Case Study - Pott's Disease (Final)

7/27/2019 Case Study - Pott's Disease (Final)

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Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City

COLLEGE OF NURSING

CASE STUDY

ON

POTTS DISEASE

___________________

Presented to

THEA C. TURQUEZA, RN, MAT Ng, MAN

Clinical Instructor


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Tamag, Vigan City

COLLEGE OF NURSING

CASE STUDY GRADING SHEET

PARAMETERS PERCENTAGE

%

ACTUAL

GRADE

Introduction & Objectives 5

Personal Data

Nursing History of Past and Present Illness

5

PEARSON Assessment 15Diagnostic Procedures

a. Idealb. Actual 5

Anatomy & Physiology of Organs Involved 5

Pathophysiology


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Tamag, Vigan City

COLLEGE OF NURSING

TABLE OF CONTENTS

PAGE

Title Page i

Grading Sheet ii

Table of Contents iii

INTRODUCTION 1

Objective of the Study 3


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INTRODUCTION

Marvin Paccial Piangco, 15 years old and a resident of 019 Road 10 Joseph St.,

Bagumbayan, Taguig City, was admitted last May 22, 2010 at 4:22 in the afternoon at Philippine

Orthopedic Center with a chief complaint of nape pain. He was admitted by Dr. Llanes with an

admission diagnosis ofPotts disease, C5C6 without Neurologics. He was admitted at the Male

Traction Ward all throughout his hospitalization.

The case study that is to be presented features a patient who has Potts disease. It is a

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

and collapse of the vertebrae, resulting in kyphotic deformity or curvature of the spine. It is a

grave disorder that produces destruction of the vertebrae.

The source of infection is usually outside the spine. It is most often spread from the lungs

via the blood. There is a combination of osteomyelitis and infective arthritis. Usually more than

one vertebra is involved. The area most affected is the anterior part of the vertebral body


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OBJECTIVES

This case study aims to attain the following:

1. Obtain a broader and deeper understanding ofPotts disease as to its:1.1Cause and precipitating factors,1.2Clinical manifestations,1.3Diagnostic and laboratory procedures,1.4Affectation of the heart and other physiological organs,1.5Pathophysiology and disease process.

2. Assess the client as to its:2.1Medical or surgical management,2.2Promotive and preventive measures against Potts disease,2.3Potential complications.


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PATIENTS PROFILE

PERSONAL DATA

NAME: Marvin Paccial Piangco

AGE: 15 years old

ADDRESS: 019 Road 10 Joseph St., Bagumbayan, Taguig City

SEX: Male

DATE OF BIRTH: October 1, 2004

BIRTHPLACE: Taguig City

CIVIL STATUS: Single

RELIGION: Roman Catholic

NATIONALITY: Filipino


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HISTORY OF PAST AND PRESENT ILLNESS

PAST ILLNESS

Marvin Paccial Piangco, 15 years old, male, a high school student from Taguig City, has

completed his immunization when he was younger. He did not have any allergies and he did not

have any history of childhood illness and during his growth years, he just experienced cough,colds, and fever. He had no previous hospitalizations. No family history of major medical

illnesses was stated.

PRESENT ILLNESS

The present health history started four months ago prior to admission. Patient Marvin has

started to experience neck pain with associated weight loss. According to the mother, the patient

had an accident while he was playing basketball with his friends. The patient was noted having

left neck mass approximately 1 5 cm in its greatest diameter soft movable and non-tender No


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PEARSON ASSESSMENT

June 9, 2010

(Hospital)

June 10, 2010

(Hospital)

P

(Psycho-social)

Marvin Paccial Piangco, 15years old from Road 10

Joseph St., Bagumbayan,

Taguig City

He was born on October 1,2004

Psychosocial Crisis: Identityvs. Role Confusion

Weak in appearance Conscious and coherent With significant other to

Conscious and coherent Answers questions accordingly An upcoming third year high

school student

Sleeps at times With pale lips With poor interaction


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Has limited ROM Unable to perform gross and

fine motor skills

Has continuous sleep Sleeps early at night Weak and pale

S(Safety)

