St.

Augustine School of nursing

A Case Study of Potts Disease
Section 4B
Group 2
Douglas adriane B. Danao
!iguel "afael #. Carlos
Char$aine !u%o&
'a(le of Contents
#. Ac)no*ledge$ent
##. #ntroduction
###. Assess$ent
#. Personal data
##. !edical istory
A. istory of present illness
B. Past !edical istory
C. +a$ily !edical istory
D. Personal and Social history
#,. Physical assess$ent
,. Anato$y and Physiology
,#. Pathophysiology
,##. -ursing Care Plan
,###. Drug Study
#.. Discharge Planning
AC/-0123DG3!3-'
'his case study on Potts disease *ould not (e
possi(le *ithout those people *ho continually helped
and contri(uted in the said case study. !y heartfelt
e4pression of appreciation goes out to each and e5ery
one of you.
+irst and fore$ost6 # *ould li)e to than) the 1est B
staff of 3A!C for generously gi5ing $e their ti$e.
'o our Professor6 !a$ Diente6!a$ Donnie for
patiently super5ising and assisting us *ith your
)no*ledge6 as *e gradually go through the process of
doing the case study itself6 our sincerest than)s.
'o our patient6 for the generous ti$e e4tended for
$e to e4plore this case7 and for gi5ing $e his full
cooperation and )indness that helped $e co$plete the
needed infor$ation for this paper.
Also6 to our friends and class$ates6 *ho6 li)e $e6
$anaged to encourage and support each other a$idst
e5ery discourage$ent and difficulty6 'han) you.
'o $y parents6 for supporting $e all the *ay6
pro5iding $e *ith e5erything # need6 financially and
e$otionally. All of those things are genuinely
appreciated.
2ast (ut not the least6 to our Al$ighty +ather6 for
his unceasing guidance and (lessings6 for constantly
gi5ing $e hope6 courage6 and patience. 'ruly6 none of
this is possi(le *ithout you.
#-'"0D8C'#0-
Tuberculosis (TB) of the spine also known as Potts disease, Potts
Caries, David's disease, Tuberculosis spondylitis and Pott's
curvature, is the most common site of bone infection in TB. The
lower thoracic and upper lumbar vertebrae are the areas of the spine
most often affected. The original name was formed after Percivall
Pott, a London surgeon, who first studied the disease. When he died,
Patrick David was the one who continued his work.
Potts disease results from haematogenous spread of
tuberculosis (m!cobacterium tuberculosis) from other sites. The
infection then spreads from two ad"acent vertebrae into the ad"oining
disc space. #f onl! one vertebra is affected, the disc is normal,but if
two are involved the intervertebral disc, which is avascular, cannot
receive nutrients and collapses. The disc tissue dies and is broken
down b! caseation, leading to vertebral narrowing and eventuall! to
vertebral collapse and spinal damage. $ dr! soft tissue mass often
forms and superinfection is rare.
The disease progresses slowl!. %igns and s!mptoms include&
back pain, fever, night sweats, anore'ia, weight loss, and eas!
fatigabilit!.
(iagnosis is based on& blood tests ) elevated *%+ , skin tests
,radiographs of the spine , bone scan ,,T of the spine , and bone
biops!. -ibbus formation is the pathognomonic sign of this disease.
$ person with Pott.s disease often develops k!phosis, which
results in a hunchback. This is often referred to as Potts curvature.
#n some cases, a person with Pott.s disease ma! also develop
paral!sis, referred to as Potts paraplegia, when the spinal nerves
become affected b! the curvature.
$ person who has been diagnosed with Pott.s disease ma! be
treated through a variet! of options. /e or she ma! utili0e analgesics
or antituberculosis drugs to get the infection under control. #t ma!
also be necessar! to immobili0e the area of the spine affected b! the
disease, or the person ma! need to undergo surger! in order to drain
an! abscesses that ma! have formed or to stabili0e the spine.
