Downloaded Potts Dx

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Table of Contents

I. Acknowledgement

II. Introduction

III. Assessment

I. Personal data


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VIII. Drug Study

IX. Discharge Planning

ACKNOWLEDGEMENT

This case study on Potts disease would not bepossible without those people who continually helped

and contributed in the said case study. My heartfeltexpression of appreciation goes out to each and everyone of you.

First and foremost, I would like to thank the West Bstaff of EAMC for generously giving me their time.

To our Professor, Mam Diente,Mam Donnie forpatiently supervising and assisting us with your


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To my parents, for supporting me all the way,

providing me with everything I need, financially andemotionally. All of those things are genuinelyappreciated.

Last but not the least, to our Almighty Father, forhis unceasing guidance and blessings, for constantly

giving me hope, courage, and patience. Truly, none ofthis is possible without you.

INTRODUCTION

Tuberculosis (TB) of the spine also known as

Potts disease, Potts Caries, David's disease,Tuberculosis spondylitis and Pott's curvature,is the most common site of bone infection inTB. The lower thoracic and upper lumbarvertebrae are the areas of the spine most oftenaffected. The original name was formed after

Percivall Pott, a London surgeon, who firststudied the disease. When he died, PatrickDavidwas the one who continued his work.
http://en.wikipedia.org/wiki/Percivall_Potthttp://en.wikipedia.org/wiki/Percivall_Pott


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and spinal damage. A dry soft tissue mass

often forms and superinfection is rare.The disease progresses slowly. Signs and

symptoms include: back pain, fever, nightsweats, anorexia, weight loss, and easyfatigability.

Diagnosis is based on: blood tests -elevated ESR , skin tests ,radiographs of thespine , bone scan ,CT of the spine , and bonebiopsy. Gibbus formation is the pathognomonicsign of this disease.

A person with Pott's disease oftendevelops kyphosis, which results in ahunchback. This is often referred to as Pottscurvature. In some cases, a person with Pott'sdisease may also develop paralysis, referred to

as Potts paraplegia, when the spinal nervesbecome affected by the curvature.

A person who has been diagnosed with
http://www.wisegeek.com/what-is-kyphosis.htmhttp://www.wisegeek.com/what-is-kyphosis.htm


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proper control. The best method for preventing

the disease is reduce or eliminate the spreadof tuberculosis. In addition, testing fortuberculosis is an important preventativemeasure, as those who are positive for purifiedprotein derivative (PPD) can take medicationto prevent tuberculosis from forming. A

tuberculin skin test is the most commonmethod used to screen for tuberculosis, thoughblood tests, bone scans, bone biopsies, andradiographs may also be used to confirm thedisease
http://www.wisegeek.com/what-is-para-phenylenediamine-ppd.htmhttp://www.wisegeek.com/what-is-a-blood-test.htmhttp://www.wisegeek.com/what-is-para-phenylenediamine-ppd.htmhttp://www.wisegeek.com/what-is-a-blood-test.htm


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For the theoretical framework, I used the 21nursing problems according to Faye Glenn Abdellah.She defined nursing as broadly grouped into the 21nursing problem areas to guide care and promote theuse of nursing judgement. She also said that nursing is

a service that is based on the art and science and aimsto help people, sick or well, cope with their healthneeds.

The 21 nursing problems are as follows:

1) To maintain good hygiene.2) To promote optimal activity: exercise,

rest, and sleep3) To promote safety4) To maintain good body mechanics.5) To facilitate the maintenance of a supply

of oxygen6) To facilitate maintenance of nutrition7) To facilitate maintenance of elimination


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14) To facilitate the maintenance of

effective verbal and non-verbalcommunication15) To promote the development of

productive interpersonal relationships16) To facilitate progress towards

achievement of personal spiritual goals

17) To cerate and maintain a therapeuticenvironment18) To facilitate awareness of self as an

individual with varying needs19) To accept the optimum possible

goals

20) To use community resources as aidin resolving problems

21)To understand the role of socialproblems as influencing factor


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I. Personal Data:

Name: B.P.Address: Novaliches Quezon CityAge: 28 years oldSex: FemaleCivil status: MarriedReligion: Roman CatholicBirthday: November 19, 1978Birthplace: ManilaAttending Physician: Dr. Adrian CatbaganAdmitting Diagnosis: Spinal cord compression on T/3level