Medications No known allergies to food

and medications

Level of consciousness:conscious

Skin integrity: dry Temperature: 37.0oC BP: 120/90 mmHg With hot environment Afebrile

Medications No known allergies to food and

medications

Level of consciousness:conscious

Skin integrity: dry Temperature: 36.7oC BP: 120/80 mmHg Patient has significant others to

attend his needs


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DIAGNOSTIC PROCEDURES

IDEAL

LABORATORY STUDIES Tuberculin skin test (purified protein derivative [PPD]) results are positive in 84-95% of

patients with Potts disease who are not infected with HIV.

The erythrocyte sedimentation rate (ESR) may be markedly elevated (>100 mm/h). Microbiology studies are used to confirm diagnosis. Bone tissue or abscess samples are

obtained to stain foracid-fast bacilli (AFB), and organisms are isolated for culture and

susceptibility. CT-guided procedures can be used to guide percutaneous sampling of

affected bone or soft-tissue structures. These study findings are positive in only about50% of the cases.

IMAGING STUDIES


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CT scanning reveals early lesions and is more effective for defining the shape andcalcification of soft-tissue abscesses.

In contrast to pyogenic disease, calcification is common in tuberculous lesions. MRI

o MRI is the criterion standard for evaluating disk-space infection and osteomyelitis ofthe spine and is most effective for demonstrating the extension of disease into softtissues and the spread of tuberculous debris under the anterior and posterior

longitudinal ligaments. MRI is also the most effective imaging study for

demonstrating neural compression.

o MRI findings useful to differentiate tuberculous spondylitis from pyogenicspondylitis include thin and smooth enhancement of the abscess wall and well-

defined paraspinal abnormal signal, whereas thick and irregular enhancement of

abscess wall and ill-defined paraspinal abnormal signal suggest pyogenic spondylitis.

Thus, contrast-enhanced MRI appears to be important in the differentiation of these

two types of spondylitis


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HEMATOLOGY:

NAME ANDPURPOSE OF

THE

PROCEDURE

NORMAL

VALUES

ACTUAL

VALUES

NURSING

IMPLICATION

NURSING

REPSONSIBILITES

Complete BloodCount (CBC)

- To diagnoseand managenumerous

diseases such

as acute andchronic

infection,

allergies and

problems withclotting.

Hemoglobin- To detect and

monitor the

severity of

RBC:3.8-6.5x10

12/L

HgB:

140-180g/L

HcT:

0.40-0.54%

WBC:

10-25x109/L

Neutrophils:

0 40 0 75

5.45x1012

/L

122g/L

0.37%

10.3 x109/L

0 63

Normal

Normal

Normal

Normal

Normal

Explain theprocedure andpresent the

benefits of thetest.

Inform thepatient that the

blood be drawnfrom a vein,

usually above

the elbow or

back of thehand.

Wipe thepuncture site.

Place theb d d


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MANTOUX TESTThe Mantoux test (or Mantoux screening test, Tuberculin Sensitivity Test, Pirquet test, or

PPD test for Purified Protein Derivative) is a diagnostic tool for tuberculosis. The Mantoux test

is used in the United States and is endorsed by the American Thoracic Society and Centers for

Disease Control and Prevention (CDC). Multiple puncture tests such as the Tine test are not

recommended. The Mantoux test is one of the two major tuberculin skin tests for tuberculosis

used in the world.

A standard dose of 5 Tuberculin units (0.1 mL) is injected intradermally (into the skin)

and read 48 to 72 hours later. A person who has been exposed to the bacteria is expected to

mount an immune response in the skin containing the bacterial proteins.

The reaction is read by measuring the diameter of induration (palpable raised hardenedarea) across the forearm (perpendicular to the long axis) in millimeters. No induration should be

recorded as "0 mm". Erythema (redness) should not be measured.