%ince Pott.s disease is caused b! a bacterial infection, prevention is
possible through proper control. The best method for preventing the
disease is reduce or eliminate the spread of tuberculosis. #n addition,
testing for tuberculosis is an important preventative measure, as
those who are positive for purified protein derivative (PP() can take
medication to prevent tuberculosis from forming. $ tuberculin skin
test is the most common method used to screen for tuberculosis,
though blood tests, bone scans, bone biopsies, and radiographs
ma! also be used to confirm the disease
'30"3'#CA2 +"A!310"/
+or the theoretical fra$e*or)6 # used the 29
nursing pro(le$s according to +aye Glenn A(dellah.
She defined nursing as (roadly grouped into the 29
nursing pro(le$ areas to guide care and pro$ote the
use of nursing :udge$ent. She also said that nursing is
a ser5ice that is (ased on the art and science and ai$s
to help people6 sic) or *ell6 cope *ith their health
needs.
'he 29 nursing pro(le$s are as follo*s;
9< 'o $aintain good hygiene.
2< 'o pro$ote opti$al acti5ity; e4ercise6
rest6 and sleep
=< 'o pro$ote safety
4< 'o $aintain good (ody $echanics.
>< 'o facilitate the $aintenance of a supply
of o4ygen
?< 'o facilitate $aintenance of nutrition
@< 'o facilitate $aintenance of eli$ination
A< 'o facilitate $aintenance of fluid and
electrolyte i$(alance
B< 'o recogni&e the physiologic response
of the (ody to disease conditions
9C< 'o facilitate the $aintenance of
regulatory $echanis$s and functions
99< 'o facilitate the $aintenance of
sensory function
92< 'o identify and accept positi5e and
negati5e e4pressions6 feelings and
reactions
9=< 'o identify and accept the
interrelatedness of e$otions and illness
94< 'o facilitate the $aintenance of
effecti5e 5er(al and nonD5er(al
co$$unication
9>< 'o pro$ote the de5elop$ent of
producti5e interpersonal relationships
9?< 'o facilitate progress to*ards
achie5e$ent of personal spiritual goals
9@< 'o cerate and $aintain a therapeutic
en5iron$ent
9A< 'o facilitate a*areness of self as an
indi5idual *ith 5arying needs
9B< 'o accept the opti$u$ possi(le
goals
2C< 'o use co$$unity resources as aid
in resol5ing pro(le$s
29< 'o understand the role of social
pro(le$s as influencing factor

ASS3SS!3-'
#. Personal Data;
-a$e; B.P.
Address; -o5aliches Eue&on City
Age; 2A years old
Se4; +e$ale
Ci5il status; !arried
"eligion; "o$an Catholic
Birthday; -o5e$(er 9B6 9B@A
Birthplace; !anila
Attending Physician; Dr. Adrian Cat(agan
Ad$itting Diagnosis; Spinal cord co$pression on 'F=
le5el
Chief co$plaint; *ea)ness of lo*er e4tre$ities
##. !edical istory
A. History of Present Illness:
'his is a case of B.P.6 *ho *as ad$itted
for the first ti$e last Septe$(er 9=62CC@ *ith a chief
co$plaint of *ea)ness of lo*er e4tre$ities. 'he
history of present illness started t*o $onths prior to
ad$ission6 *hen the patient started to e4perience
*ea)ness of (oth lo*er e4tre$ities. -o other
associated signs and sy$pto$s *ere noted. +e*
hours prior to ad$ission6 persistence of a(o5e
sy$pto$s pro$pted consult.
B. Past Medical History:
G D < P-
G D < D!
G D < asth$a
G D < allergy
B. Family Medical History:
G D < P-
G D < D!
G D < CA
G D < asth$a
C. Personal and Social History:
G D < s$o)er
( - ) alcoholic (e5erage drin)er
A-A'0!H
'he 5erte(ral colu$n pro5ides structural support for the
trun) and surrounds and protects the spinal cord. 'he
5erte(ral colu$n also pro5ides attach$ent points for
the $uscles of the (ac) and ri(s. 'he 5erte(ral dis)s
ser5e as shoc) a(sor(ers during acti5ities such as
*al)ing6 running6 and :u$ping. 'hey also allo* the
spine to fle4 and e4tend.
