D5 Kyohotic disorder, Introduction Definition Classification Clinical feature Etiology Nursing management Prognosis Conclusion Risk factors

1. S N E H A D E R I A
B A S I C B S C . 3 R D Y E A R
R O L L N O - 3 6
M E D I C A L S U R G I C A L N U R S I N G - 2
D5-KYPHOTIC
DISORDER

2. • Kyphosis is a deformity of the spine as an increased roundness of the thoracic curve. It occurs
due to exaggeration or angulation of the normal posterior curve with convexity background and
forward curvatures of the shoulders.
• It may develop due to defective posture , rickets, congenital anomaly, diseased skin ( SYPHILIS,
TUBERCULOSIS ) malignancy , rheumatic arthritis , compression fractures or due to idiopathic
cause as in SCHEUREMANN disease.
• Management is performed by orthotic devices or orthopaedic after clinical and radiological
evaluation.
INTRODUCTION

3. • IDENTIFICATION DATA
• HISTORY OF PATIENT
• PHYSICAL EXAMINATION
• NEUROLOGICAL ASSESSMENT

4. DEFINITION
• KYPHOSIS is a curving of the spine that causes a bowing or rounding of the back . Which leads to
a hunchback or slouching posture.

5. Difference of normal and kyphotic spine

6. CLASSIFICATION
There are three main types of KYPHOSIS
1. POSTURAL KYPHOSIS
2. SCHEUEMANN’S KYPHOSIS
3. CONGENITAL KYPHOSIS.

7. POSTURAL KYPHOSIS
• It is most common type of kyphosis.
• Most common in girls than in boys, which is
typically noticed in adolescent age.
• It is caused by poor posture and weakening
of the muscle , ligaments in the back.
• The vertebrae are typically placed in the
postural kyphosis.
• It progressively gets worse with time.
• These people will have symptoms of pain and
muscle failure.

8. SCHEUERMANN’S KYPHOSIS
• It is also first noticed during adolescent
period.
• It is result of structural deformity.
• It commonly develops with scoliosis.
• Reasons are not well understood.

9. CONGENITAL KYPHOSIS
• It is least common type of kyphosis .
• It is caused by abnormal development of
vertebrae prior to birth.
• It occurs due to fusion of many vertebrae
together.

10. KYPHOSIS LORDOSIS AND SCOLIOSIS

11. RELATED ANATOMY AND PHYSIOLOGY
The spinal cord is a part of CNS, which lies within
the vertebral column.it begins as a continuation od
the medulla oblongata. It extends from the level of
FORAMEN MAGNUM to the lower border of L1
vertebra . It is approximately 45 cm long. In the
adult , it occupies only 2/3rd of the vertebral column.

12. External features -
• Spinal cord is a cylindrical structures that is
slightly flattened anteriorly and posteriorly.
• The cervical enlargements – the cervical spinal
nerves arising from here a plexus or network
called brachial plexus , which innervates the
muscles of the upper limb.
• The lumbosacral enlargements – innervates the
muscle of lower limb.
• The lowest part of spinal cord is conical and is
known as the CONUS MEDULLARIS . The conus
is a continuous below with a thin Filous cord ,
the FILUM TERMINALE.

13. COVERING OF SPINAL CORD
• The spinal cord is loosely surrounded by the three meninges as discussed – outer dura mater,
middle arachnoid and inner pia mater , which are continuous with the meninges of the brain.

14. Internal structures of spinal cord
• Transverse section of spinal cord shows that it is
compassed of grey and white mater. Gray mater
is placed centrally and white mater is placed
periphery. Gray mater is composed of nerve cells,
neuroglia and blood vessels and white mater is
composed of myelinated and non myelinated
nerve fibres.

15. Internal section of spinal cord

16. Tracts of spinal cord
They are constituted by a group of sensory fibres ascending from the receptors to the central nervous
system . They include
ascending tracts
• Dorsal column
• Spinothalamic tracts
• Spinocerebellar tracts
• Spino olivary tracts
descending tracts
• Corticospinal tracts
• Extrapyramidal tracts

17. Spinal segments-
• The spinal cord gives attachment on the both
sides to a series of spinal nerves. the part of
the spinal cord giving origin to one pair of
spinal nerve called spinal segment. Spinal
cord is made up of spinal segments – 8
cervical , 12 thoracic, 5 lumbar , 5 sacral and
1 coccygeal.

18. Spinal segments

19. Blood supply -
The anterior supply of the cord derived
from following –
• anterior spinal artery
• Two posterior spinal arteries
• The radicular arteries.