If a person has had a history of a positive tuberculin skin test, another skin test is not


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ANATOMY AND PHYSIOLOGY OF THE ORGANS INVOLVED

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 provides structural

support for the trunk and surrounds and

protects the spinal cord. The vertebral

l l id tt h t i t f th l f th b k d ib Th t b l di k


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PATHOPHYSIOLOGY OF POTTS DISEASE

A. ALGORITHMHematogenous

spread of TB

Spread of

Mycobacterium

tuberculein the T7-T9of the spine

Inflammation of a

portion of the vertebral

column

Pus or lesion formation

in the intervertebral disc

k i f


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B. EXPLANATIONPotts disease is usually secondary to an extraspinal source of infection. The basic lesion

involved in Potts disease is a combination of osteomyelitis and arthritis that usually involves

more than one vertebra. The anterior aspect of the vertebral body adjacent to the subchondral

plate is area usually affected. Tuberculosis may spread from that area to adjacent intervertebral

disks. In adults, disk disease is secondary to the spread of infection from the vertebral body. In

children, because the disk is vascularized, it can be a primary site.

Progressive bone destruction leads to vertebral collapse and kyphosis. The spinal canal

can be narrowed by abscesses, granulation tissue, or direct dural invasion, leading to spinal cord

compression and neurologic deficits. The kyphotic deformity is caused by the collapse in the

anterior spine. Lesions in the thoracic spine are more likely to lead to kyphosis than those in the

lumbar spine. A cold abscess can occur if the infection extends to adjacent ligaments and soft

tissues. Abscesses in the lumbar region may descend down the sheath of the psoas to the femoral

trigone region and eventually erode into the skin.


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MEDICAL AND SURGICAL MANAGEMENT

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 anti-tuberculosis treatment is required. Duration of anti-tuberculosis 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 twelve months

treatment is required.

There have been discussions on whether the treatment of choice should be conservative

chemotherapy for 12 months or chemotherapy and surgery combined. Management should be

based on the goals of treatment for each individual case.

Effective chemotherapy for spinal tuberculosis is the gold standard and mainstay of the

treatment and all other methods of treatment are regarded as supplementary.


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effectively remove the diseased tissue and sequestra and also can evacuate the abscess; however,

it does not prevent the progression of kyphosis due to the lack of anterior support. Focal

dbridement and simple abscess evacuation provide no long-term advantage over ambulant

chemotherapy alone and therefore are no longer accepted as a preferred method of treatment.

2. Anterior radical surgery. Anterior radical debridement and arthrodesis with a strut graft and

chemotherapy has been the treatment of choice. There is evidence that better results regarding

deformity, recurrence, development of paralysis, and resolution are obtained when radical

surgery is performed combined with chemotherapy.

Paraplegia.During the early phases of the disease with active infection, possible reasons include

direct compression of the neural structures by the abscess and/or sequestrated bone fragments,

direct dural invasion, vascular compromise due to compression or thrombosis, acute instability,

or severe deformity. Direct compression by abscess or necrotic tissue is the most frequent causeof early onset paralysis and generally has a good prognosis and a relatively high probability to

resolve with effective treatment. Paraplegia due to vertebral tuberculous lesion is caused by

direct impingement of the abscess, ischemia due to altered blood supply, intra dural abscess and

k h i It i ll k th t th t f l i i i fl d b


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Kyphosis / Deformi ty. Tuberculosis kyphosis is an unstable lesion that tends to progress until

there is sound bony fusion anteriorly. Kyphosis has been managed by several surgical

procedures: posterior fusion, anterior radical surgery, and various combined operations such as a

one-stage, two-stage, or three-stage procedures. Each patient should be cautioned about the high

neurologic risk with corrective surgery of the rigid deformed spine. Until now, the following

surgical procedures have been practiced by various surgeons: 1. Flexible Kyphosis: Skeletal

traction Posterior fusion Anterior radical surgery Two-stage operation: Posterior instrumentation

followed by anterior radical surgery Anterior release and graft, followed by posterior

instrumentation Three-stage operation (anterior release followed by posterior instrumentation

and delayed anterior radical surgery). 2. Fixed Kyphosis. One-stage operation

Two-stage operation (anterior release, deformity correction and anterior graft, followed by

posterior instrumentation) Multi-stage operation (osteotomy, halopelvic device, posterior

instrumentation and fusion). Skeletal traction for cervical kyphosis.