Chief complaint: weakness of lower extremities

II. Medical History

A.History of Present Illness:This is a case of B.P., who was admitted

for the first time last September 13,2007 with a chiefcomplaint of weakness of lower extremities. Thehistory of present illness started two months prior to


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B.Family Medical History:

( - ) HPN( - ) DM( - ) CA( - ) asthma

C.Personal and Social History:

( - ) smoker( - ) alcoholic beverage drinker


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MEDICAL/SURGICAL INTERVENTIONS

Management of Potts disease

Drug treatment is generally sufficient for

Potts disease, with spinal immobilization if

required. Surgery is required if there is spinal

deformity or neurological signs of spinal cord

compression.

Standard antituberculosis treatment is

required. Duration of antituberculosis

treatment: If debridement and fusion with

bone grafting are performed, treatment can be

for six months. If debridement and fusion with

bone grafting are NOT performed a minimum of
http://www.bsac.org.uk/pyxis/RTI/Tuberculosis/Tuberculosis.htm#managementhttp://www.bsac.org.uk/pyxis/RTI/Tuberculosis/Tuberculosis.htm#management


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Surgery includes ADSF ( Anterior

decompression Spinal fusion).

Drug Study

GENERIC NAME: HRZE(isoniazid+rifampicin+pyrazinamide+ethambutol)Brand name: Myrin

Dosage: 3 tab 30 min before breakfastDrug Classification:Anti-infective

MECHANISM INDICATIONS CONTRA-INDICATIONS

ADVERSEREACTION

NURSINGResponsibilities


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Unknown.Appears to

inhibit cell-wallbiosynthesisbyinterferingwith lipidand DNAsynthesis

> Activelygrowing

tubercle bacilli>prevention oftubercle bacilliin thoseexposed totuberculosis orthose withpositive skin

test resultswhose chest x-rays andbacteriologicstudies areconsistent withnon-progressive

tuberculosis

-

Contraindicate

d in patientswith acutehepatic diseaseor isoniazid-related liverdamge

> peripheralneuropathy,

fluiddiscoloration,optic neuritis,hepatitis

>Usecautiously

in elderlypatients>peripheralneuropathyis morecommon inpatientswho are

slowacetylatorsor who aremalnourished, alcoholicor diabetic,>Monitorhepatic

functionclosely forchanges


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Unknown.Produces

anti-inflammatory,analgesic,andantipyreticeffects,possibly byinhibiting

prostaglandin synthesis

> short-termmanagement

of moderatelysevere, acutepain for singledose treatment> Short-termmanagementof moderatelysever, acute

pain formultiple dosetreatment

-

Contraindicate

d in patientshypersensitiveto drug and inthose withactive pepticulcer disease ,recent GIbleeding or

perforation,advanced renalimpairment,incompletehomeostasisand with highrisk ofbleeding.

> drowsiness,sedation,

edema,hypertension,diarrhea,stomatitis,pepticulceration,rash,diaphoresis

> Ketorolacisnt

recommended forchildren> Usecautiouslyin patientswith hepaticand renal

impairment>NSAIDSmay masksigns andsymptomsof infectionbecause oftheir

antipyreticand anti-inflammatory actions


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MECHANISM INDICATIONS CONTRA-INDICATIONS

ADVERSEREACTION

NURSINGResponsibilities

Inhibitsbacterial dnasynthesis,mainly byblockingDNA gyrase,bactericidal.

> Severe orcomplicatedbone or jointinfections>Complicatedintraabdominalinfections

-Contraindicatedto patientssensitive tofluoroquinolones

> headache,retlessness,fatigue,drowsiness,edema, chestpain, nausea,diarrhea,leucopenia,

crystalluria

> Usecautiouslyin patientswith CNSdisorders,such asseverecerebral

arteriosclerosis orseizuredisorders,and in thosewith risk forseizures.> Monitorpatientsintake andoutput andobserve forsigns ofcrystalluria>Obtain

specimenfor cultureandsensitivity


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Spread of mycobacterium tuberculosis from othersite

Extrapulmomary tuberculosis

The infection spreads from two adjacent vertebraeinto the adjoining disc space

One vertebra is affected, the disc is normalTwo are involved, the avascular intervertebral disc cannot

receive nutrients and collapse

Disk tissue dies and broken down by caseation

Vertebral narrowing

Vertebral collapse

Spinal damage

back pain, fever, night sweats,anorexia, weight loss, and easyfatigability.


