Anatomy and Physiology The spinal cord is the largest nerve in the body, and it is comprised of the nerves whichact as the communication system for the body. The nerve fibers within the spinal cord carrymessages to and from the brain to other parts of the body. The spinal cord is surrounded byprotective bone segments, called the vertebral column. The vertebral column is comprised ofseven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae and five sacralvertebrae. The vertebral column also provides attachment points for muscles of the back and ribs.The vertebral disks serve as shock absorbers during activities such as walking, running andjumping, they also allow the spine to flex and extend.
IntroductionPotts 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. Commonly localized in the thoracic 11 and thoracic 12. The original name was formed after Percivall Potts a London surgeon. Patient with BCG has 80% immunity. Pathognomonic Sign: Gibbus Formation Signs and Symptoms: Back Pain, Fever, Night Sweating, Anorexia, Weight Loss, Spinal mass, sometimes associated with numbness, tingling, or muscle weakness of the legs Diagnostic Exam: Blood Test: elevated erythrocyte sedimentation rate, Tuberculin test, Bone Scan, Radiographs of the spine, CT of the spine, Bone biopsy, MRI Predisposing Factors: Direct contaminant especially in children, Malnutrition, Poor Environmental Condition, Trauma
Nursing History1. Personal Data Name: Ms. RB Age: 3y/o Sex: Female Address: Sto. Tomas Santiago, Batangas Occupation: N/A Religion: Roman Catholic Date and Time of admission: March 5, 2009 4:30pm Admitting Physician: Dr. HM2. Chief Complaint Fever and Back pain3. History of Present illness 5 months before hospitalization the patient felled from the stairs. The patient’s mother brought her to a “manghihilot”. 2 weeks before hospitalization the patient’s mother have seen a mass at the patient’s back, the patient had fever and accompanied with back pain. The mother decided to go to the doctor for consultation.
1 day before hospitalization the patient’s mother went to the hospital and was referred to Phil. Orthopedic Center. The patient was admitted at children’s ward and scheduled for CBC and x-ray of the thoracolumbar spine. 4. Past Medical History The patient’s 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 worker, smoke cigarettes at least 3-4 sticks a day. The mother stays at home to take care of her 5 children.Pathophysiology Pulmonary Tuberculosis Spread of Mycobacterium Tubercule in the T7-T9 of the spine Extra-pulmonary Tuberculosis The infection spreads from intervertebral disc Pus formation between the intervertebral disc Back Pain, Fever, and Disc tissue dies Night Sweats, Spinal mass broken down by Vertebral Disease VertebralNarrowing Potts’ Damage Spinal Collapse caseation
Laboratory / Diagnostic Examinations March 5, 2009 Blood Chemistry Normal Value Result Findings
Component:-Hemoglobin mass 110-150 g/L(female) 125 g /L Normal-Leucocyte count 4.5-10 x 10 g/L 16.90 g/L May indicate infectionDifferential count:-Segmenters 0.50-0.70 0.45 Normal-Lymphocyctes 0.20-0.40 0.42 May indicate infection-Monocytes 0.00-0.07 0.08 May indicate infection-Eosinophils 0.00-0.05 0.05 Normal-Platelet count 150-400 x 109/L 532 x 109/L May indicate inflammatory disease April 16, 2009 Blood Chemistry Normal Value Result FindingsComponent:-Hemoglobin mass 110-150 g/L(female) 129 g/L Normal-Hematocrit 0.37-0.54 0.40 Normal-Leucocyte count 4.5-10 x 10 g/L 13.6 x 10 g/L May indicate infectionDifferential count:-Segmenters 0.50-0.70 0.45 Normal-Lymphocyctes 0.20-0.40 0.50 May indicate infection-Monocytes 0.00-0.07 0.01 Normal-Eosinophils 0.00-0.05 0.04 Normal-Platelet count 150-400 x 109/L 375 x 109/L Normal March 5, 2009 Urinalysis Normal Value Result Findings
Electrolytes:Sodium 135-148 mmol/L 139.7 mmol/L NormalPotassium 3.5-5.3 mmol/L 3.98 mmol/L NormalChloride 98-107 mmol/L 101.7 mmol/L Normal March 10, 2009 Urinalysis Normal Value Result FindingsColor Straw to Dark yellow Light yellow NormalTransparency Slightly Hazy Hazy NormalSpecific Gravity 1.002-1.006 1.003 NormalReaction Acidic March 12, 2009X-ray of the Thoracolumbar spineImpression: Pneumonitis, both lower lung zone with lyphadenopathiesConsolidation vs. Extension of paravertebral abscess, right lower lung zonePotts disease, as described, T6-T11 March 24, 2009CT scan of the Thoracic spineImpression: Findings as consistent with Potts disease T8-T9 with pulmonary extension asdescribed
Drug Study Classification Dosage Mechanism of Indication Contraindication Adverse Reaction Nursing Action ConsiderationGeneric Name: Anti-infectives 200mg/5ml Rifampicin Maintenance phase Hypersensitivity, GI disturbances, >Assess lungRifampicin syrup inhibits DNA- treatment of all jaundice, severe pseudomembranous sounds and 6ml OD ac PO dependent forms of hepatic disease colitis (rare), character andBrand Name: polymerase, pulmonary and abnormalities of amount of sputum decreases extra-pulmonary liver function, periodically replication tuberculosis(TB) fatalities in those during therapy with liver disorders, >Assess results of influenza-like periodic symptoms, skin laboratory tests reactions, and chest x-ray, eosinophilia, therapeutic transient effectiveness and leucopenia, adverse reactions thrombocytopenia, >Monitor patient purpura, shock, compliance with drowsiness, treatment regimen headache, ataxia, visual disturbances, menstrual irregularities. Reddish colored urine and tears. IV: Thrombophloebitis; extravasation following local irritation and inflammation.