20. ETIOLOGY
• Congenital abnormalities
• Improper vertebral development
• Certain endocrine disorder
• Connective tissue disorder
• Infection
• Muscular dystrophy
• Poliomyelitis
• tumours
ACCORDING TO BOOK
• Congenital abnormalities from birth
( no genetic history of neuro problems)
ACCORDING TO PATIENT

21. RISK FACTORS OF KYPHOSIS
• Arthritis
• Cancerous tumors and cancer treatments
• Chronic disorders such as PAGET’S disease
• Genetic disease
• Injury to spine
• Infectious disease such as tuberculosis or polio
• Osteoporosis
• Spondyolothisthesis

22. PATHOPHYSIOLOGY
Congenital
abnormality of
vertebral column
Development of
wedge-shaped
vertebrae during
adolescence
Results in difficulties
while walking

23. CLINICAL MANIFESTATION
ACCORDING TO BOOK ACCORDING TO PATIENT
• Difficulty in breathing ( only in severe
cases)
• Fatigue
• Mild back pain
• Rounded back appearance
• Tenderness and stiffness of the spine
• Difficulty during walking
• Back pain
• Fatigue
• Tremor
• Muscle strain
• Difficulty in lower limb movement

24. S
I
G
N
&
S
Y
M
P
T
O
M
s

25. INVESTIGATION
ACCORDING TO BOOK ACCORDING TO PATIENT
• History and physical
examination
• X- rays
• CT scan
• MRI
• MRI( MAGNETIC RESONANCE IMAGING)-
1. DATE- 25/01/2021
2. IMPRESSION- partial hypoplasia D5 vertebrae is seen with
anterior wedging likely developmental ?
kyphotic tilt of dorsal spine is seen. Indentation seen on dorsal
cord at D5 level which showing mild past compressive signal
changes .
• CYTOPATHOLOGY TEST -
1. DATE- 25/01/2021
2. IMPRESSION- CT guided FNAC from D5 vertebral lesion for
cytology. No acid fast bacilli is seen. No equivocal epithelioid
cell granuloma is seen

26. Contd..
ACCORDING TO PATIENT
• ELECTROCARDIOGRAPH TEST -
1. DATE – 23/01/2021
2. LVEF – 67%
3. LVFS- 60%
• C T SCAN -
1. DATE – 21/02/21
2. CT scan of dorso lumbar spine show– vertebral segmentation anomaly with hemivertebrae at D5
level causing acute kyphotic deformity at same level.
• COVID 19 TEST
1. DATE – 20/03/21
2. RAPID ANTIGEN ICT FOR COVID 19 - NAGETIVE
• GLASGO COMA SCALE – E4V5M6

27. Xray of kyphosis

28. MANAGEMENT
ACCORDING TO BOOK ACCORDING TO PATIENT
A. NON SURGICAL MANAGEMENT –
An initial programme of conservative treatment
that includes exercise and anti inflammatory
medications is recommended for patient with
SCHEUREMANN’S kyphosis. If the patient is still
growing, the doctor may prescribe a brace until
skeletal maturity is reached.
B. SURGICAL TREATMENT-
Surgery may be recommended if the kyphotic
curve exceeds 7.5 ,
A. MEDICAL MANAGEMENT-
1. Comfort devices are recommended
2. Medications –
 Tab PCM 650 mg – BD
 Tab Pan – 40 mg-ODAC
 Tab Methyl cobalamin – 500
mg-OD
 Tab non- Tryptiline -100 mg -OD
B. SURGICAL MANAGEMENT--

29. DIVICES USED IN KYPHOSIS
NECT BELT BRACE POSTURE CORRECTOR

30. Contd..
• GOALS OF SURGERIES—
 to reduce deformity
 Reduce pain and neurological symptoms
 To maintain the improvement over time.
 NAME OF SURGERIES—
 OSTEOTOMY
 SPINAL INSTRUEMENTATION AND FUSION
 BALLOON KYPHOPLASTY– A SPECIAL ORTHOPAEDIC BALLOON IS INSERTED INTO THE
COMPRESSED ( COLLAPSED) VERTEVRA.

31. COMPLICATIONS
ACCORDING TO BOOK ACCORDING TO PATIENT
• DECREASED LUNG CAPACITY
• DISABELING PAIN
• NEUROLOGICAL SYMPTOMS
INCLUDING LEG WEAKENING OR
PARALYSIIS
• ROUND BACK INFORMITY
• DIFFICULTIES IN WALKING
• TREMOR IN HANDS
• PAIN IN BACK

32. PROGRESS NOTE
CRITERIA DAY 1 DAY 2 DAY 3
TEMPERATURE (℉) 98.1 97.9 97.8
PULSE (b/m) 86 84 84
RESPIRATION RATE
(br/m)
22 20 24
BLOOD PRESSURE (
mm hg)
130/70 140/70 126/82
PAIN IN BACK
(pain scale)
present present Present
DIETARY INPUT balanced balanced Balanced
OUTPUT balanced balanced balanced

33. PROGNOSIS
• The progress rate of the patient is initially good. He is planned for surgery. So his pre operative
prognosis is good.