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Beforehospitalization

Duringhospitalization

Health-perception/Health-managementpattern

It is her first timeto get hospitalized.She usually justbears the pain oruses self-medication.

She hopes that shewill get better..

Nutritional/Metabolic pattern

The patient eats allkinds of food. She

likes to eatvegetables.

The patient stilleats a lot.

Elimination pattern The patientdefecates regularlyat least once a dayor sometimes onceevery two days and

urinates frequently.The patient sweatsa lot because of theweather.

The patient hasurinary and bowelincontinencebecause of spinalcord injury.

Activity/ Exercisepattern

The patients formof exercise is doingthe householdchores.

She doesnt have aform of exercise inthe hospitalbecause she is

bedridden, as aresult of spinal cordinjury.

Sleep rest pattern The patient usually The patient s sleep


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because she thinksshe is useless.

Role/ Relationshippattern

The patient is veryfriendly and has agood relationshipwith people aroundher.

The patient iscommunicativewhen you talk toher but she will notbe the one to openup conversations.

Coping/ Stress-tolerance pattern

WEhen stressed,she usually diverts

it by watchingtelevision.

When the patientexperiences stress,

she just prays togod because thereare not otherdiversionalactivities she cando in the hospital.

Discharge Plan

P- atient should be reminded to attend check-ups at the nearest.

O- rthopedic center


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PHYSICAL ASSESSMENT

Body part Technique used Normal findings Actual findings Analysis/InterpretationHead

Eyes

Hair

Ears

Nose

Skin

PalpationInspection

Inspection

Inspection

Inspection

Inspection

Inspection

Absence of massesand nodules

Conjunctiva is pink

Usually black andshiny.

Color is the same asfacial skin. Pinnatends to bend easilyand recoils easily afterbending.

Symmetrical with nodeformities.

Good or active skinturgor. Absence of

Head does not appear toolarge or too small. Therewere no masses andnodules.

Anicteric scleraPink palpebralconjunctiva

Hair doesnt look dull.

Color is the same asfacial skin. No deformitiesfound. No discharge

Symmetrical. Nodeformities found.(-) nasal congestion

Good skin turgor(-) rashes

Normal

Normal

Normal

Normal

Normal

Normal


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Mouth

Nails

Arms

Chest

Inspection

Inspection

Inspection

Palpation,Inspection andAuscultation

ecchymosis.

Uniform, pink color ofthe gums, moist andsmooth in texture

Smooth and usuallylong enough to extend

over the fingertips;should be coloredpink, convex in shapeand with 160o anglebetween the nails andthe nailbeds.

Should have goodmuscle contraction.Good flexion andextension. Absence ofecchymosis anddeformities.

Chest is symmetrical,

Pink-colored gums. Moistbuccal mucosa.

Good capillary refill.Light pink in color,

convex in shape.

No ecchymosis noted. full

and equal pulses.

Slight DOB(+) gibbus formation

Normal

Normal

Normal

Abnormal


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Abdomen

Genitalia

Legs andExtremities

Respiratorysystem

Cardiovascularsystem

Palpation and

Inspection

Inspection

Inspection

Auscultation

Auscultation

rhythmic andbreathing pattern iseffortless

Contour is slightlyprotuberant.

Pinkish in color andintact.

Absence ofdeformities and goodROM. Absence ofedema andecchymosis.

No unusual soundsshould be heard; RRshould range

from normaland effortlessrespiration.

Regular rhythm, noheart murmurs.

Flat abdomen.Normoactive bowelsounds.

N/A

Grossly normal.

No edema.No cyanosis.

Clear breath sounds. Noretractions.

Adynamicprecordium,normalrate,regular rhythm,Nomurmur

Normal

N/A

Normal

Normal

Normal


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NURSING CARE PLAN

Cues Nursing Diagnosis Planning Implementation Rationale Evaluation

SUBJECTIVE:Ayoko ngganito.Mahirap.Inaasa nalanglahat sa iba..Wala namandin akomagawa dahil

hindi ko namankaya, asverbalized bythe patient.

