# A 14-year-old boy with neuromuscular scoliosis secondary to cerebral palsy has a lumbar curve of 50 degrees. The orthopedic surgeon has recommended spinal fusion surgery. Which nursing intervention is most important during the preoperative period?

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## 문제

A 14-year-old boy with neuromuscular scoliosis secondary to cerebral palsy has a lumbar curve of 50 degrees. The orthopedic surgeon has recommended spinal fusion surgery. Which nursing intervention is most important during the preoperative period?

A 12-year-old girl diagnosed with idiopathic scoliosis presents with a thoracic curve measuring 45 degrees on radiographic examination. The curve has progressed from 35 degrees over the past 6 months despite bracing. The orthopedic surgeon has recommended posterior spinal fusion with instrumentation. The patient and family are scheduled for preoperative teaching and preparation.

## 보기

1. Encourage the patient to practice deep breathing exercises and use of incentive spirometry
2. Assess the patient's understanding of postoperative mobility restrictions
3. Review pain management options available after surgery
4. Evaluate the patient's and family's emotional readiness and coping mechanisms for the surgical procedure **✔ 정답**

**정답: 4**

## 해설

Assessing emotional readiness and coping is most critical preoperatively to address anxiety and improve surgical outcomes. Other options (breathing exercises, mobility restrictions, pain management) are important but secondary to psychological preparation.

## 심화 해설

Preoperative Psychosocial Assessment in Pediatric Spinal Fusion

The most important nursing intervention during the preoperative period for this patient is to evaluate the patient's and family's emotional readiness and coping mechanisms for the surgical procedure. While all listed interventions are components of comprehensive preoperative preparation, the foundational step that influences the success of all other interventions is a psychosocial assessment. This is because unaddressed psychological distress directly predicts worse surgical outcomes.

The rationale is strongly supported by current evidence linking preoperative psychological state to postoperative pain and recovery. A systematic review and meta-analysis identified presurgical psychological factors as significant prognostic indicators for chronic postsurgical pain (CPSP) in children and adolescents [3]. If a patient has high preoperative anxiety, maladaptive coping strategies, or significant emotional distress, their risk for developing persistent pain and experiencing a complicated recovery is substantially increased. By evaluating emotional readiness first, the nurse can identify these risk factors and tailor subsequent teaching and interventions accordingly. For instance, a patient with high anxiety may not effectively learn or perform deep breathing exercises (option 1) or retain information about mobility restrictions (option 2) until their emotional state is addressed.

Furthermore, a foundational principle of modern perioperative pain pathways is the integration of preoperative psychological intervention. A quality improvement initiative for pediatric surgery demonstrated that a key focus of their successful pain pathway was preoperative psychological preparation and patient and caregiver education, which led to reduced length of stay and opioid consumption [1]. This confirms that addressing psychological needs is not secondary but a core, first-line intervention that potentiates the effectiveness of physical preparation and education. A recent review on pain management in pediatric spine surgery also highlights that pre-operative mental health conditions are associated with increased post-operative pain [2]. Therefore, a nurse's assessment of a patient's and family's coping mechanisms is a critical clinical action that directly informs the entire plan of care, making it the most important initial step. The nurse must first understand the patient's emotional baseline to effectively guide them through pain management education (option 3) and other preparatory activities.References (research sources)

- [1]Implementation of an Integrated Pediatric Perioperative Pain Pathway: A Quality Improvement Initiative.Research articleCharron BP, Karuppiah N, Shah U, Katchky R, Poolacherla R. (2025) · DOI: 10.1155/anrp/8014510

- [2]An Update on Pain Management in Pediatric Spine Surgery.Research articleKiani SN, Bach K, Kwok V, Swarup I. (2026) · DOI: 10.1007/s12178-026-10037-8

- [3]Presurgical Prognostic Factors for Chronic Postsurgical Pain Across Developmental Stages in Children, Adolescents, and Young Adults: A Systematic Review and Meta-Analysis.Meta-analysis/systematic reviewCeniza-Bordallo G, Sieberg CB, Lopez-de-Uralde-Villanueva I, Martín-Casas P. (2026) · DOI: 10.2147/jpr.s590486

## 임상 시나리오

Preoperative Psychosocial Readiness in Pediatric Spinal FusionWhy emotional assessment must precede all other teaching
Begin the preoperative period by evaluating the patient's and family's emotional readiness and coping mechanisms. Unaddressed psychological distress is a strong prognostic indicator for chronic postsurgical pain (CPSP) in adolescents.

A patient with high anxiety or maladaptive coping cannot effectively learn or perform incentive spirometry or retain instructions about mobility restrictions. Address the emotional state first to enable success with all subsequent interventions.

CautionDo not defer psychosocial screening. Use validated tools to assess anxiety, and involve child life specialists or psychology early if distress is identified. Tailor all teaching to the patient's emotional baseline.

## 핵심 개념

- **Chronic postsurgical pain (CPSP)** — Pain persisting beyond the expected healing period after surgery, strongly predicted by preoperative psychological distress in pediatric patients.
- **Psychosocial assessment** — Evaluation of a patient's emotional state, coping mechanisms, and family dynamics to identify risks that may impede surgical recovery.
- **Posterior spinal fusion** — Surgical procedure to correct scoliosis by fusing vertebrae through an incision on the back, often using metal rods and screws.
- **Incentive spirometry** — A device used to encourage deep breathing postoperatively to prevent atelectasis and pneumonia, requiring patient cooperation and effort.

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