The patient's mother understands the situation and treatment regimen including safety measures such as limiting range of motion and use of Taylor brace after nursing interventions of encouraging position changes every 2 hours, scheduling rest periods with activities, providing skin care and passive exercises, explaining use of devices, and encouraging nutritious intake.

1. Nursingcasestudy.blogspot.com

2. Anatomy and Physiology
The spinal cord is the largest nerve in the body, and it is comprised of the nerves which
act as the communication system for the body. The nerve fibers within the spinal cord carry
messages to and from the brain to other parts of the body. The spinal cord is surrounded by
protective bone segments, called the vertebral column. The vertebral column is comprised of
seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae and five sacral
vertebrae. 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 and
jumping, they also allow the spine to flex and extend.

3. 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.
 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

4. Nursing History
1. 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. HM
2. Chief Complaint
Fever and Back pain
3. 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.

5. 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

6. Laboratory / Diagnostic Examinations
March 5, 2009
Blood Chemistry Normal Value Result Findings

7. 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 infection
Differential 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 Findings
Component:
-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 infection
Differential 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

8. Electrolytes:
Sodium 135-148 mmol/L 139.7 mmol/L Normal
Potassium 3.5-5.3 mmol/L 3.98 mmol/L Normal
Chloride 98-107 mmol/L 101.7 mmol/L Normal
March 10, 2009
Urinalysis Normal Value Result Findings
Color Straw to Dark yellow Light yellow Normal
Transparency Slightly Hazy Hazy Normal
Specific Gravity 1.002-1.006 1.003 Normal
Reaction Acidic
March 12, 2009
X-ray of the Thoracolumbar spine
Impression: Pneumonitis, both lower lung zone with lyphadenopathies
Consolidation vs. Extension of paravertebral abscess, right lower lung zone
Potts disease, as described, T6-T11
March 24, 2009
CT scan of the Thoracic spine
Impression: Findings as consistent with Potts disease T8-T9 with pulmonary extension as
described

9. Drug Study
Classification Dosage Mechanism of Indication Contraindication Adverse Reaction Nursing
Action Consideration
Generic Name: Anti-infectives 200mg/5ml Rifampicin Maintenance phase Hypersensitivity, GI disturbances, >Assess lung
Rifampicin syrup inhibits DNA- treatment of all jaundice, severe pseudomembranous sounds and
6ml OD ac PO dependent forms of hepatic disease colitis (rare), character and
Brand 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.

11. Classification Dosage Mechanism of Indication Contraindication Adverse Reaction Nursing
Action Consideration
Generic Name: Anti-infectives 200mg/5ml syrup Isoniazid inhibits Pulmonary and Acute liver disease Peripheral >Assess
Isoniazid 6ml OD ac PO RNA synthesis, extra-pulmonary or history of neuritis, optic laboratory
decreases tuberculosis(TB) hepatic damage neuritis; psychotic examinations
Brand 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

12. Classification Dosage Mechanism of Indication Contraindication Adverse Reaction Nursing
Action Consideration
Generic Name: Analgesics 125mg/5ml syrup Paracetamol Treatment of Hypersensitivity Stimulation, >Assess patient’s
Paracetamol 5ml Q4 PRN PO exhibits analgesic fever drowsiness, nausea, fever
action by vomiting, >Assess for
Brand 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

13. Nursing Care Plan
Assessment Diagnosis Inference Planning Intervention Rationale Evaluation
Subjective: 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 the
timbang sabi ng requirements related patient will activity/rest level patient has
doctor” as verbalized to ingest adequate demonstrate a demonstrated a
by 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 weight
Objective: food preferences to
-Under weight the mother
-Lack of interest in Generalized
eating nutritious weakness -Administer -To enhance patients
food 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

14. Assessment Diagnosis Inference Planning Intervention Rationale Evaluation
Subjective: 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 the
Taylor Brace” as therapeutic patient’s mother will every 2 hours patient’s mother has
verbalized by the restrictions of Spread of verbalize verbalized
mother movement Mycobacterium understanding of the -Schedule activities -To reduce fatigue understanding the
Tubercule in the situation and with adequate res situation and
Objective: spine treatment regimen periods treatment regimen
-Limited range of and safety measures and safety measures
motion Extra-pulmonary -Provide regular skin -To promote good
-Difficulty in turning Tuberculosis care hygiene
-Presence of Taylor
Brace 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