!3D#CA2FS8"G#CA2 #-'3",3-'#0-S
Management of Potts disease
(rug treatment is generall! sufficient for Potts disease, with spinal
immobili0ation if re1uired. %urger! is re1uired if there is spinal
deformit! or neurological signs of spinal cord compression.
%tandard antituberculosis treatment is re1uired. (uration of
antituberculosis treatment& #f debridement and fusion with bone
grafting are performed, treatment can be for si' months. #f
debridement and fusion with bone grafting are 23T performed a
minimum of 45 months treatment is re1uired.
#t ma! also be necessar! to immobili0e the area of the spine affected
b! the disease, or the person ma! need to undergo surger! in order
to drain an! abscesses that ma! have formed or to stabili0e the
spine.
3ther interventions include application of knight6 ta!lor brace, head
halter traction. %urger! includes $(%7 ( $nterior decompression
%pinal fusion).
Drug Study
G3-3"#C -A!3; "I3
Gisonia&idJrifa$picinJpyra&ina$ideJetha$(utol<
Brand na$e; !yrin
Dosage; = ta( =C $in (efore (rea)fast
Drug Classification;AntiDinfecti5e
!3CA-#S! #-D#CA'#0-S C0-'"AD
#-D#CA'#0-S
AD,3"S3
"3AC'#0-
-8"S#-G
"esponsi(ilities
8n)no*n.
Appears to
inhi(it cellD
*all
(iosynthesis
(y
interfering
*ith lipid
and D-A
synthesis
K Acti5ely
gro*ing
tu(ercle (acilli
Kpre5ention of
tu(ercle (acilli
in those
e4posed to
tu(erculosis
or those *ith
positi5e s)in
test results
*hose chest
4Drays and
(acteriologic
studies are
consistent
*ith nonD
progressi5e
tu(erculosis
-
Contraindicate
d in patients
*ith acute
hepatic disease
or isonia&idD
related li5er
da$ge
K peripheral
neuropathy6
fluid
discoloration6
optic neuritis6
hepatitis
K8se
cautiously in
elderly
patients
Kperipheral
neuropathy is
$ore
co$$on in
patients *ho
are slo*
acetylators or
*ho are
$alnourished6
alcoholic or
dia(etic6
K!onitor
hepatic
function
closely for
changes
G3-3"#C -A!3; )etorolac tro$etha$ine
Brand na$e;'oradol
Dosage; =C $g #5 LAh
Drug Classification; -SA#DS
!3CA-#S! #-D#CA'#0-S C0-'"AD
#-D#CA'#0-S
AD,3"S3
"3AC'#0-
-8"S#-G
"esponsi(ilities
8n)no*n.
Produces
antiD
infla$$atory6
analgesic6
and
antipyretic
effects6
possi(ly (y
inhi(iting
prostaglandi
n synthesis
K shortDter$
$anage$ent
of $oderately
se5ere6 acute
pain for single
dose
treat$ent
K ShortDter$
$anage$ent
of $oderately
se5er6 acute
pain for
$ultiple dose
treat$ent
-
Contraindicate
d in patients
hypersensiti5e
to drug and in
those *ith
acti5e peptic
ulcer disease 6
recent G#
(leeding or
perforation6
ad5anced renal
i$pair$ent6
inco$plete
ho$eostasis
and *ith high
ris) of
(leeding.
K dro*siness6
sedation6
ede$a6
hypertension6
diarrhea6
sto$atitis6
peptic
ulceration6
rash6
diaphoresis
K /etorolac
isnt
reco$$ended
for children
K 8se
cautiously in
patients *ith
hepatic and
renal
i$pair$ent
K-SA#DS $ay
$as) signs
and
sy$pto$s of
infection
(ecause of
their
antipyretic
and antiD
infla$$atory
actions
G3-3"#C -A!3; ciproflo4acin
Brand na$e; Cipro(ay
Dosage; >CC$gFcap B#D4> days
Drug Classification; +luoroLuinolones
!3CA-#S! #-D#CA'#0-S C0-'"AD
#-D#CA'#0-S
AD,3"S3
"3AC'#0-
-8"S#-G
"esponsi(ilities
#nhi(its
(acterial dna
synthesis6
$ainly (y
(loc)ing
D-A gyrase6
(actericidal.
