You are on page 1of 27

St.

Augustine School of nursing

“A Case Study of Pott’s Disease”

Section 4B

Group 2
Douglas Hadriane B. Danao
Miguel Rafael I. Carlos
Charmaine MuÑoz
Table of Contents

I. Acknowledgement
II. Introduction
III. Assessment
I. Personal data
II. Medical History
A. History of present illness
B. Past Medical History
C. Family Medical History
D. Personal and Social history
IV. Physical assessment
V. Anatomy and Physiology
VI. Pathophysiology
VII. Nursing Care Plan
VIII. Drug Study
IX. Discharge Planning

ACKNOWLEDGEMENT
This case study on Pott’s disease would not be
possible without those people who continually helped
and contributed in the said case study. My heartfelt
expression of appreciation goes out to each and every
one of you.

First and foremost, I would like to thank the West B


staff of EAMC for generously giving me their time.

To our Professor, Mam Diente,Mam Donnie for


patiently supervising and assisting us with your
knowledge, as we gradually go through the process of
doing the case study itself, our sincerest thanks.

To our patient, for the generous time extended for


me to explore this case; and for giving me his full
cooperation and kindness that helped me complete the
needed information for this paper.

Also, to our friends and classmates, who, like me,


managed to encourage and support each other amidst
every discouragement and difficulty, Thank you.

To my parents, for supporting me all the way,


providing me with everything I need, financially and
emotionally. All of those things are genuinely
appreciated.

Last but not the least, to our Almighty Father, for


his unceasing guidance and blessings, for constantly
giving me hope, courage, and patience. Truly, none of
this is possible without you.

INTRODUCTION
Tuberculosis (TB) of the spine also known as
Potts disease, Pott’s 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.

Pott’s disease results from haematogenous


spread of tuberculosis (mycobacterium
tuberculosis) from other sites. The infection
then spreads from two adjacent vertebrae into
the adjoining disc space. If only 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 by caseation, leading to vertebral
narrowing and eventually to vertebral collapse
and spinal damage. A dry soft tissue mass
often forms and superinfection is rare.

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.
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.

A person who has been diagnosed with


Pott's disease may be treated through a
variety of options. He or she may utilize
analgesics or antituberculosis drugs to get the
infection under control. It may also be
necessary to immobilize the area of the spine
affected by the disease, or the person may
need to undergo surgery in order to drain any
abscesses that may have formed or to stabilize
the spine.

Since Pott's disease is caused by a bacterial


infection, prevention is possible through
proper control. The best method for preventing
the disease is reduce or eliminate the spread
of tuberculosis. In addition, testing for
tuberculosis is an important preventative
measure, as those who are positive for purified
protein derivative (PPD) can take medication to
prevent tuberculosis from forming. A
tuberculin skin test is the most common
method used to screen for tuberculosis, though
blood tests, bone scans, bone biopsies, and
radiographs may also be used to confirm the
disease
THEORETICAL FRAMEWORK

For the theoretical framework, I used the “21


nursing problems” according to Faye Glenn Abdellah.
She defined nursing as broadly grouped into the 21
nursing problem areas to guide care and promote the
use of nursing judgement. She also said that nursing is
a service that is based on the art and science and aims
to help people, sick or well, cope with their health
needs.

The 21 nursing problems are as follows:

1) To maintain good hygiene.


2) To promote optimal activity: exercise,
rest, and sleep
3) To promote safety
4) To maintain good body mechanics.
5) To facilitate the maintenance of a supply
of oxygen
6) To facilitate maintenance of nutrition
7) To facilitate maintenance of elimination
8) To facilitate maintenance of fluid and
electrolyte imbalance
9) To recognize the physiologic response
of the body to disease conditions
10)To facilitate the maintenance of
regulatory mechanisms and functions
11)To facilitate the maintenance of sensory
function
12)To identify and accept positive and
negative expressions, feelings and
reactions
13)To identify and accept the
interrelatedness of emotions and illness
14)To facilitate the maintenance of
effective verbal and non-verbal
communication
15)To promote the development of
productive interpersonal relationships
16)To facilitate progress towards
achievement of personal spiritual goals
17)To cerate and maintain a therapeutic
environment
18)To facilitate awareness of self as an
individual with varying needs
19)To accept the optimum possible goals
20)To use community resources as aid in
resolving problems
21) Tounderstand the role of social
problems as influencing factor

ASSESSMENT

I. Personal Data:

Name: B.P.
Address: Novaliches Quezon City
Age: 28 years old
Sex: Female
Civil status: Married
Religion: Roman Catholic
Birthday: November 19, 1978
Birthplace: Manila
Attending Physician: Dr. Adrian Catbagan
Admitting Diagnosis: Spinal cord compression on T/3
level
Chief complaint: weakness of lower extremities
II. Medical History

A. History of Present Illness:


This is a case of B.P., who was admitted
for the first time last September 13,2007 with a chief
complaint of weakness of lower extremities. The
history of present illness started two months prior to
admission, when the patient started to experience
weakness of both lower extremities. No other
associated signs and symptoms were noted. Few
hours prior to admission, persistence of above
symptoms prompted consult.

