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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
May indicate infection
May indicate infection
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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Classification Dosage Mechanism of Action
Indication Contraindication Adverse Reaction NursingConsideration
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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Classification Dosage Mechanism of Action
Indication Contraindication Adverse Reaction NursingConsideration
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
After 8hrs of Nursing
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
After 4hrs of Nursing
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
After 4hrs of Nursing
Interventions the
patients mother hasverbalizedunderstanding the
situation andtreatment regimen
and safety measures
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