Posterior fusion for kyphosis. Disproportionate posterior spinal growth has been suspected as a

contributing factor in the progression of kyphotic deformity after management of spinal

t b l i b t i f i l E i ll i hild f tl th ill b l f th


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Two-stage operations.

1. Anterior radical surgery, followed by posterior resection and instrumentation. Yau et al used

Luque instrumentation in a two-stage procedure to correct the deformity.

2. Combined posterior instrumentation plus anterior radical surgery for flexible kyphosis (two-

stage operation). This procedure may be most appropriate for active cases of progressive

kyphosis where the curve is stil flexible. Prevention and correction of kyphosis and

kyphoscoliosis by posterior instrumentation has three advantages. Posterior stabilization of thespine arrests the disease early, encourages early fusion, and enables correction of the deformity.

The procedure is indicated only in those patients who are likely to develop or who have a pre-

existing deformity. It is suggested that a formula be used to predict the kyphosis that will remain

at the end of chemotherapy to determine if prophylactic or corrective spinal instrumentation

surgery is indicated.


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PREVENTIVE AND PROMOTIVE MANAGEMENT

Eat a well-balanced diet that includes plenty of protein foods, fresh fruits, and vegetablesto help your skin, urinary tract, and bowel functions healthy.

Change your position frequently in a wheelchair and in bed to prevent pressure sores.Exercise to improve respiratory function, increase bone strength, regulate bodily

functions, and possibly improve spasticity.

Drink water throughout the day to benefit your skin, urinary tract, and bowel functions. Do not smoke. Smoking constricts your vessels making it harder to blood oxygen and

nutrients to flow to the body tissues. Smoking also negatively affects respiratory health.

Regularly examine your skin and pay special attention to bony areas such as heels,tailbone, and shoulder blades.

The patient is best treated initially in the supine position. Occasionally, the patient mayhave been transported prone by the pre-hospital care providers. Logrolling the patient to

the supine position is safe to facilitate diagnostic evaluation and treatment. Use

analgesics appropriately and aggressively to maintain the patients comfort if he or she


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DISCHARGE PLAN

Medication

Pyrazinamide 500 mg tab two times a day Bisacodyl 10 mg tab once a day Pyridoxine (Vitamin B6) 1 tab two times a day Isoniazid 400 mg 1 tab once a day Rifampicin 450 mg tab once a day Ethambutol 450 mg tab two times a day

Exercise

Encourage patients relative to perform passive range of motion exercises on patientsextremities

Encourage the patient to do simple exercises as tolerated such range of motion exercise

T reatment


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Instruct family to return to their attending physician for scheduled check-up andconsultation

Advise family to report to the physicians any complaints Advice patient to report signs of unusualities that may happen to him

Diet

Diet as Tolerated but be careful and be selective to the foods.

Instruct the patient to eat foods rich in protein Eat meals when their energy levels are at their highest which is usually in the morning. Eat slowly and chewed food thoroughly to avoid becoming breathless while eating and to

prevent choking

Eat balance nutritious food

S-pecial care:

Special attention and precaution is needed for the patient. Advice SO to watch everyactivity that the patient does and assist him


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UPDATES


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BIBLIOGRAPHY

BOOKS

Burke, Shirley R. Himan Anatomy & Physiology in Health and Diseases, 3rd

Ed. Canada:

Delmar Publisher Inc., 1992.

