosthesis
crutch walking
phantom limb sensation as normal recurrence
4. Prevent hip and knee contractures
prone position several times a day (unless otherwise ordered)

5. Provide stump care

 Ewing’s Sarcoma
Malignant tumor arising
most often in the bone marrow
of the diaphysis area (midshaft)
of long bones

The diaphyses of the femur are

the most common sites,
followed by the tibia and the humerus

Lungs is the most frequent

site of metastasis
 Clinical Findings
1. Pain and swelling on affected part

2. Palpable mass

3. Tender and warm to touch

4. 15- 35% of clients have metastasis @ time

of diagnosis

Management

1. High doses of radiation therapy

2. Chemotherapy
3. Surgery
 Diagnosis

X-ray
Bone scan
Biopsy
Bone marrow aspiration

Nursing intervention

Caution adolescent to continue to be

careful and avoid activities that may cause
added stress to affected limb such as football
and weight lifting
Sexually Transmitted Disorders
are those disease spread through sexual contact
A. Gonorrhea
Causative agent Neisseria Gonorrhea
Signs & symptoms: often asymptomatic in females
purulent yellow-green vaginal discharge
May cause ophthalmia neonatorum and sepsis to newborn
Treatment:
Penicillin
Erythromycin
Ceftriaxone
Doxycycline

all sexual contacts must be treated

B. Chlamydia
Chlamydia trachomatis
Most common STD
Signs & symptoms: watery, gray-white vaginal
discharge
vulvar itching

May causes ophthalmia neonatorum,

sterility in female or male, tubal pregnancy
Drug: doxycycline or tetracycline, azithromycin,
 C. Syphilis
Treponema pallidum (spirochete)
Crosses placenta after 16 week of pregnancy
Manifestation
Primary
cardinal sign – CHANCRE - a hard red painless lesion @ the point of
infection site
disappear without treatment in 4-6 weeks
Secondary - rash, malaise, alopecia

Tertiary
effect any organ system – cardiovascular, neurovascular system
Treatment :
penicillin or erythromycin
 D. Trichomoniasis

Trichomonas vaginalis - a single-cell protozoan

Sign & symptoms: thin, irritating, frothy gray- green

discharge
strong odor, itching to genitalia
Treatment: metronidazole
douche with weak vinegar solution to reduce pruritus
 E. Candidiasis
Candida Albicans - fungus
Caused by a yeast transmitted from GI tract to vagina

Sign & symptoms – thick , white cheese-like vaginal

discharges
vulvar reddening and pruritus

Treatment: topical application or suppositories of antifungal

drug such as:
clotrimazole , nystatin, miconazole, diflucan, gentian violet
Bathing with diluted sodium bicarbonate solution to
reduce pruritus
Anorexia nervosa
A disorder characterized by refusal to maintain a minimally
normal body weight because of a disturbance in perception of the
size or appearance of the body

an eating disorder characterized by extremely low

body weight, body image distortion and
an obsessive fear of gaining weight.

May be manifested as severe weight restriction

controlled by:
▪ limiting food intake
▪ excessive exercise
▪ binge eating/purging
 Clinical findings and diagnosis
The American Psychiatric Association Criteria for
Diagnosis

body mass index – less than 85% of expected weight

intense fear of getting fat or gaining weight even though
underweight
severely distorted body image
refusal to acknowledge seriousness of weight loss
amenorrhea
Manifestation

Almost skeleton-like appearance

Sexually immature
Dry skin, brittle nails
Presence of lanugo
Constipation, hypothermia, bradycardia, low blood pressure
anemia
Depression, social withdrawal and poor individual coping
Management

Nutritional therapy
Total parenteral nutrition
Enteral tube feeding

Behavior modification

Medication - antidepressant

Counselling
Individual therapy
Group therapy
Family therapy
 Bulimia Nervosa
Bulimia – refers to recurrent and episodes
binge eating and purging

accompanied by an awareness that eating

pattern is abnormal but not being able to stop

Bulimic person is of normal of weight or slightly overweight

or underweight
may abuse purgative, laxatives and
diuretic to aid in weight control
 Clinical manifestation and Diagnosis

Dental caries and erosion

Throat irritation

Electrolytes imbalance- hypokalemia

Behavior problem
drug abuse
alcoholism
stealing
impulsive activities
 American Psychiatric Association the criteria
for bulimia are:

Recurrent episodes of binge eating

A feeling of lack of control over behavior during binges

Self-induced purging; use of laxatives, diuretics, enemas

Average of at least two binge-eating episodes a week during

3 months period

Obsessiveness regarding body weight and shape

 Management
Pharmacology – antidepressant
Psychotherapy

Nursing intervention
Monitor vital signs
Monitor intake and output
Record food intake
Monitor weight
Encourage client to express feelings
Help client to set realistic goal for self
Help client identify interest and positive
aspect of self
Obesity
An excessive accumulation of fat that increases body weight
by 20% or more

Obesity is now among the most widespread medical

problems affecting children and adolescents living in the
United States and other developed countries.

