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Pott’s disease is a presentation of extrapulmonary tuberculosis that affects the spine, a kind of tuberculous arthritis of the intervertebral joints. Scientifically, it is called tuberculous spondylitis. Pott’s disease is the most common site of bone infection in TB; hips and knees are also often affected. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected. Pott's disease, which is also known as Pott’s caries, David's disease, and Pott's curvature, is a medical condition of the spine. Individuals suffering from Pott's disease typically experience back pain, night sweats, fever, weight loss, and anorexia. They may also develop a spinal mass, which results in tingling, numbness, or a general feeling of weakness in the leg muscles. Often, the pain associated with Pott's disease causes the sufferer to walk in an upright and stiff position. Pott’s disease is caused when the vertebrae become soft and collapse as the result of caries or osteitis. Typically, this is caused by mycobacterium tuberculosis. As a result, a person with Pott's disease often develops kyphosis, which results in a hunchback. This is often referred to as Pott’s curvature. In some cases, a person with Pott's disease may also develop paralysis, referred to as Pott’s paraplegia, when the spinal nerves become affected by the curvature. The disease progresses slowly. Signs and symptoms include: back pain, fever, night sweats, anorexia, weight loss, and easy fatigability. Diagnosis is based on: blood tests - elevated ESR , skin tests ,radiographs of the spine , bone scan ,CT of the spine , and bone biopsy. Gibbus formation is the pathognomonic sign of this disease. Gibbus formation refers to a sharply angled curvature of the backbone, resulting from collapse of a vertebra or simply a hunchback.
Fuertes, Rheegell E. N413 POC
She also said that nursing is a service that is based on the art and science and aims to help people. The researcher chose to discuss Pott's disease as one of the requirement in the rotation. to analyze and dig deeper and see a clearer picture.5% of all tuberculosis cases (0.3-6. It is the responsibility of the nurse to meet the different needs of the client to achive the optimum level of functioning. This study will help the researcher future registered nurses. sick or well.2-1. The said disease could lead to different problems that the patient can experince. “21 nursing problems” according to Faye Glenn Abdellah could be best adapted on this kind of case.Pott's Disease: A Case Report Approximately 1-2% of total tuberculosis cases are attributable to Pott disease. tuberculosis of the bone and joints accounted for 3. Internationally. The incidence rate here in the Philippines is approximately 20-30% of all the patient diagnosed to have Tuberculosis. She defined nursing as broadly grouped into the 21 nursing problem areas to guide care and promote the use of nursing judgement. between 1993 and 2001. Rheegell E. in response to our roles as Fuertes.3% in patients of non-European origin) . Most of the cases of the Pott's disease in the Philippines is caused by the non-compliance of the treatment regimen of TB. N413 POC .1% in patients of European origin and 2. cope with their health needs.
• To accurately explain the various laboratory examinations that require for the detection of the disease and how the significant remarks or findings relate to his disease. N413 POC . SPECIFIC OBJECTIVES: • To know the patho-physiologic mechanism of the disease process of Pott's disease. • • • Cite various drugs required for the treatment of the disease in giving a client based analysis on the said pharmacologic treatment. To evaluate the presenting clinical manifestations based on the overall Fuertes. To be able to give health teachings regarding the prevention and cure of the disease. Rheegell E. placing emphasis on how the complications and the disease etiology relate and sync with each other.Pott's Disease: A Case Report OBJECTIVES OF THE STUDY GENERAL OBJECTIVES: To be able to develop a comprehensive case study that would focus on the chosen case with regards to the pathology of the disease. its corresponding medical actions and the associative function of client-based interventions which will be used to facilitate the client’s health status which is aimed towards achieving optimum level of functioning.
Pott's Disease: A Case Report condition with emphasis placed on the alterations. N413 POC . Rheegell E. Fuertes.
Rheegell E. The spinal cord is surrounded by protective bone segments. N413 POC . twelve thoracic vertebrae. The nerve fibers within the spinal cord carry messages to and from the brain to other parts of the body. called the vertebral column. five lumbar vertebrae and five sacral vertebrae. The vertebral column also provides attachment points for muscles of the back and ribs.Pott's Disease: A Case Report 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 vertebral column is comprised of seven cervical vertebrae. The vertebral disks serve as shock absorbers during activities such as Fuertes.
