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
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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
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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
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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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