34. NURSING MANAGEMENT
• NURSING DIAGNOSIS 1 –
Impaired physical mobility related to neuro muscular impairment as evidenced by patient’s
verbalization.
• Goal –
To reduce impairment during physical mobility
• Intervention –
1. Continuously assessment of motor function of the patient should be done.
2. He should be assisted with full range of motion exercises in all extremities and joints using slow
movements.
3. Comfortable position should be given.
4. Lower extremities should be elevated in intervals in chair or raise foot or bed when permitted in
individual situation.
5. Neck collar should be provided if prescribed

35. Nursing diagnosis – 2
Pain at upper back related to spinal anomaly as evidenced by patients' verbalization
Goal –
To reduce pain
Interventions-
1. Degree of pain should be assessed by pain scale
2. Comfortable position should be given
3. Analgesic medication should be given as prescribed
4. Relaxation techniques should be provided as per patient’s comfort.2

36. Nursing diagnosis -3
Impaired skin integrity related to physical immobility as evidenced by patient’s verbalization and physical
examination.
Goal –
To maintain skin hygiene
Interventions-
1. Skin should be inspected
2. Pressure points should be assessed
3. Skin care should be given
4. Comfortable position change should be done at regular interval.

37. Nursing diagnosis -4
Anxiety related to physical immobility and lack of knowledge regarding anatomical deformities as evidenced by
patient’s facial expression and verbalization.
Goal-
To reduce anxiety
Interventions-
1. Psychological support should be given.
2. Orientation and good therapeutic relationship should be established.
3. Health talk and knowledge regarding KYPHOSIS should be given.
4. Spiritual support should be given.
5. Relaxation should be provided by different techniques like music , calm environment , muscle relaxation
technique etc.
Day 2

38. Nursing diagnosis – 5
Disturbed sleeping pattern related to physical discomfort as evidenced by patient’s verbalization
Goal-
To maintain normal sleeping pattern
Interventions-
1. Provide measures to take before bed time to assist in sleep .
2. Keep environment quiet and comfortable
3. Encourage minimum activities within limits during day time.
4. Teach relaxation techniques
5. Encourage patient to avoid coffee and caffeinated food and liquids
6. Try to maintain patient’s regular sleeping time and pattern.
7. Give mental support to the patient.

39. Nursing diagnosis 6
Risk for injury related to physical immobility
Goal-
To reduce risk of injury
Interventions-
1. Proper orientation of the ward should be done
2. Precautions like side rails, padded bed, low position of bed should be done
3. Provide adequate light
4. Avoid sedative drugs to avoid medications induces confusion
5. Remove any obstacles in floor, proper dry floor should be maintained
6. Calling bell should be provided at bed side for emergency
7. Reduce unnecessary movement of patient

40. Nursing diagnosis 7-
Self care deficit due to physical limitations as evidenced by physical examination
Goal-
To maintain self hygiene
Interventions-
1. Encourage patient to perform self car to maximum of ability to promote sense of self independency
2. Encourage patient in planning schedule of daily activities
3. We should anticipate hygiene needs
4. Consult with psychotherapist or occupational therapist
5. Provide ROM exercise on a regular basis to prevent muscle spasm.
Day 3

41. Nursing diagnosis 8-
Fatigue related to physical immobility as evidenced by patient’s verbalization and facial expression
Goal—
To reduce fatigue and encourage patient
Interventions—
1. Nurse should identify the factors affecting activities
2. Plan care with consistent rest periods in between activates
3. Avoid overheating and infection
4. Encourage patient in energy saving techniques
5. Try to maintain relaxation and encouraging activities like reading books, watching TVs , listening music
etc.

42. Nursing diagnosis 9—
Risk for urinary retention or incontinence
Goal—
To reduce risk for urinary retention
Interventions—
1. Assess the sign and symptoms of UTI
2. Encourage to take adequate amount of water and liquids
3. Provide prescribed drugs
4. Encourage minimum amount 0f exercise
5. Intake output chart should b maintained and informed to the physician if abnormalities occurs

43. I T I S E X A G G E R A T I O N O F P O S T E R I O R S P I N A L C U R V E
L O C A L I Z E D T O D O R S A L S P I N E . T H I S A B N O R M A L I T Y A F F E C T S
B O T H C L I N I C A L A N D Q U A N T I T A T I V E A S S E S S M E N T ,
A S S O C I A T E D W I T H D I M I N I S H E D F U N C T I O N A N D M O B I L I T Y
T A S K . T H E O S T E O P O R O S I S P R E V E N T I O N A N D T R E A T M E N T
C O U N S E L L I N G S H O U L D B E D O N E W I T H C O N S C I O U S M E D I C A L
G U I D E A N D N U R S I N G S U P E R V I S I O N .
CONCLUSION

44. BIBLIOGRAPHY
• Lewis ‘s medical surgical nursing, volume –II
Second south Asia edition
ELSVIER publication
• Brunner and Suddarth ‘s Textbook of medical surgical nursing
Janice l. Hinkle, Kerry h. Cheever
14th edition
• Textbook of anatomy and physiology for nurses
PR Ashalatha and G Deepa
third edition
JAYPEE publishers
• kenhub.com
• Spineuniverse.com
• Aurorahealthcare.org