K Se5ere or
co$plicated
(one or :oint
infections
KCo$plicated
intraa(do$inal
infections
-
Contraindicated
to patients
sensiti5e to
fluoroLuinolone
s
K headache6
retlessness6
fatigue6
dro*siness6
ede$a6
chest pain6
nausea6
diarrhea6
leucopenia6
crystalluria
K 8se
cautiously in
patients *ith
C-S disorders6
such as se5ere
cere(ral
arteriosclerosis
or sei&ure
disorders6 and
in those *ith
ris) for
sei&ures.
K !onitor
patients inta)e
and output and
o(ser5e for
signs of
crystalluria
K0(tain
speci$en for
culture and
sensiti5ity
(efore gi5ing
firstDdose
PA'0PHS#020GH
Pul$onary tu(erculosis
G0"D0-S PA''3"- 0+ +8-C'#0-#-G
Spread of $yco(acteriu$ tu(erculosis fro$ other
site
34trapul$o$ary tu(erculosis
'he infection spreads fro$ t*o ad:acent 5erte(rae
into the ad:oining disc space
0ne 5erte(ra is affected6 the disc is nor$al
'*o are in5ol5ed6 the a5ascular inter5erte(ral disc cannot
recei5e nutrients and collapse
Dis) tissue dies and (ro)en do*n (y caseation
,erte(ral narro*ing
,erte(ral collapse
Spinal da$age
/yphosis6 paraplegia6 (o*el and urinary incontinenece
Surgery; e5acuation of pus6 Anterior
deco$pression spinal fusion
back pain, fever, night sweats, anore'ia, weight
loss, and eas! fatigabilit!.
P0''S D#S3AS3
Before hospitalization During hospitalization
/ealth)perception6 /ealth)
management pattern
#t is her first time to get
hospitali0ed. %he usuall!
"ust bears the pain or uses
self)medication.
%he hopes that she will get
better..
2utritional6 8etabolic pattern The patient eats all kinds of
food. %he likes to eat
vegetables.
The patient still eats a lot.
*limination pattern The patient defecates
regularl! at least once a da!
or sometimes once ever!
two da!s and urinates
fre1uentl!. The patient
sweats a lot because of the
weather.
The patient has urinar! and
bowel incontinence because
of spinal cord in"ur!.
$ctivit!6 *'ercise pattern The patients form of
e'ercise is doing the
household chores.
%he doesnt have a form of
e'ercise in the hospital
because she is bedridden, as
a result of spinal cord in"ur!.
%leep)rest pattern The patient usuall! sleeps
for about 9 hours.
The patient s sleep was still
for about 9 hours.
,ognitive6 Perceptual pattern The client likes to talk to her
neighbors after doing all the
household chores.
$t first the client doesnt
speak much but once !ou
have established rapport
with her, !ou will see that
she is a ver! friendl! person.
%he became open and was
talking more than before.
%elf)perception6 %elf)concept
pattern
The patient has a good self :
esteem.
The patient somewhat lost
her self)esteem because she
thinks she is useless.
+ole6 +elationship pattern The patient is ver! friendl!
and has a good relationship
with people around her.
The patient is
communicative when !ou
talk to her but she will not be
the one to open up
conversations.
,oping6 %tress)tolerance
pattern
W*hen stressed, she usuall!
diverts it b! watching
television.
When the patient
e'periences stress, she "ust
pra!s to god because there
are not other diversional
activities she can do in the
hospital.
Discharge Plan
PD atient should (e re$inded to attend chec)Dups at the nearestM.
0D rthopedic center
'D reat$ent should (e ta)en in aM..
'D i$ely $anner
SD ight any sy$pto$s other than the usual and report it to the physician
PHS#CA2 ASS3SS!3-'
Body part 'echniLue used -or$al findings Actual findings AnalysisF#nterpretation
ead
3yes
air
3ars
-ose
S)in
Palpation
#nspection
#nspection
#nspection
#nspection
#nspection
#nspection
A(sence of $asses
and nodules
Con:uncti5a is pin)
8sually (lac) and
shiny.
Color is the sa$e as
facial s)in. Pinna
tends to (end easily
and recoils easily after
(ending.