Doenges, Marilynn E., et al. Nurses pocket Guide: Diagnoses, Interventions, and Rationales,

11th

Ed. Philadelphia, Pennsylvania: F.A. DAVIS COMPANY, 2008.

Doenges, Marilynn E., et al. Nursing Care Plans: Guidelines for Individualizing Client Care

Across the Lifespan, 7th

Ed. Philadelphia, Pennsylvania: F.A. DAVIS COMPANY, 2006.

Karch, Amy M. Nursing 2007 Lippincotts Nursing Drug Guide, 27th

Ed. Philadelphia,

Pennsylvania: Lippincott William & Wilkins, 2007.

Lippincott Williams & Wilkins. Nursing 2006 Drug Handbook, 26th

Ed. Philadelphia,

Pennsylvania: Lippincott William & Wilkins, 2006.


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DRUG STUDY

NAME OF

DRUGDOSAGE

MECHANISM OF

ACTIONINDICATIONS CONTRAINDICATIONS SIDE EFFECTS

NURSING

RESPONSIBILITIES

Isoniazid 400 mg 1 tabOD

Bactericidal:Interferes with lipid

and nucleic acid

biosynthesis in

actively growing

tubercle bacilli.

Tuberculosis, allforms in which

organisms are

susceptible

prophylaxis in

specific patients who

are tuberculin

reactors or

household members

of recently

diagnosed tubercular

or who are

considered to be

high risk (patients

with HIV, IV drug

users.

Containdicated with allergyto isoniazid, isoniazid-

associated hepatic injury or

other severe adverse

reactions to isoniazid, acute

hepatic disease.

CNS: Peripheralneuropathy, seizures,

toxic encephalopathy,

optic neuritis and

atrophy, memory

impairment, toxic

psychosis

GI: Nausea, vomiting,

epigastric distress,

bilirubinemia, elevated

AST, ALT levels,

jaundice, hepatitis

Hematologic:

Agranulocytosis,

hemolytic and aplastic

anemia,

thrombocytopenia,

eosinophilia,

Observe 10 Rs ofadministration.

Give on an emptystomach, 1 hour

before or 2 hours

after meals, may be

given with food if

GI upset occurs.

Give in a singledaily dose.

Decrease foodscontaining tyramine

or histamine in

patients diet.

Instruct patient notto drink alcohol as

muscle as possible.


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pyridoxine deficiency,

pellagra,

hyperglycemia,

hypophospphatemia

due to altered vitamin

D metabolism


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Rifampicin 450 mg tab OD Inhibits DNA-

dependent RNA

polymerase activity

in susceptible

bacterial cells.

Treatment ofpulmonary TB on

conjunction with

at least oneanother effective

antituberculotic

Unlabeled uses:Infections caused

by

Staphylococcus

aureus and

Staphylococcusepidermis,

usually in

combination

therapy

Contraindicated withallergy to any

rifampicin, acute

hepatic disease. Use cautiously with

pregnancy (teratogenic

effects have been

reported in preclinical

studies; safest

antituberculosis

regimen for use in

pregnancy is associatedto be rifampin,

isoniazid, and

ethambutol).

CNS: Headache,

drowsiness, fatigue,

dizziness, irritability

to concentrate, mental

confusion, generalized

numbness, ataxia,

muscle weakness,

visual disturbances,

exudative

conjunctivitis

Dermatologic: Rash,

pruritus, urticaria,

flushing, reddish to

orange coloring of

body fluids

GI: Heartburn,

epigastric distress,

anorexia, nausea,

vomiting, cramps,

Observe 10 Ps ofadministration.

Administer on anempty stomach, 1

hour before or 2

hours after meal.

Administer on ansingle daily dose.

Instruct patient thathe might experience

reddish to orange

coloring of body

fluids (urine, sweat,

sputum, tears, feces,

saliva).

Instruct client totake drug regularly.