N413 POC . running and jumping. Fuertes.Pott's Disease: A Case Report walking. Rheegell E. they also allow the spine to flex and extend.
another skin test may be needed. it rarely leads directly to a specific diagnosis. A person who has been exposed to the bacteria is expected to mount an immune response in the skin containing the bacterial proteins. It is a test that indirectly measures how much inflammation is in the body. which means it cannot be used to diagnose a specific disorder. Tuberculin skin test (purified protein derivative [PPD]) results are positive in 84-95% of patients with Pott disease who are not infected with HIV. The reaction is read by measuring the diameter of induration (palpable raised hardened area) across the forearm (perpendicular to the long axis) in millimeters. However. The Fuertes. ESR stands for erythrocyte sedimentation rate.1ml solution for injection. If a person has had a history of a positive tuberculin skin test. and inflammatory diseases that cause vague symptoms. or has not had a recent tuberculin skin test (within one year). A standard dose of 5 Tuberculin units (0. The erythrocyte sedimentation rate (ESR) may be markedly elevated (>100 mm/h). Radiography Radiographic changes associated with Pott disease present relatively late. N413 POC . it is useful in detecting and monitoring tuberculosis. Rheegell E.1 mL)(The standard Mantoux test in the UK consists of an intradermal injection of 2TU of Statens Serum Institute (SSI) tuberculin RT23 in 0. 2. This test can be used to monitor inflammatory or cancerous diseases. certain forms of arthritis. autoimmune disorders. It is a screening test. This intradermal injection is termed the mantoux technique. tissue death. If there is no induration.Pott's Disease: A Case Report DIAGNOSTIC PROCEDURES 1. the result should be recorded as "0 mm". Erythema (redness) should not be measured. However.) Injected intradermally (between the layers of dermis) and read 48 to 72 hours later. 3.
particularly in epidural and paraspinal areas. or other bone disorders. 6. Thus. CT scanning reveals early lesions and is more effective for defining the shape and calcification of soft-tissue abscesses. contrast-enhanced MRI appears to be important in the differentiation of these two types of spondylitis. sclerosis. CT scanning CT scanning provides much better bony detail of irregular lytic lesions. In contrast to pyogenic disease.Pott's Disease: A Case Report following are radiographic changes characteristic of spinal tuberculosis on plain radiography: visibly seen curvature of the spine or visible bone lesions on different levels. Low-contrast resolution provides a better assessment of soft tissue. Fuertes. N413 POC . Rheegell E. disk collapse. Bone biopsy A bone biopsy is a procedure in which a small sample of bone is taken from the body and looked at under a microscope for cancer. 4. MRI is also the most effective imaging study for demonstrating neural compression. calcification is common in tuberculous lesions. MRI MRI is the criterion standard for evaluating disk-space infection and osteomyelitis of the spine and is most effective for demonstrating the extension of disease into soft tissues and the spread of tuberculous debris under the anterior and posterior longitudinal ligaments. 5. whereas thick and irregular enhancement of abscess wall and ill-defined paraspinal abnormal signal suggest pyogenic spondylitis. and disruption of bone circumference. infection. MRI findings useful to differentiate tuberculous spondylitis from pyogenic spondylitis include thin and smooth enhancement of the abscess wall and welldefined paraspinal abnormal signal.
Find the cause of ongoing bone pain.Socio-economic status . PATHOPHYSIOLOGY PRECIPITATING FACTORS PREDISPOSING FACTORS . See what is causing a bone infection (osteomyelitis) or if an infection is present.Pott's Disease: A Case Report Confirm the diagnosis of a bone disorder that was found by another test. Check bone problems seen on an X-ray.PTB diagnosed MEDICATIONS: HRZE Exposure to Mycobacterium Tubeculosis Primary Pulmonary Tuberculosis Intermittent fever. CT scan.Non-compliance to medicines . and bone cancer. such as a bone cyst.Malnutrition .Tubeculosis . night sweats. Tell the difference between a noncancerous (benign) bone mass. Tuberculosis Fuertes. Spread of M. N413 POC . such as multiple myeloma. or a MRI. such as an X-ray. poor appetite. Rheegell E. upper back pain. weight loss.Continuous exposure to M. bone scan.
Rheegell E. N413 POC .Pott's Disease: A Case Report Extrapulmonary Tuberculosis Infection spreads to the intervertebral disc in the T7-T9 of the spine Persistent back pain Progressive bone destruction Intervertebral Collapse Caseation takes place Gibbus formation between T4-T7 or T7-T9 Spinal cord depression Neurological effects and lower motor defficits Pott's parplegia Fuertes.
