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INTRODUCTION

A compression fracture is a collapse of a vertebra. It may be due to trauma or due to a


weakened vertebra in a patient with osteoporosis or osteogenesis imperfecta. In healthy
patients it is most often seen in individuals suffering extreme vertical shocks, such as ejection
seats. Seen in lateral views in plain x-ray films, compression fractures of the spine
characteristically appear as wedge deformities, with greater loss of height anteriorly than
posteriorly and intactpedicles in the anteroposterior view.

Back pain is by far the most common problem in patients with a compression fracture. Patients
with osteoporosis who sustain multiple compression fractures may begin to notice a curving of
the spine, like a hunchback, called akyphotic deformity. The reason for this is the vertebrae are
compressed in front, and usually normal in back. This wedge shaped appearance causes the
spine to curve forward. When enough compression occurs, this may become a noticeable
curvature. Patients with compression fractures also often notice a loss of their overall height
because of the decreased size of the spinal column.

Nerve complaints are unusual in compression fractures because the spine and its nerves are
behind the vertebra, and, as mentioned above, the front of the vertebra is compressed and the
back remains normal. In some serious traumatic fractures, called "burst fractures," the
compression occurs around the spinal cord and nerves. This is more serious and may require
immediate treatment to prevent or relieve pressure on the spinal cord or nerves.

Treatment of compression fractures


The best treatment is prevention. Usually, treatment is aimed at alleviating the pain, and
preventing injuries in the future. This is best accomplished by treating osteoporosis with
exercise, calcium, and medications.

If the pain is severe, and collapse is becoming problematic, a procedure called a vertebroplasty
may be considered. In this procedure an interventional radiologist restores the height of the
bone and injects cement into the vertebra to stabilize the fracture and prevent further collapse.

Surgical procedure

 Kyphoplasty and vertebroplasty, (Vertebroplasty and kyphoplasty are medical spinal


procedure where bone cement is injected through a small hole in the skin (percutaneously)
into a fractured vertebra with the goal of relieving the pain of osteoporotic compression
fractures. It has been found to be ineffective in treating compression fracture of the spine.
The procedures are controversial with conflicting evidence regarding their effectiveness.)
minimally invasive procedures designed to treat pain from osteoporotic compression
fractures and sometimes other forms of fracture, such as a fracture caused by certain types
of cancer. Vertebroplasty has been found to be ineffective.

Symptoms of a Spinal Compression Fracture


It is important to identify the symptoms of spinal compressionfractures and notify your doctor.
Sudden, severe back pain, especially in older women, may signal a spinal compression fracture.
Anyone with significant back pain -- especially a woman who is near or over age 50 -- should
see a doctor. Most compression fractures in women over 50 are due toosteoporosis and
treatment can help reduce the chance of further compression fractures.

One or more symptoms can indicate a spinal fracture:

• Sudden, severe back pain.

• Worsening of pain when standing or walking.

• Some pain relief when lying down.

• Difficulty and pain when bending or twisting.

• Loss of height.

• Deformity of the spine - the curved, "hunchback" shape.

The pain typically occurs with a slight back strain during an everyday activity, like:

• Lifting a bag of groceries.


• Bending to the floor to pick something up.
• Slipping on a rug or making a misstep.
• Lifting a suitcase out of the trunk of a car.
• Lifting the corner of a mattress when changing bed linens.
Personal Profile

Name: Veronica Quinacman


Age: 39 years old
Sex: female
Religion: Roman Catholic
Birth Place: Pangasinan
Birthday: June 18, 1971

History

Past History:
-2002 (+) emergence of draining sinus over right lumbar area
-Six mass quadruple Anti-Koch,s given with resolution sinus
-Patient never undergone any confinement
-She has complete immunization when she was a child
-When she was a child, she slipped on their floor, and she doesn’t gone any check-up
after that.

Present History:

December 11, 2010 – fracture noted sudden onset of mild back pain with associated left
lower extremity numbness and weakness which was soon followed by numbness and weakness
of the right extremity.
1day PTA – she experience back pain. Initially, she can walk from their bed and going
to their living room, but when she decided to sit up, she experience a severe back pain and
weakness of her left lower extremities
December 28, 2010 – Further progression of lower extremities weakness and numbness
consulted at Philippine Orthopedic Center OPD advised MRI
January 2011 – fracture follow-up with MRI, result Pott’s disease of T12-L1, seen and
advised admission and post anterior decompression spinal fusion.

Social History:

Patient Veronica is third from her six siblings; her father has health history of diabetes
and hypertension. Luckily, they don’t acquire that diseases.

Patient Veronica doesn’t have any history of alcohol drinking, using of tobacco and
taking of drugs. She worked at the mall as a sales lady. She doesn’t want to hang out, she just
want to work and stayed at home.
Laboratory Result:

MRI of Left Lumbo-Sacral Spine


Impression:
-Pott’s Disease T10 – L1 with anterior paravertebral soft tissue at T10 –T12 levels
-Bilateral PSOAS ABSCESS L1-L4
-Kyposis of T12-L1
-Degenerative or traumatic disc disease on L5-S1

January 10, 2011

Result Normal Interpretation


SGOT 36.23 <31.00 When detected to be
SGPT 32.56 <32.00 high, it is necessary to
check whether it is
due to a temporary
condition that is
affecting liver
function, such as
recent intake of
alcohol or due to a
more serious
condition, such as
liver damage or partial
liver failure.