OBJECTIVE:- patient hasbeen bedriddenever since shewas

hospitalized

Disturbed bodyimage related totrauma/ injury tospinal cord asevidenced byverbal reports ofnegative feelingsabout body(feelings of

helplessness andpowerlessness)

GOAL:

After 1 day of nursingintervention, thepatient will recognizeand incorporate bodyimage change into self-concept in accuratemanner without

negating self-esteem.

EXPECTED OUTCOME:The patient will:

1) Verbalizeacceptance ofself in situation.

2) Verbalize reliefof anxiety andadaptation to

actual/alteredbody image.3) Acknowledge

self as anindividual whohasresponsibility forself.

Independent:

1) Determinewhethercondition ispermanent/ nohope forresolution

2) Evaluate level ofclients

knowledge ofand anxietyrelated tosituation.Observeemotionalchanges.

3) Have clientdescribe self ,noting what is

positive andwhat is negative.Beware of howclient believesothers see self.

4) Note signs ofgrieving/indictors of depression

>To assesscausative/contributingfactors

> To assesscausative/

contributingfactors

>To assescausative/contributingfactors

>To evaluateneeds forcounseling and

Evaluateresponse tointerventions,teachings andactionsperformed.

* The patientwas able to

incorporatebody imagechange intoself-conceptwithoutnegating self-esteem.The goal wasmet.


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5) Identifypreviously usedcoping

strategies and itseffectiveness.6) Establish

therapeuticnurse-clientrelationshipconveying anattitude of caringand developing asense of trust.

7) Provideassistance withself care needs/measures asnecessary whilepromotingindividualabilities/independence

Collaborative:8) Refer toappropriatesupport groups.

9) Talk to SO(s)about ways tohelp client dealwith problem

medication>To determinecoping

skills/capabilities

> To assistclient/SO(s) todeal with/acceptissues of self-concept related tobody image.

>To enhance

capabilities

>To providecontinuity of care

>To promotecollaboration .


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Cues Nursing Diagnosis Planning Implementation Rationale Evaluation

SUBJECTIVE: Ang hirap ngganito, nakahigana lang lagi, kahitpaligo inaasa saiba, as verbalizedby the patient

OBJECTIVE:> patient has been

bedridden eversince she washospitalizedbecause of spinalcord injury

Self-bathing/hygiene deficitrelated to musculo-skeletal impairmentas evidenced byinability to washbody or body parts,obtain or get towater source, get inand out of

bathroom.

GOAL:

After 1 day ofnursingintervention, thepatient willperform self-careactivities withinlevel of ownability

EXPECTEDOUTCOME:The patient will:1) Identify

individualareas ofweakness/needs

2) Demonstrate

techniques/lifestylechanges tomeet self-care needs

3) Identifypersonalresources

Independent:

1) Determine existingconditionsaffecting ability ofindividual to carefor own needs, i.e.spinal cord injury.

2) Determineindividualstrengths of client

3) Note whetherdeficient istemporary orpermanent, shoulddecrease orincrease in time

4) Promote client/ SOparticipation inproblemidentification and

decision making.5) Develop plan ofcare appropriate toindividualsituation,schedulingactivities toconform to clients

> To identifycausative/contributingfactors

> To assessdegree of

disability>To assess degreeof disability

>enhancescommitment toplan, optimizing

outcomes> to assist incorrecting/ dealingwith situation

Evaluateresponses tointerventions,teachings andactionsperformed.

*The client wasable to performself-care

activities withinlevel of ownability.Goal was met


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that canprovideassistance

normal schedule.6) Assist with rehab

program

7) Allow sufficienttime for client toaccomplish tasksto fullest extent ofability

8) Assist withnecessaryadaptation toaccomplish ADLs.Begin with familiar,

easilyaccomplishedtasks.

9) Review/modifyprogramperiodically toaccommodatechanges in abilities

Dependent:

10)Administermedicationregimen

Collaborative:11)Consult with

dietitian/nutritionalsupport team

> To enhancecapabiities> To enhance

capabilities

>To encourageclient and build onsuccesses.

>Assist patient toadhere to plan ofcare to fullestextent

>To providecontinuity of care

> To providecontinuity of care

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