Kyphoscoliosis

Terms in this set (18)

Anatomic Alterations of Kyphoscoliosis
lung restriction and compression as a result of the thoracic deformity
mediastinal shift
mucous accumulation throughout the tracheobronchial tree
atelectasis
Etiology of Kyphoscoliosis
affects about 2% of the population of the US
mostly young children going through growth spurts are affected
very rarely develops in adulthood- unless its a worsening condition from childhood
may also develop in adults from a degenerative joint condition in the spine
Infantile Scoliosis
curvature of the spine develops during the first 3 years of life
Juvenile Scoliosis
curvature occurs between 4 years of age and the onset of adolescence
Adolescent Scoliosis
curvature develops after age 10
Risk Factors
location: curves in the middle to lower spine are less likely to progress than those in the upper spine
height: taller people have a greater chance of curve progression
spinal problems at birth: children with scoliosis at birth have a greater risk of worsening of the curve
Diagnosis of Kyphoscoliosis
diagnosed by means of the patient's medical history, physical exam, x-ray evaluation and curve measurement
commonly defined according to the following factors related to curvature of the spine:
1) shape
2) location
3) direction
4) angle (COBB angle: curvature of the spine greater than 10 degrees)
Clinical Manifestations of Kyphoscoliosis
atelectasis because the patient cannot expand their lungs (restrictive disease process)
excessive airway secretions because the patient is usually unable to clear their own secretions because of the restrictions placed on the lungs
Physical Exam Findings In a Patient with Kyphoscoliosis
tachypnea
tachycardia
cyanosis
digital clubbing
peripheral edema
venous distention
cough and sputum production
tracheal shift
dull percussion note
crackles/rhonchi/wheezing
bronchial breath sounds
obvious thoracic deformities
whispered pectoriloquy
PFTs In a Patient with Moderate to Severe Kyphoscoliosis
all capacities are decreased
ERV, IRV, RV are decreased
FEV1, FEV1/FVC ratio, FEF 25-75, PEFR, MVV, FEF 50%, VT are all normal or decreased
RV/TLC ratio is normal
ABG in Mild to Moderate to Severe Kyphoscoliosis
acute alveolar hyeprventilation with hypoxemia (acute respiratory alkalosis)
ABG in Severe Kyphoscoliosis
chronic ventilatory failure with hypoxemia (compensated respiratory acidosis)

acute on chronic situations seen a lot in patients
Hemodynamic Findings in Kyphoscoliosis
CVP, PA, PVR are all increased
CO, SV, SVR are all normal
C(a-v)O2 is increased
polycythemia can be found as well
CXR Finding in Kyphoscoliosis
blunting thoracic deformities
mediastinal shift
increased lung opacity
atelectasis in areas of compressed lungs
enlarged heart (cor pulmonale)
General Management of Kyphoscoliosis
depends on the cause, size and location of the curve and how much growing the patient is expected to do
curvatures less than 20 degrees are considered minor and require only observation to ensure that the curve does not get any worse
More Management Techniques of Kyphoscoliosis
surgery
spinal fusion
rod instrumentation (usually done in curves between 40 and 50 degrees)
electrical stimulation
chiropractic maneuvers
deep breathe/cough
Braces
boston- plastic, spinal jacket
charleston- bending brace worn at night and is more preferred
milwaukee brace- extends from a chin cup with a neck pad to the pelvis
Respiratory Care Protocols
oxygen therapy protocol
bronchopulmonary hygiene protocol
lung expansion therapy protocol
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