February 2, 2011
Result Normal Interpretation
SGOT 44.77 <31.00 When detected to be
high, it is necessary
SGPT 88.17 <32.00 to check whether it is
due to a temporary
condition that is
affecting liver
function, such as
recent intake of
alcohol or due to a
more serious
condition, such as
liver damage or
partial liver failure.
Uric Acid 668.80umol/L 140-420umol/L Increased: gout,
renal failure, drugs
(diuretics, others),
hypothyroidism,
chemotherapy,
parathyroid diseases,
lactic acidosis.

(Pott’s Disease secondary to Compression Fraction)

Submitted by: Rose Ann R. Repollo


BSN 4F Group 2
Submitted to: Ms. Milagros Rea
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective: Acute pain related After effective >determined the >to know the After effective
to spine deformity nursing cause of pain precipitating factor nursing intervention,
“Bigla nalang as evidence by intervention, the and to assess the the patient pain
sumakit yung likod difficulty in moving pain experiencing etiology already lessen
ko” as verbalized by secondary to by the patient will
the client compression lessen >encouraged the >to destruct
fraction client to divert attention to pain
Objective: thinking like think of
happy experiences
-difficulty in moving
>Provide comfort >to promote non-
-limited movement measure like pharmacological
communicating pain management
-inability to sit therapeutically,
touch, repositioning
-facial grimace
when pain occurs >Encouraged >to prevent fatigue
adequate rest
periods

>Provided proper >to promote proper


health teaching in knowledge about
reducing pain the condition
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective: Activity intolerance After effective >noted report of >it maybe After effective
“hindi ako related to bed rest/ nursing weakness, fatigue, contribute to activity nursing intervention,
makatayo, immobility as intervention, the pain intolerance the patient already
makaupo at evidence by patient will participated in
makalakad, weakness and participate in >teach method of >to conserve desired activities
namamanhid ung numbness of lower desired activities proper exercises energy like ROM
paa ko” as extremities like ROM
verbalized by the secondary to >Planed care to >to reduce fatigue
patient compression carefully balance
fracture rest periods with
Objective: activities
-weakness of
extremity >Assisted client to >to prevent and
-numbness of all activities protect client from
extremity injury
-limited movement
-difficulty in moving >Gave client >to sustain
information that motivation
provides evidence
of daily progress
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective: Imbalance nutrition After effective >Monitored vital >to have baseline After effective
“nawawalan ako ng less than body nursing sign data nursing intervention,
gana kumain kasi requirements intervention, the the client
nawawala yung related to inability to patient will >determined client’s demonstrated
panlasa ko” as taste food as demonstrate ability to chew or >can affect lifestyle changes to
verbalized by the evidence by loss of lifestyle changes to swallow and taste ingestion or regain and maintain
patient appetite regain and maintain foods digestion of foods appropriate weight
appropriate weight
Objective: >Emphasized
-loss of appetite importance of >to promote
-weight loss (10kg) balance diet wellness
-slim body size
>Provided health
teaching about >to gain knowledge
nutrition and information

>prevent
unpleasant odor / >may have negative
sights effect on appetite or
eating
>

Generic Name INDICATION (Dosage Mechanism of Action Adverse Effects Nursing Responsibilities
(Brand name) and Frequency)

Classification
ihydropyridine calcium- Rifampicin: Cutaneous • Blood pressure
Fixcom 4 [tab] Treatment of
channel blocker, which is syndrome, flu syndrome. GI determinations
pulmonary & extra- also known as calcium disturbances & bleeding,
Natrapharm pulmonary TB. antagonists, calcium-entry erosive gastritis. Ulcerative,
Natrapharm
blockers, and slow- eosinophilic &
channel blockers. It pseudomembranous colitis. • ECG reading
Anti-TB agent Patients
inhibits the cellular Transient liver function a
weighing <55
movements of calcium bnormalities, hepatitis,
kg 3 tab/day 55-
ions across cell thrombocytopenia, purpura,
70 kg 4 • Heart rate
membranes. It acts eosinophilia, leukopenia,
tab/day >70 kg 5 determinations
primarily via inhibition of hemolytic anemia, renal
tab/day. Duration: calcium into vascular failure, menstrual
2 month smooth muscle and, to disturbances. Headache,
lesser extent cardiac drowsiness, ataxia, • Reduced frequency or
muscle. As a result, dizziness, numbness, severity of anginal
amlodipine produces edema, myopathy, attacks
peripheral arterial muscular weakness.
vasolidation and lowers Orange-red discoloration of
blood pressure, with the urine & other body
relatively little negative fluids. INH: Peripheral
inotropic effect. neuritis, psychotic reactions
Amlodipine interacts with & convulsions, increase in
calcium ions channel by liver enzymes, hepatitis,
an ongoing anemia, agranulocytosis,
association/dissociation thrombocytopenia,
with the receptor binding eosinophilia, skin eruption,
site, producing a gradual fever, casculitis, nausea,
onset of action. vomiting, pellagra, purpura,
hyperglycemia, lupus-like
syndrome, urinary retention
& gynecomastia.
Pyrazinamide:
Hepatotoxicity. Ethambutol
: Retrolobular neuritis,
visual field constriction,
central or peripheral
scotoma, green-red color
blindedness. Confusion,
disorientation, hallucination,
headache, dizziness,
malaise, jaundice, transient
liver function, peripheral
neuritis, thrombocytopenia,
pulmonary infiltrates,
eosinophilia, GI
disturbances.
Hypersensitivity reactions.