B. Past Medical History:

( - ) HPN
( - ) DM
( - ) asthma
( - ) allergy

B. Family Medical History:


( - ) HPN
( - ) DM
( - ) CA
( - ) asthma

C. Personal and Social History:


( - ) smoker
( - ) alcoholic beverage drinker
ANATOMY
The vertebral column provides structural support for the
trunk and surrounds and protects the spinal cord. The
vertebral column also provides attachment points for
the 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.
MEDICAL/SURGICAL INTERVENTIONS

Management of Pott’s disease

Drug treatment is generally sufficient for


Pott’s disease, with spinal immobilization if
required. Surgery is required if there is spinal
deformity or neurological signs of spinal cord
compression.

Standard antituberculosis treatment is


required. Duration of antituberculosis
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
12 months’ treatment is required.

It may also be necessary to immobilize the


area of the spine affected by the disease, or
the person may need to undergo surgery in
order to drain any abscesses that may have
formed or to stabilize the spine.

Other interventions include application of


knight/ taylor brace, head halter traction.
Surgery includes ADSF ( Anterior
decompression Spinal fusion).
Drug Study

GENERIC NAME: HRZE


(isoniazid+rifampicin+pyrazinamide+ethambutol)
Brand name: Myrin
Dosage: 3 tab 30 min before breakfast
Drug Classification:Anti-infective

MECHANISM INDICATIONS CONTRA- ADVERSE NURSING


INDICATIONS REACTION Responsibilities
Unknown. > Actively - > peripheral >Use
Appears to growing Contraindicate neuropathy, cautiously in
inhibit cell- tubercle bacilli d in patients fluid elderly
wall >prevention of with acute discoloration, patients
biosynthesis tubercle bacilli hepatic disease optic neuritis, >peripheral
by in those or isoniazid- hepatitis neuropathy is
interfering exposed to related liver more
with lipid tuberculosis damge common in
and DNA or those with patients who
synthesis positive skin are slow
test results acetylators or
whose chest who are
x-rays and malnourished,
bacteriologic alcoholic or
studies are diabetic,
consistent >Monitor
with non- hepatic
progressive function
tuberculosis closely for
changes

GENERIC NAME: ketorolac tromethamine


Brand name:Toradol
Dosage: 30 mg Iv q8h
Drug Classification: NSAIDS

MECHANISM INDICATIONS CONTRA- ADVERSE NURSING


INDICATIONS REACTION Responsibilities
Unknown. > short-term - > drowsiness, > Ketorolac
Produces management Contraindicate sedation, isn’t
anti- of moderately d in patients edema, recommended
inflammatory, severe, acute hypersensitive hypertension, for children
analgesic, pain for single to drug and in diarrhea, > Use
and dose those with stomatitis, cautiously in
antipyretic treatment active peptic peptic patients with
effects, > Short-term ulcer disease , ulceration, hepatic and
possibly by management recent GI rash, renal
inhibiting of moderately bleeding or diaphoresis impairment
prostaglandi sever, acute perforation, >NSAIDS may
n synthesis pain for advanced renal mask signs
multiple dose impairment, and
treatment incomplete symptoms of
homeostasis infection
and with high because of
risk of their
bleeding. antipyretic
and anti-
inflammatory
actions

GENERIC NAME: ciprofloxacin


Brand name: Ciprobay
Dosage: 500mg/cap BIDx5 days
Drug Classification: Fluoroquinolones
MECHANISM INDICATIONS CONTRA- ADVERSE NURSING
INDICATIONS REACTION Responsibilities
Inhibits > Severe or - > headache, > Use
bacterial dna complicated Contraindicated retlessness, cautiously in
synthesis, bone or joint to patients fatigue, patients with
mainly by infections sensitive to drowsiness, CNS disorders,
blocking >Complicated fluoroquinolone edema, such as severe
DNA gyrase, intraabdominal s chest pain, cerebral
bactericidal. infections nausea, arteriosclerosis
diarrhea, or seizure
leucopenia, disorders, and
crystalluria in those with
risk for
seizures.
> Monitor
patients intake
and output and
observe for
signs of
crystalluria
>Obtain
specimen for
culture and
sensitivity
before giving
first-dose