Avoid missing any

doses; do not

continue this drug

without consulting

healthcare provider.


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diarrhea,

pseudomembranous

colitis, pancreatitis,

elevations of liver

enzymes, hepatitis

GU: Hemoglibinuria,

hematuria, renal

insufficiency, acute

renal function

Hematologic:

Eosinophilia,

thrombocytopenia,transient leucopenia,

hemolytic anemia,

decreased Hgb,

hemolysis

Other: Pain in

extremities,

osteomalacia,

myopathy, fever


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Pyridoxine 1 tab BID Needed for fat,

protein,

carbohydrates

metabolism;

enhances glycogen

release from liver

and muscle tissue

needed as

coenzyme for

metabolic

transformations of a

variety of amino

acids

Vitamin B6

deficiency associated

with isoniazid

therapy

CNS: Paresthesia,

flushing, warmth,

lethargy

Integumentary: pain at

injury site

Observe 10 Rs ofadministration.

Monitor pyridoxinelevels throughout

the treatment.

Assess forpyridoxine

deficiency; nausea,

vomiting,

dermatitis, cheilosis,

irritability.

Instruct patient toswallow the tabs

whole, do not break,

crush or chew.

Teach patient toavoid other vitamin

supplements unless

directed by

prescriber.


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Ethambutol 450 mg tab OD Inhibits the

synthesis of

metabolites in

growing

mycobacterium

cells, impairing cell

metabolism,

correcting cell

multiplication and

causing cell death.

Treatment of

pulmonary

tuberculosis in

conjunction with at

least other

antituberculotics

Contraindicated withallergy to ethambutol;

optic neuritis.

Use cautiously withimpaired renal function,

visual problems.

CNS: Optic neuritis,

fever, malaise,

headache, dizziness,

mental confusion,

disorientation,

hallucination,

peripheral neuritis

GI: Anorexia, nausea,

vomiting, GI upset,

abdominal pain,

transient liverimpairment

Hypersensitivity:

Allergic reactions,

dermatitis, pruritus,

anaphylactoid reaction

Assess for allergy toethambutol: optic

neuritis, and

impaired renal

function.

Administer in asingle daily dose;

must be used in

combination with

other

antituberculotics.

Instruct client totake drug regularly;

avoid missing any

doses and drug must

be used in

combination with

other

antituberculotics.


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Pyrazinamide 500 mg tab

BID

Bactericidal

interference with

lipid; nucleic acid

biosynthesis is

possible

Tuberculosis, as an

adjunct when other

drugs are not feasible.

Hypersensitivity, severe

hepatic damage, acute gout

CNS: headache

GI: hepatotoxicity,

abnormal liver

function tests, peptic

ulcer, nausea,

vomiting, anorexia,

diarrhea

GU: Urinary

difficulty, increased

uric acid

HEMATOLOGY:

Hemolytic anemia

INTEGUMENTARY:

photosensitivity,

urticaria

Observe the 10 Rsof administration.

Monitor serum uricacid, which may be

elevated and cause

gout symptoms.

Monitor liverstudies weekly.

Give with meals todecrease GI

symptoms.

Instruct patient thatcompliance with

dosage schedule,

duration is

necessary.


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NURSING CARE PLAN

CUESNURSING

DIAGNOSISANALYSIS OBJECTIVES

NURSING

INTERVENTIONSRATIONALE EVALUATION

June 9, 2010, 8:00

9:00 AM

Subjective: Sumasakit

ang likod ko as

verbalized by the

patient.

Objective:

Facial mask of pain Self narrowed focus Fatigue Pain scale of 6/10 Weak and pale-

looking

Facial grimace With limited range

of motion

P: Acute pain

E: related to

inflammatory

process

S: as evidenced

by:

Patientsverbalization

of pain

Facial grimace Pain scale of

6/10

Discomfort

Potts disease is a

form of

extrapulmonary

tuberculosis that

impacts the spine. It

has an effect that is

sometimes described

as being a sort of

arthritis for the

vertebrae that make

up the spinal column.