Sy$$etrical *ith no
defor$ities.
Good or acti5e s)in
turgor. A(sence of
ead does not appear too
large or too s$all. 'here
*ere no $asses and
nodules.
Anicteric sclera
Pin) palpe(ral
con:uncti5a
air doesnt loo) dull.
Color is the sa$e as
facial s)in. -o defor$ities
found. -o discharge
Sy$$etrical. -o
defor$ities found.
GD< nasal congestion
Good s)in turgor
GD< rashes
-or$al
-or$al
-or$al
-or$al
-or$al
-or$al
!outh
-ails
Ar$s
Chest
#nspection
#nspection
#nspection
Palpation6
#nspection and
Auscultation
ecchy$osis.
8nifor$6 pin) color of
the gu$s6 $oist and
s$ooth in te4ture
S$ooth and usually
long enough to e4tend
o5er the fingertips7
should (e colored
pin)6 con5e4 in shape
and *ith 9?C
o
angle
(et*een the nails and
the nail(eds.
Should ha5e good
$uscle contraction.
Good fle4ion and
e4tension. A(sence of
ecchy$osis and
defor$ities.
Chest is sy$$etrical6
Pin)Dcolored gu$s. !oist
(uccal $ucosa.
Good capillary refill.
2ight pin) in color6
con5e4 in shape.
-o ecchy$osis noted. full
and eLual pulses.
Slight D0B
GJ< gi((us for$ation
-or$al
-or$al
-or$al
A(nor$al
A(do$en
Genitalia
2egs and
34tre$ities
"espiratory
syste$
Cardio5ascular
syste$
Palpation and
#nspection
#nspection
#nspection

Auscultation
Auscultation
rhyth$ic and
(reathing pattern is
effortless
Contour is slightly
protu(erant.
Pin)ish in color and
intact.
A(sence of
defor$ities and good
"0!. A(sence of
ede$a and
ecchy$osis.
-o unusual sounds
should (e heard7 ""
should range
fro$ nor$al
and effortless
respiration.
"egular rhyth$6 no
heart $ur$urs.

+lat a(do$en.
-or$oacti5e (o*el
sounds.
-FA
Grossly nor$al.
-o ede$a.
-o cyanosis.
Clear (reath sounds. -o
retractions.
Adyna$ic
precordiu$6nor$al
rate6regular rhyth$6-o
$ur$ur
-or$al
-FA
-or$al
-or$al
-or$al
-8"S#-G CA"3 P2A-
Cues -ursing Diagnosis Planning #$ple$entation "ationale 35aluation
S8BN3C'#,3;
Ayo)o ng
ganito.
!ahirap.
#naasa nalang
lahat sa i(a..
1ala na$an
din a)o
$aga*a dahil
hindi )o na$an
)aya6 as
5er(ali&ed (y
the patient.
0BN3C'#,3;
D patient has
(een (edridden
e5er since she
*as
hospitali&ed
Disturbed body
image related to
trauma in!ury to
s"inal cord as
e#idenced by
#erbal re"orts of
negati#e feelings
about body
$feelings of
%el"lessness and
"o&erlessness'
G0A2;
After 9 day of nursing
inter5ention6 the
patient *ill recogni&e
and incorporate (ody
i$age change into selfD
concept in accurate
$anner *ithout
negating selfDestee$.
3.P3C'3D 08'C0!3;
'he patient *ill;
9< ,er(ali&e
acceptance of
self in situation.
2< ,er(ali&e relief
of an4iety and
adaptation to
actualFaltered
(ody i$age.
=< Ac)no*ledge
self as an
indi5idual *ho
has
responsi(ility for
self.
Inde"endent:
9< Deter$ine
*hether
condition is
per$anentF no
hope for
resolution
2< 35aluate le5el of
clients
)no*ledge of
and an4iety
related to
situation.
0(ser5e
e$otional
changes.
=< a5e client
descri(e self 6
noting *hat is
positi5e and
*hat is negati5e.
Be*are of ho*
client (elie5es
others see self.