Classification Dosage Mechanism of Indication Contraindication Adverse Reaction Nursing Action ConsiderationGeneric Name: Anti-infectives 200mg/5ml syrup Isoniazid inhibits Pulmonary and Acute liver disease Peripheral >AssessIsoniazid 6ml OD ac PO RNA synthesis, extra-pulmonary or history of neuritis, optic laboratory decreases tuberculosis(TB) hepatic damage neuritis; psychotic examinationsBrand Name: tubercule bacilli during INH reactions, >Monitor replication therapy; convulsions, liver/renal hypersensitivity nausea, vomiting, function fatigue, epigastric >Assess CNS distress, visual often disturbances, >Assess hepatic fever, rash, status pyridoxine >Assess for visual deficiency disturbance that may indicate optic neuritis
Classification Dosage Mechanism of Indication Contraindication Adverse Reaction Nursing Action ConsiderationGeneric Name: Analgesics 125mg/5ml syrup Paracetamol Treatment of Hypersensitivity Stimulation, >Assess patient’sParacetamol 5ml Q4 PRN PO exhibits analgesic fever drowsiness, nausea, fever action by vomiting, >Assess forBrand Name: peripheral abdominal pain, allergic reactions blockage of pain hepatotoxicity, >Assess impulse hepatic seizure, hepatotoxicity generation. It renal failure, >Monitor liver produces luekopenia, and renal antipyresis by neutropenia, functions inhibiting the hemolytic anemia, hypothalamic thrombocytopenia, heat-regulating pancytopenia, rash, centre. Its weak urticaria, anti-inflammatory hypersensitivity, activity is related cyanosis, anemia, to inhibition of neutropenia, prostaglandin jaundice, synthesis in the pancytopenia, CNS CNS. stimulation, delirium followed by vascular collapse, convulsions, coma, death
Nursing Care Plan Assessment Diagnosis Inference Planning Intervention Rationale EvaluationSubjective: Imbalanced Nutrition Pulmonary After 8hrs of Nursing -Assess weight, age, -To provide After 8hrs of Nursing “Kulang daw siya sa less than body Tuberculosis Interventions the body build, strength, comparative baseline Interventions thetimbang sabi ng requirements related patient will activity/rest level patient hasdoctor” as verbalized to ingest adequate demonstrate a demonstrated aby the mother nutrients Weakens immune behaviors to achieve -Discuss eating -To appeal to the behaviors to achieve system appropriate weight habits, including patients likes appropriate weightObjective: food preferences to-Under weight the mother-Lack of interest in Generalizedeating nutritious weakness -Administer -To enhance patientsfood Vitamins as ordered intake Loss of appetite -Encourage and -To conserve energy, provide for frequent especially in rest periods metabolic requirements Imbalanced Nutrition -Encourage small, -To maximize frequent meals with nutrient intake food high in protein without undue and carbohydrates fatigue -Provide oral care -To reduce bad taste before/after meals at left from the bedtime medications used in respiratory treatment
Assessment Diagnosis Inference Planning Intervention Rationale EvaluationSubjective: Impaired Physical Pulmonary After 4hrs of Nursing -Encourage to -To prevent After 4hrs of Nursing“Nilagyan siya ng Mobility related to Tuberculosis Interventions the change position complications Interventions theTaylor Brace” as therapeutic patient’s mother will every 2 hours patient’s mother hasverbalized by the restrictions of Spread of verbalize verbalizedmother movement Mycobacterium understanding of the -Schedule activities -To reduce fatigue understanding the Tubercule in the situation and with adequate res situation andObjective: spine treatment regimen periods treatment regimen-Limited range of and safety measures and safety measuresmotion Extra-pulmonary -Provide regular skin -To promote good-Difficulty in turning Tuberculosis care hygiene-Presence of TaylorBrace Infection spreads -Provide passive -To maintain muscle from the exercises integrity intervertebral disc -Encourage adequate -To maximize energy Pus formation intake nutritious production between the foods intervertebral disc -Explain the use of -To promote Disc tissue dies and adjunctive devices knowledge and broken down by such as Taylor Brace enhances safety caseation Vertebral Collapse Spinal Damage Impaired Physical Mobility