MEDICAL MANAGEMENT • Before the advent of effective antituberculosis chemotherapy. testing for tuberculosis is an important preventative measure. The best method for preventing the disease is reduce or eliminate the spread of tuberculosis.Pott's Disease: A Case Report MEDICAL-SURGICAL-NURSING MANAGEMENT Since Pott's disease is caused by a bacterial infection. bone scans. • According to the most recent recommendations issued in 2003 by the US Centers for Disease Control and Prevention. Rheegell E. and used to confirm the disease. A radiographs may also be tuberculin skin test is the most common method used to screen for tuberculosis. prevention is possible through proper control. • Studies performed by the British Medical Research Council indicate that tuberculous spondylitis of the thoracolumbar spine should be treated with combination chemotherapy for 6-9 months. N413 POC . the Infectious Diseases Society of America. as those who are positive for purified protein derivative (PPD) can take medication to prevent tuberculosis from forming. Pott disease was treated with immobilization using prolonged bed rest or a body cast. though blood tests . and the American Thoracic Society. a 4-drug regimen should be Fuertes. In addition. bone biopsies.
which include pyrazinamide. and presence of cord compression or spinal deformity determine the specific operative approach (kyphosis. The lesion site. The treatment decision should be individualized for each patient. and streptomycin. N413 POC • . These are generally chosen among the first-line drugs. • Isoniazid and rifampin should be administered during the whole course of therapy. The use of second-line drugs is indicated in cases of drug resistance. SURGICAL MANAGEMENT • Indications for surgical treatment of Pott disease generally include the following: o Neurologic paraplegia) deficit (acute neurologic deterioration. paraplegia. extent of vertebral destruction. ethambutol. Rheegell E. Additional drugs are administered during the first 2 months of therapy. paraparesis.Pott's Disease: A Case Report used empirically to treat Pott disease. • Opinions differ regarding whether the treatment of choice should be conservative chemotherapy or a combination of chemotherapy and surgery. tuberculous abscess). Fuertes. o o Spinal deformity with instability or pain No response to medical therapy (continuing progression of kyphosis or instability) Large paraspinal abscess Nondiagnostic percutaneous needle biopsy sample o o • Resources and experience are key factors in the decision to use a surgical approach.
Duration of antituberculosis treatment: If debridement and fusion with bone grafting are performed. head halter traction. • • Fuertes. Surgery is required if there is spinal deformity or neurological signs of spinal cord compression. Rheegell E.Pott's Disease: A Case Report • In Pott disease that involves the cervical spine. the following factors justify early surgical intervention: o o o High frequency and severity of neurologic deficits Severe abscess compression that may induce dysphagia or asphyxia Instability of the cervical spine Nursing Diagnosis • • • • • Acute pain related to inflammatory process Disturbed body image related to trauma/injury to spinal cord Self – bathing hygiene deficit related to musculoskeletal impairment Impaired physical mobility related to therapeutic restriction of movement Imbalance nutrition related to inadequate food intake Nursing Responsibilities • • • Drug treatment is generally sufficient for Pott’s disease. It may also be necessary to immobilize the area of the spine affected by the disease. Other interventions include application of knight/ taylor brace. with spinal immobilization if required. If debridement and fusion with bone grafting are NOT performed a minimum of 12 months’ treatment is required. treatment can be for six months. or the person may need to undergo surgery in order to drain any abscesses that may have formed or to stabilize the spine. N413 POC . Standard antituberculosis treatment is required.
atient should be reminded to attend check-ups at the nearest….reatment should be taken in a…. Rheegell E.Pott's Disease: A Case Report PATIENT HEALTH TEACHING P. N413 POC .. Fuertes.rthopedic center T. O.
Pott's Disease: A Case Report T. N413 POC .ight any symptoms other than the usual and report it to the physician Fuertes.imely manner S. Rheegell E.
Rheegell E.Pott's Disease: A Case Report Global City Innovative College Bonifacio Global City. N413 POC . N413 Group B Cluster 2 December 2010 Fuertes. Rheegell E. Taguig City Philippines In Partial Fulfilment of the Requirements in Nursing Care Management 105 CASE STUDY POTT'S DISEASE Clinical Agency : Philippine Orthopedic Hospital Submitted By: FUERTES.
Pott's Disease: A Case Report Fuertes. N413 POC . Rheegell E.
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