To treat and prevent A group of naturally Skeletal weakness, >taking large dose of iron, the
Vitamin B
occurring fat soluble headache, fatigue, RDA of vit.E maybe increased
haemolytic anemia due
complex substance known as
to vit.E deficiency; To >teach that sources of vit.E
tocopherols, it is the most
prevent retrolental biologically potent and found in wheat germs as well
fibroplasiasecondary to has been synthesized. An as in vegetables oil, green leafy
oxygen treatment; used anti-oxidant, it prevent vegetables, nuts, daily
products, eggs, cereal, meats
in patient diet peroxidation, a process
and liver.
containing large that gives rise to free
amount of fats for long radicals.
period

Generic Prohep is By promoting These tablets should not be >report to physician any
Generic Prohep
improvement in taken by those who have adverse effect seen by the
indicated for patients
SILYMARINE measurable liver any kind of hypersensitivity
suffering from liver functions, Generic Prohep towards Silymarin or any patient
tablets protect the liver other component of these
Sivylar, cirrhosis and chronic
from a variety of toxins. tablets >always monitor patient vital
hepatitis. Having sign
Generic Prohep tablets
detoxifying properties, contain amino acids which
it is also indicated in are obtained from fresh
patients subject to liver liver by a special process
damage and liver of hydrolysis. The liver
stress (such as hydrolyses with amino
excessive intake of acids. The hydrolysis of
fresh liver cells yield
alcohol and fats).
important nucleosides and
nucleotides along with the
blood-forming elements
including vitamin B12.
These elements along
with amino acids directly
act on the cell metabolism
and protect the liver. They
even stimulate the
regeneration of an already
affected liver.
Pathophysiology

Predisposing Precipitating
Factor Factor

Age Lifestyle
Heredity Environment

Pulmonary

Spread of mycobacterium
tuberculosis

Vertebra is affected

Disc tissue dies and

Vertebral narrowing

Vertebral
Collapse

Spinal
Damage

Pott’s
disease

Pott’s disease is usually secondary to an extraspinal source of infection. The basic


lesion involved in Pott’s disease is a combination of osteomyelitis andarthritis 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 andk yphosis. 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 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.

DISCHARGE HEALTH TEACHING

>Discussed the importance of proper diet to the patient

>Instructed the client exercises that are appropriate for her condition

>instructed proper hygiene and divertional activities to reduce pain sensation

Learning Feedback Diary

February 7-11, 2011


On our first day here at Philippine Orthopedic Center, we have our orientation
all about the institution, their rules and regulations and also they demonstrated the
proper applying of Balance Skeletal Traction to affected fracture at leg area. After
the demonstration, we go to our perspective clinical instructor, and our C.I was Ms.
Milagros Rea. After we meet our C.I we proceed to the second floor for further
clarification of performing Balance Skeletal Traction and also, she gave our
requirements for entire week.

On our second day here at POC We have a short discussion all about the hard
ware, the common instruments that used by the surgeon, we also saw the different
instrument that inserted in the bone by the X-ray, after the discussion, we proceed
again to the second floor for our practice of return demonstration. After our
practice, we have a break and we proceed to the ward, we went to male ward and
we saw different hard ware instruments. We also went to the female ward and we
get our own patient for us to make a case study. We will need to bring a kit for our
patient nursing care tomorrow.

On our third day, we have a discussion all about the gadgets. First, we
discussed all about the different kinds of Tractions in adhesive type and non-
adhesive type, also the different kind of braces depends on affected area, its uses
and indications, we also discussed all about the cast, after the discussion, we have
our exam all about the discussion yesterday, the hardware. After our exam we went
to the ward to continue our data gathering for our case study and we also attended
the mass because POC was celebrating their 66 founding anniversary.

On our fourth day of duty here, we have our return demonstration all about
balance skeletal traction and nursing care of patient with traction. After our return
demonstration, we proceed to the ward for our actual nursing care to our patient.
We also observe how to apply fiber cast to a client who has a hip injury. This are all
what we’ve done for this day.

On our final day here at Philippine Orthopedic Center, we have our


examination all about gadgets which includes cast, braces and traction. After
gadgets exam, we have a evaluation examination. After our examination, we have a
ward tour and we have our Out Patient Department for observing applying and
removal of cast.

We gained too much knowledge here at Orthopedic Center. We thank our


clinical instructor Ms. Rea for sharing her knowledge to us. This are one of
unforgettable and a very good experience for us.