Obesity increases the child's risk of of serious health problems

such as heart disease, DM type 2 and stroke
 Obesity

It also can create emotional and social problems

often feels isolated from the peer group
embarrassed to participate in sports

Adolescents may have difficulty achieving a sense of

identity if they are always excluded from group and if
they don’t like their image in the a mirror

BMI – most accurate method of assessment

indicates relationship between height and weight
 Causes
Many different factors contribute
to this imbalance between calorie intake and consumption
Genetic factors
Obesity tends to run in families

Dietary habits
fast food, processed snack foods, and sugary drinks.
use food as means of satisfying emotional needs
Indulging in late – night eating
Physical inactivity
The popularity of television, computers, and video games
results into an increasingly sedentary lifestyle
 Management
Lifestyle modification,
Physical activity,
Nutrition education

Ways to manage obesity in children and adolescents

include:
1. Start a weight-management program
2. Change eating habits (eat slowly, develop a routine)
3. Plan meals and make better food selections
4. Increase physical activity and have a more active
lifestyle
5. Know what your child eats at school
6. Do not use food as a reward
7. Limit snacks
8. Attend a support group (e.g., Overeaters Anonymous)
Substance Abuse
is the misuse of an addictive substance that changes
the user’s mental state
refers to the use of chemicals to improve a mental state
or induce euphoria
Commonly abuse substance – alcohol, tobacco
and illicit drugs
Cause/Reasons: a means of relieving
the tension and pressure of their lives
Adolescent
a desire to feel more confident and mature
due to peer pressure
a form of rebellion
 Children at greatest risk
1. have family in which alcohol or drug abuse is present
2. suffer from abuse, neglect
3. have behavior problems – aggressiveness and excessively
rebelious
4.slow learners
5. have problems with depression and low-self esteem
Stages of substance abuse

Stage 0: Preabuse or Curiosity Stage

describes the adolescent with an increased potential for
substance abuse
need for peer acceptance; anger and boredom
 Stage 1: Experimental Stage (Learning the Euphoria)

Adolescents have already made a decision

to “try”drugs and begun learning the drug induced
mood swing oreuphoria.
drug use is confined to social situations
there are few behavioral changes other than “lying”
Stage 2, Early Regular Use (Seeking the Euphoria)
the adolescent now actively seeks the drug-induced mood
swing
use drugs to seeks relief from everyday stress
changes in dress, decline in personal hygiene, deterioration in school
performance, loss of previous interest in extra curricular activities
adolescent exhibits more mood swings, engages in regular lying
Stage 3 Late Regular Use (Preoccupation with theEuphoria)

dependent on substance abuse

Dependence -compulsive need to use a substance for its
satisfying effect
deterioration of behavior such as fighting, lying, stealing,
Prostitution often depressed, suicidal ideation, self-destructive
and risk-taking behavior

Stage 4 End Stage or “Burn Out”

Adolescent needs drugs just to feel normal and to
avoid the profound and nearly constant dysphoria.
Depression,guilt, shame, and other remorse may be
overwhelming, and suicidal ideation becomes more common

Paranoia, angry outbursts, and aggression are common

 Common Assessment findings

1. Failure to complete assignments

in school
Therapeutic
2. Demonstration of poor reasoning communicati
ability on and non-
3. Decreased school attendance judgemental

4. Frequent mood swings

5. Deteriorating physical appearance

6. Recent change in peer group

7. Expressed negative perceptions of parents

 Treatment

Prevention is the most effective and least

expensive treatment for substance abuse

Medication, -nicotine patches and methadone

Rehabilatation, counseling, social support, family

support
Suicide
Is a deliberate self- injury with the intent to end
one’s life.

successful suicide occurs more frequently

in male than females
third cause of cause of death
between 15 – 19 years of age

Suicide as viable solution to life problems

Risk Factors
Previous suicide attempts

Close family member who has committed suicide.

Past psychiatric hospitalization

Recent losses: death of a relative, a family divorce

or a breakup with a girlfriend
Social isolation

Drug or alcohol abuse

Exposure to violence in the home or
the social environment
 As a nurse
Warning Signs for Suicide confidential
Suicidal talk and
Preoccupation with death and dying compassionate
Signs of depression approach is
Behavioral changes essential.
Giving away special possessions and
making arrangements to take care of unfinished business
Difficulty with appetite and sleep
Taking excessive risks
Increased drug use
Loss of interest in usual activities
 Tips for Parents
Know the warning signs!
Do not be afraid to talk to your child.
The message is, “Suicide is not an option, help
is available."
Suicide-proof your home.
Make the knives, pills and firearms inaccessible.
Utilize school and community resources.
school psychologist, crisis intervention personnel
Take immediate action. If your child indicates
contemplating suicide
Do not leave your child alone
Seek professional
Listen to your child’s friends. They may give hints about your
Be open. Ask questions.
Three steps teens can take
1. Take your friend's actions seriously

2. Encourage your friend to seek

professional help, accompany if necessary

3. Talk to an adult you trust.

Don't be alone in helping your friend.
Salamat po!!!