case study potts disease2

8/4/2019 Case Study Potts Disease2

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Anatomy and Physiology


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Introduction

Potts disease

Is a spine infection associated with tuberculosis that is characterized by bone destruction,

fracture, and collapse of the vertebrae, resulting in kyphotic deformity.

Is the presentation of the extra-pulmonary tuberculosis arthritis of the intervertebral joints

Also called tuberculosis spondylitis, tuberculous spondyloarthropathy, spinal TB,musculoskeletal tuberculosis

The causative agent is Mycobacterium Tubercule

Particularly the lower thoracic and the upper lumbar regions are affected.


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Nursing History

1. Personal Data

Name: Ms. RB

Age: 3y/o

Sex: Female

Address: Sto. Tomas Santiago, Batangas


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1 day before hospitalization the patients mother went to the hospital and was referred

to Phil. Orthopedic Center. The patient was admitted at childrens ward and scheduled for

CBC and x-ray of the thoracolumbar spine.

4. Past Medical History

The patients mother always consults Manghihilot when her daughter is sick. The

mother has lack of interest in going to health center to seek medical consultation when

her daughter is sick.

5. Family Medical History

The mother and father of the patient self-medicates when there are sick, the mother

said that there family has never been hospitalized. The father works as a construction


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Component:

-Hemoglobin mass

-Leucocyte count

Differential count:

-Segmenters

-Lymphocyctes

-Monocytes

-Eosinophils

-Platelet count

110-150 g/L(female)

4.5-10 x 10 g/L

0.50-0.70

0.20-0.40

0.00-0.07

0.00-0.05

150-400 x 109/L

125 g /L

16.90 g/L

0.45

0.42

0.08

0.05

532 x 109/L

Normal

May indicate infection

Normal



Normal

May indicate inflammatory

disease

April 16, 2009

Blood Chemistry Normal Value Result Findings


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Electrolytes:

Sodium

Potassium

Chloride

135-148 mmol/L

3.5-5.3 mmol/L

98-107 mmol/L

139.7 mmol/L

3.98 mmol/L

101.7 mmol/L

Normal

Normal

Normal

March 10, 2009

Urinalysis Normal Value Result Findings

Color

Transparency

Specific Gravity

Reaction

Straw to Dark yellow

Slightly Hazy

1.002-1.006

Light yellow

Hazy

1.003

Acidic

Normal

Normal

Normal


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Drug Study

Classification Dosage Mechanism of Action

Indication Contraindication Adverse Reaction NursingConsideration

Generic Name:

Rifampicin

Brand Name:

Anti- infectives 200mg/5ml

syrup6ml OD ac PO

Rifampicin

inhibits DNA-dependent

polymerase,

decreasesreplication

Maintenance phase

treatment of allforms of

pulmonary and

extra-pulmonarytuberculosis(TB)

Hypersensitivity,

jaundice, severehepatic disease

GI disturbances,

pseudomembranouscolitis (rare),abnormalities of

liver function,fatalities in those

with liver disorders,influenza-like

symptoms, skinreactions,

eosinophilia,transient

leucopenia,

thrombocytopenia,purpura, shock,drowsiness,

headache, ataxia,visual disturbances,

menstrualirregularities.

Reddish coloredurine and tears. IV:

Thrombophloebitis;extravasation

following local

irritation andinflammation.

>Assess lung

sounds andcharacter andamount of sputum

periodicallyduring therapy

>Assess results ofperiodic

laboratory testsand chest x-ray,

therapeuticeffectiveness and

adverse reactions

>Monitor patientcompliance withtreatment regimen


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Generic Name:Isoniazid

Brand Name:

Anti-infectives 200mg/5ml syrup6ml OD ac PO

Isoniazid inhibitsRNA synthesis,

decreasestubercule bacilli

replication

Pulmonary andextra-pulmonary

tuberculosis(TB)