4< -ote signs of
grie5ingFindictor
s of depression
K'o assess
causati5eF
contri(uting
factors
K 'o assess
causati5eF
contri(uting
factors
K'o asses
causati5eF
contri(uting
factors
K'o e5aluate
needs for
counseling and
35aluate
response to
inter5entions6
teachings and
actions
perfor$ed.
O 'he patient
*as a(le to
incorporate
(ody i$age
change into
selfDconcept
*ithout
negating selfD
estee$.
'he goal *as
$et.
>< #dentify
pre5iously used
coping
strategies and its
effecti5eness.
?< 3sta(lish
therapeutic
nurseDclient
relationship
con5eying an
attitude of caring
and de5eloping a
sense of trust.
@< Pro5ide
assistance *ith
self care needsF
$easures as
necessary *hile
pro$oting
indi5idual
a(ilitiesFindepen
dence
Collaborati#e:
A< "efer to
appropriate
support groups.
B< 'al) to S0Gs<
a(out *ays to
help client deal
*ith pro(le$
$edication
K'o deter$ine
coping
s)illsFcapa(ilities
K 'o assist
clientFS0Gs< to
deal *ithFaccept
issues of selfD
concept related to
(ody i$age.
K'o enhance
capa(ilities
K'o pro5ide
continuity of care
K'o pro$ote
colla(oration .
Cues -ursing Diagnosis Planning #$ple$entation "ationale 35aluation
S8BN3C'#,3;
Ang hirap ng
ganito6 na)ahiga
na lang lagi6 )ahit
paligo inaasa sa
i(a6 as 5er(ali&ed
(y the patient
0BN3C'#,3;
K patient has (een
(edridden e5er
since she *as
hospitali&ed
(ecause of spinal
cord in:ury
Self(bat%ing
%ygiene deficit
related to musculo(
s)eletal im"airment
as e#idenced by
inability to &as%
body or body "arts*
obtain or get to
&ater source* get in
and out of
bat%room.
G0A2;
After 9 day of
nursing
inter5ention6 the
patient *ill
perfor$ selfDcare
acti5ities *ithin
le5el of o*n
a(ility
3.P3C'3D
08'C0!3;
'he patient *ill;
9< #dentify
indi5idual
areas of
*ea)nessF
needs
2< De$onstrate
techniLuesF
lifestyle
changes to
$eet selfD
care needs
=< #dentify
personal
resources
Inde"endent:
9< Deter$ine e4isting
conditions
affecting a(ility of
indi5idual to care
for o*n needs6 i.e.
spinal cord in:ury.
2< Deter$ine
indi5idual
strengths of client
=< -ote *hether
deficient is
te$porary or
per$anent6 should
decrease or
increase in ti$e
4< Pro$ote clientF S0
participation in
pro(le$
identification and
decision $a)ing.
>< De5elop plan of
care appropriate to
indi5idual
situation6
scheduling
acti5ities to
confor$ to clients
K 'o identify
causati5eF
contri(uting
factors
K 'o assess
degree of
disa(ility
K'o assess degree
of disa(ility
Kenhances
co$$it$ent to
plan6 opti$i&ing
outco$es

K to assist in
correctingF dealing
*ith situation
35aluate
responses to
inter5entions6
teachings and
actions
perfor$ed.
O'he client *as
a(le to perfor$
selfDcare
acti5ities *ithin
le5el of o*n
a(ility.
Goal *as $et
that can
pro5ide
assistance
nor$al schedule.
?< Assist *ith reha(
progra$
@< Allo* sufficient
ti$e for client to
acco$plish tas)s
to fullest e4tent of
a(ility
A< Assist *ith
necessary
adaptation to
acco$plish AD2s.
Begin *ith fa$iliar6
easily
acco$plished
tas)s.
B< "e5ie*F$odify
progra$
periodically to
acco$$odate
changes in a(ilities
De"endent:
9C<Ad$inister
$edication
regi$en
Collaborati#e:
99<Consult *ith
dietitianFnutritional
support tea$
K 'o enhance
capa(iities
K 'o enhance
capa(ilities
K'o encourage
client and (uild on
successes.
KAssist patient to
adhere to plan of
care to fullest
e4tent
K'o pro5ide
continuity of care
K 'o pro5ide
continuity of care