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.
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
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.
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 discPus formation between the intervertebral disc Back Pain, Fever, Night
Sweats, Spinal mass
Disc tissue dies and broken down by
caseation Vertebral NarrowingVertebral CollapseSpinal DamagePotts’ Disease
Laboratory / Diagnostic Examinations
March 5, 2009
Blood Chemistry Normal Value Result Findings
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
May indicate infection May indicate infection Normal
May indicate inflammatory disease
April 16, 2009
Blood Chemistry Normal Value Result Findings
Component: -Hemoglobin mass -Hematocrit -Leucocyte count Differential count: -Segmenters -Lymphocyctes -Monocytes -Eosinophils -Platelet count 110-150 g/L(female) 0.37-0.54 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 129 g/L 0.40 13.6 x 10 g/L 0.45 0.50 0.01 0.04 375 x 109/L Normal Normal
May indicate infection
Normal
May indicate infection Normal
Normal Normal
March 5, 2009
Urinalysis Normal Value Result Findings
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
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
Drug Study
Classification Dosage Mechanism of Action
Indication Contraindication Adverse Reaction Nursing Consideration Generic Name: Rifampicin Brand Name: Anti-infectives 200mg/5ml syrup 6ml OD ac PO Rifampicin inhibits DNA-dependent polymerase, decreases replication Maintenance phase treatment of all forms of pulmonary and extra-pulmonary tuberculosis(TB) Hypersensitivity, jaundice, severe hepatic disease GI disturbances, pseudomembranous colitis (rare), abnormalities of liver function, fatalities in those with liver disorders, influenza-like symptoms, skin reactions, eosinophilia, transient leucopenia, thrombocytopenia, purpura, shock, drowsiness, headache, ataxia, visual disturbances, menstrual irregularities. Reddish colored urine and tears. IV: Thrombophloebitis; extravasation following local irritation and inflammation. >Assess lung sounds and character and amount of sputum periodically during therapy >Assess results of periodic laboratory tests and chest x-ray, therapeutic effectiveness and adverse reactions >Monitor patient compliance with treatment regimen
Classification Dosage Mechanism of
Action Indication Contraindication Adverse Reaction ConsiderationNursing Generic Name: Isoniazid Brand Name: Anti-infectives 200mg/5ml syrup 6ml OD ac PO Isoniazid inhibits RNA synthesis, decreases tubercule bacilli replication Pulmonary and extra-pulmonary tuberculosis(TB)
Acute liver disease or history of hepatic damage during INH therapy; hypersensitivity Peripheral neuritis, optic neuritis; psychotic reactions, convulsions, nausea, vomiting, fatigue, epigastric distress, visual disturbances, fever, rash, pyridoxine deficiency >Assess laboratory examinations >Monitor liver/renal function >Assess CNS often >Assess hepatic status
>Assess for visual disturbance that may indicate optic neuritis
Classification Dosage Mechanism of
Action Indication Contraindication Adverse Reaction ConsiderationNursing Generic Name: Paracetamol Brand Name: Analgesics 125mg/5ml syrup 5ml Q4 PRN PO Paracetamol exhibits analgesic action by peripheral blockage of pain impulse generation. It produces antipyresis by inhibiting the hypothalamic heat-regulating centre. Its weak anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the CNS. Treatment of fever 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, CNS stimulation, delirium followed by vascular collapse, convulsions, coma, death >Assess patient’s fever >Assess for allergic reactions >Assess hepatotoxicity >Monitor liver and renal functions
Nursing Care Plan
Assessment Diagnosis Inference Planning Intervention Rationale Evaluation
Subjective:
“Kulang daw siya sa timbang sabi ng doctor” as verbalized by the mother Objective: -Under weight -Lack of interest in eating nutritious food Imbalanced Nutrition less than body
requirements related to ingest adequate nutrients Pulmonary Tuberculosis Weakens immune system Generalized weakness Loss of appetite Imbalanced Nutrition After 8hrs of Nursing Interventions the patient will demonstrate a behaviors to achieve appropriate weight
-Assess weight, age, body build, strength, activity/rest level -Discuss eating habits, including food preferences to the mother -Administer Vitamins as ordered -Encourage and provide for frequent rest periods
-Encourage small, frequent meals with food high in protein and carbohydrates -Provide oral care before/after meals at bedtime
-To provide
comparative baseline -To appeal to the patients likes
-To enhance patients intake
-To conserve energy, especially in metabolic requirements -To maximize nutrient intake without undue fatigue
-To reduce bad taste left from the
medications used in respiratory treatment After 8hrs of Nursing Interventions the patient has demonstrated a behaviors to achieve appropriate weight
Assessment Diagnosis Inference Planning Intervention Rationale Evaluation Subjective: “Nilagyan siya ng Taylor Brace” as verbalized by the mother Objective: -Limited range of motion -Difficulty in turning -Presence of Taylor Brace Impaired Physical Mobility related to therapeutic restrictions of movement Pulmonary Tuberculosis Spread of Mycobacterium Tubercule in the spine Extra-pulmonary Tuberculosis Infection spreads from the intervertebral disc Pus formation between the intervertebral disc Disc tissue dies and
broken down by caseation Vertebral Collapse Spinal Damage Impaired Physical Mobility After 4hrs of Nursing Interventions the patient’s mother will verbalize
understanding of the situation and
treatment regimen and safety measures
-Encourage to change position every 2 hours -Schedule activities with adequate res periods
-Provide regular skin care -Provide passive exercises -Encourage adequate intake nutritious foods
-Explain the use of adjunctive devices such as Taylor Brace
-To prevent complications -To reduce fatigue
-To promote good hygiene
-To maintain muscle integrity
-To maximize energy production -To promote knowledge and enhances safety After 4hrs of Nursing Interventions the patient’s mother has verbalized
understanding the situation and treatment regimen and safety measures