PATHOPHYSIOLOGY

Pulmonary tuberculosis
Spread of mycobacterium tuberculosis from other

Extrapulmomary tuberculosis

The infection spreads from two adjacent vertebrae


into the adjoining disc space

back pain, fever, night sweats,


anorexia, weight loss, and easy
One vertebra is affected, the disc is normal
Two are involved, the avascular intervertebral disc cannot
receive nutrients and collapse

Disk tissue dies and broken down by caseation

Vertebral narrowing

Vertebral collapse

Spinal damage

POTT’S DISEASE

Kyphosis, paraplegia, bowel and urinary incontinenece

Surgery: evacuation of pus, Anterior


decompression spinal fusion

GORDON’S PATTERN OF FUNCTIONING


Before During
hospitalization hospitalization
Health-perception/ It is her first time She hopes that she
Health- to get hospitalized. will get better..
management She usually just
pattern bears the pain or
uses self-
medication.
Nutritional/ The patient eats all The patient still
Metabolic pattern kinds of food. She eats a lot.
likes to eat
vegetables.
Elimination pattern The patient The patient has
defecates regularly urinary and bowel
at least once a day incontinence
or sometimes once because of spinal
every two days and cord injury.
urinates frequently.
The patient sweats
a lot because of the
weather.
Activity/ Exercise The patient’s form She doesn’t have a
pattern of exercise is doing form of exercise in
the household the hospital
chores. because she is
bedridden, as a
result of spinal cord
injury.
Sleep-rest pattern The patient usually The patient’ s sleep
sleeps for about 5 was still for about 5
hours. hours.
Cognitive/ The client likes to At first the client
Perceptual pattern talk to her doesn’t speak much
neighbors after but once you have
doing all the established rapport
household chores. with her, you will
see that she is a
very friendly
person. She
became open and
was talking more
than before.
Self-perception/ The patient has a The patient
Self-concept good self –esteem. somewhat lost her
pattern self-esteem
because she thinks
she is useless.
Role/ Relationship The patient is very The patient is
pattern friendly and has a communicative
good relationship when you talk to
with people around her but she will not
her. be the one to open
up conversations.
Coping/ Stress- WEhen stressed, When the patient
tolerance pattern she usually diverts experiences stress,
it by watching she just prays to
television. god because there
are not other
diversional
activities she can
do in the hospital.
Discharge Plan

P- atient should be reminded to attend check-ups at the nearest….

O- rthopedic center

T- reatment should be taken in a…..

T- imely manner

S- ight any symptoms other than the usual and report it to the physician
PHYSICAL ASSESSMENT

Body part Technique used Normal findings Actual findings Analysis/Interpretation


Head Palpation Absence of masses Head does not appear too Normal
Inspection and nodules large or too small. There
were no masses and
nodules.

Eyes Inspection Conjunctiva is pink Anicteric sclera Normal


Pink palpebral
conjunctiva

Hair Inspection Usually black and Normal


shiny. Hair doesn’t look dull.

Ears Inspection Normal


Color is the same as Color is the same as
facial skin. Pinna facial skin. No deformities
tends to bend easily found. No discharge
and recoils easily after
bending.

Nose Inspection Normal


Symmetrical with no Symmetrical. No
deformities. deformities found.
(-) nasal congestion
Skin Inspection Normal
Good or active skin Good skin turgor
turgor. Absence of (-) rashes
ecchymosis.

Mouth Inspection Normal


Uniform, pink color of Pink-colored gums. Moist
the gums, moist and buccal mucosa.
smooth in texture

Nails Inspection Normal


Smooth and usually Good capillary refill.
long enough to extend Light pink in color,
over the fingertips; convex in shape.
should be colored
pink, convex in shape
and with 160o angle
between the nails and
the nailbeds.