More properly

known as

tuberculosis

spondylitis. It is

often experienced as

a local phenomenon

that begins in the

After an hour of

rendering effective

nursing

interventions, the

patient will be able

to incorporate

relaxation skills

and diversional

activities into pain

control program.

Independent:

Investigate reportof pain, noting

characteristics,

location, intensity

(0-10 scale).

Provide firmmattress and

small pillows.

Suggest patientassume position

Helpful indetermining

pain

management

needs and

effectiveness of

the program.

Soft or saggingmattress and

large pillows

inhibits the

proper body

alignment.

In acute phase,total bed rest

Goal partially met.

The patient was able to

incorporate relaxation

skills and diversional

activities into pain

control program.


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Discomfort V/S taken as

follows:

T: 37.0oC

P: 108 bpm

R: 34 cpm

BP: 120/90 mmHg

thoracic section of

the spinal column.

Early signs of the

presence of Potts

disease generally

begin with back pain

that may seem to be

due to simple muscle

strain.

of proper comfort

while in bed or

chair. Promote

bed rest as

indicated.

Encouragefrequent changes

of position.

Apply warm ormoist compress

on the affected

area several times

a day.

Provide gentlemassage.

may be

necessary to

limit pain.

Prevents generalfatigue and joint

stiffness.

Heat promotesmuscle

relaxation and

mobility,

decreases pain

and relieves

morning

stiffness.

Promotesrelaxation andreduces muscle


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Encourage use ofstress

management

techniques.

Collaborative:

Administer non-steroidal anti-

inflammatory

drugs as

prescribed.

Administerantibiotic as

prescribed.

tension.

Promotesrelaxation,

provides sense

of control and

may enhance

coping

activities.

These drugscontrol mild to

moderate pain

and

inflammation by

inhibition of

prostaglandin

synthesis.

To preventfurther

infection.


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June 9, 2010, 8:00

9:00 AM

Subjective:

Hindi ko po maigalaw

ang katawan ko as

verbalized by the

patient.

Objective:

Inability to move With limited range

of motion

Decreased musclestrength

Discomfort V/S taken as

follows:

T: 36.7oC

P: 91 bpm

R: 28 cpm

BP: 120/80 mmHg

P: Impaired

physical mobility

E: related to pain

S: as evidenced

by:

Patientsverbalization

of inability to

move

Limited rangeof move

Decreasedmuscle

strength

Reluctant toattempt

movement

Dependence tosignificant

others

PulmonaryTuberculosis

Spread of

MycobacteriumTubercule in the

spine

Extra-pulmonaryTuberculosis

Infection spreads

from theintervertebral disc

Pus formation

between theintervertebral disc

Disc tissue dies andbroken down by

caseation

Vertebral Collapse

Spinal Damage

Impaired Physical

Mobility

After 30 minutes of

rendering effective

nursing

interventions, the

patient will perform

physical activity

independently by

changing position

without assistance.

Independent:

Encourage andfacilitate exercises

as tolerated.

Allow the patientto move or

perform activities

like changing the

position of legs at

own rate.

Keep side railsup.

Turn andreposition patient.

Perform passiveassistive range of

motion exercises

to extremities.

Teach the patienton the hazards of

immobility that

can lead to

For propercirculation.

Make thepatients

recovery faster

and increases

self-esteem of

patient.

To promote safeenvironment.

To optimizecirculation to all

tissues and

prevent pressure

ulcers.

To promotevenous return,

prevent stiffness,

and maintain

muscle strength.

To gain

Goal met. The patient

was able to perform

physical activity which

is to reposition his

body without

assistance from other

people as evidenced by

motivation in

attempting to move by

his own self.


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complications like

pressure ulcers

and respiratory

complications.

coordination of

the patient.

Documents

Case Study - Pott's Disease (Final)