Acute liver diseaseor history of

hepatic damageduring INH

therapy;hypersensitivity

Peripheralneuritis, optic

neuritis; psychoticreactions,

convulsions,nausea, vomiting,

fatigue, epigastricdistress, visual

disturbances,fever, rash,

pyridoxinedeficiency

>Assesslaboratory

examinations>Monitor

liver/renalfunction

>Assess CNSoften

>Assess hepaticstatus

>Assess for visualdisturbance that

may indicate opticneuritis


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Generic Name:Paracetamol

Brand Name:

Analgesics 125mg/5ml syrup5ml Q4 PRN PO

Paracetamolexhibits analgesic

action by

peripheralblockage of painimpulse

generation. Itproducesantipyresis by

inhibiting thehypothalamic

heat-regulatingcentre. Its weak

anti-inflammatoryactivity is related

to inhibition ofprostaglandin

synthesis in theCNS.

Treatment offever

Hypersensitivity Stimulation,drowsiness, nausea,

vomiting,

abdominal pain,hepatotoxicity,hepatic seizure,

renal failure,luekopenia,neutropenia,

hemolytic anemia,thrombocytopenia,

pancytopenia, rash,urticaria,

hypersensitivity,cyanosis, anemia,

neutropenia,jaundice,

pancytopenia, CNSstimulation,

delirium followedby vascular

collapse,convulsions, coma,

death

>Assess patientsfever

>Assess for

allergic reactions>Assesshepatotoxicity

>Monitor liverand renalfunctions


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Nursing Care Plan

Assessment Diagnosis Inference Planning Intervention Rationale Evaluation

Subjective:

Kulang daw siya sa

timbang sabi ngdoctor as verbalizedby the mother

Objective:

-Under weight-Lack of interest in

eating nutritiousfood

Imbalanced Nutrition

less than body

requirements relatedto ingest adequatenutrients

Pulmonary

Tuberculosis

Weakens immune

system

Generalized

weakness

Loss of appetite

Imbalanced Nutrition

After 8hrs of Nursing

Interventions the

patient willdemonstrate abehaviors to achieve

appropriate weight

-Assess weight, age,

body build, strength,

activity/rest level

-Discuss eating

habits, includingfood preferences to

the mother

-AdministerVitamins as ordered

-Encourage and

provide for frequent

rest periods

-Encourage small,frequent meals with

food high in proteinand carbohydrates

-Provide oral care

before/after meals atbedtime

-To provide

comparative baseline

-To appeal to the

patients likes

-To enhance patientsintake

-To conserve energy,

especially in

metabolicrequirements

-To maximizenutrient intake

without unduefatigue

-To reduce bad taste

left from themedications used in

respiratory treatment


Interventions the

patient hasdemonstrated abehaviors to achieve

appropriate weight


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Assessment Diagnosis Inference Planning Intervention Rationale Evaluation

Subjective:

Nilagyan siya ng

Taylor Brace asverbalized by themother

Objective:

-Limited range ofmotion

-Difficulty in turning-Presence of Taylor

Brace

Impaired Physical

Mobility related to

therapeuticrestrictions ofmovement

Pulmonary

Tuberculosis

Spread ofMycobacterium

Tubercule in thespine

Extra-pulmonary

Tuberculosis

Infection spreadsfrom the

intervertebral disc

Pus formationbetween the

intervertebral disc

Disc tissue dies andbroken down by

caseation

Vertebral Collapse

Spinal Damage

Impaired PhysicalMobility


Interventions the

patients mother willverbalizeunderstanding of the

situation andtreatment regimen

and safety measures

-Encourage to

change position

every 2 hours

-Schedule activities

with adequate resperiods

-Provide regular skin

care

-Provide passiveexercises

-Encourage adequateintake nutritiousfoods

-Explain the use of

adjunctive devicessuch as Taylor Brace

-To prevent

complications

-To reduce fatigue

-To promote good

hygiene

-To maintain muscleintegrity

-To maximize energyproduction

-To promote

knowledge andenhances safety


Interventions the

patients mother hasverbalizedunderstanding the

situation andtreatment regimen

and safety measures


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case study potts disease2

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