Arms Inspection Normal


No ecchymosis noted. full
Should have good and equal pulses.
muscle contraction.
Good flexion and
extension. Absence of
ecchymosis and
Chest Palpation, deformities. Abnormal
Inspection and Slight DOB
Auscultation Chest is symmetrical, (+) gibbus formation
rhythmic and
breathing pattern is
Abdomen Palpation and effortless Normal
Inspection Flat abdomen.
Normoactive bowel
Contour is slightly sounds.
protuberant.
Genitalia Inspection N/A

N/A
Legs and Inspection Pinkish in color and Normal
Extremities intact.
Grossly normal.
Absence of No edema.
deformities and good No cyanosis.
ROM. Absence of
Respiratory Auscultation edema and Normal
system ecchymosis.
Clear breath sounds. No
retractions.
No unusual sounds
should be heard; RR
should range
from normal
Cardiovascular Auscultation and effortless Normal
system respiration.
Adynamic
precordium,normal
Regular rhythm, no rate,regular rhythm,No
heart murmurs. murmur
NURSING CARE PLAN
Cues Nursing Diagnosis Planning Implementation Rationale Evaluation
Independent:
SUBJECTIVE: Disturbed body GOAL: Evaluate
“Ayoko ng image related to 1) Determine >To assess response to
ganito. trauma/ injury to After 1 day of nursing whether causative/ interventions,
Mahirap. spinal cord as intervention, the condition is contributing teachings and
Inaasa nalang evidenced by patient will recognize permanent/ no factors actions
lahat sa iba.. verbal reports of and incorporate body hope for performed.
Wala naman negative feelings image change into self- resolution
din ako about body concept in accurate 2) Evaluate level of > To assess * The patient
magawa dahil (feelings of manner without clients causative/ was able to
hindi ko naman helplessness and negating self-esteem. knowledge of contributing incorporate
kaya, “ as powerlessness) and anxiety factors body image
verbalized by EXPECTED OUTCOME: related to change into
the patient. The patient will: situation. self-concept
1) Verbalize Observe without
OBJECTIVE: acceptance of emotional negating self-
- patient has self in situation. changes. >To asses esteem.
been bedridden 2) Verbalize relief of 3) Have client causative/ The goal was
ever since she anxiety and describe self , contributing met.
was adaptation to noting what is factors
hospitalized actual/altered positive and
body image. what is negative.
3) Acknowledge Beware of how
self as an client believes
individual who others see self.
has 4) Note signs of >To evaluate
responsibility for grieving/indictor needs for
self. s of depression counseling and
5) Identify medication
previously used >To determine
coping coping
strategies and its skills/capabilities
effectiveness.
6) Establish > To assist
therapeutic client/SO(s) to
nurse-client deal with/accept
relationship issues of self-
conveying an concept related to
attitude of caring body image.
and developing a
sense of trust. >To enhance
7) Provide capabilities
assistance with
self care needs/
measures as
necessary while
promoting
individual
abilities/indepen
dence

Collaborative: >To provide


8) Refer to continuity of care
appropriate
support groups. >To promote
9) Talk to SO(s) collaboration .
about ways to
help client deal
with problem
Cues Nursing Diagnosis Planning Implementation Rationale Evaluation
Independent:
SUBJECTIVE: Self-bathing/ GOAL: Evaluate
“ Ang hirap ng hygiene deficit 1) Determine existing > To identify responses to
ganito, nakahiga related to musculo- After 1 day of conditions causative/ interventions,
na lang lagi, kahit skeletal impairment nursing affecting ability of contributing teachings and
paligo inaasa sa as evidenced by intervention, the individual to care factors actions
iba,” as verbalized inability to wash patient will for own needs, i.e. performed.
by the patient body or body parts, perform self-care spinal cord injury.
obtain or get to activities within 2) Determine *The client was
OBJECTIVE: water source, get in level of own individual > To assess able to perform
> patient has been and out of ability strengths of client degree of self-care
bedridden ever bathroom. 3) Note whether disability activities within
since she was EXPECTED deficient is >To assess degree level of own
hospitalized OUTCOME: temporary or of disability ability.
because of spinal The patient will: permanent, should Goal was met
cord injury 1) Identify decrease or
individual increase in time
areas of 4) Promote client/ SO
weakness/ participation in >enhances
needs problem commitment to
2) Demonstrate identification and plan, optimizing
techniques/ decision making. outcomes
lifestyle 5) Develop plan of
changes to care appropriate to > to assist in
meet self- individual correcting/ dealing
care needs situation, with situation
3) Identify scheduling
personal activities to
resources conform to clients
that can normal schedule. > To enhance
provide 6) Assist with rehab capabiities
assistance program > To enhance
7) Allow sufficient capabilities
time for client to
accomplish tasks
to fullest extent of
ability >To encourage
8) Assist with client and build on
necessary successes.
adaptation to
accomplish ADL’s.
Begin with familiar,
easily
accomplished
tasks. >Assist patient to
9) Review/modify adhere to plan of
program care to fullest
periodically to extent
accommodate
changes in abilities >To provide
continuity of care
Dependent:
10)Administer
medication > To provide
regimen continuity of care
Collaborative:
11) Consult with
dietitian/nutritional
support team