Bernales, Jan Lianne E.

NCM 116a Medical-Surgical Nursing RLE

BSN III-B2 Module in POC

ACTIVITY #1:
1. The doctor ordered initial laboratory work out
a. What blood test would the doctor probably request and what result does he expect to
receive?
• Tuberculin skin test (PPD) - Results are positive in 84-95% of patients with Pott disease
who are not infected with HIV
• Erythrocyte sedimentation rate (ESR) - May be markedly elevated (>100 mm/h)
• Microbiologic study- Bone tissue or abscess samples are obtained to stain for acid-fast
bacilli (AFB), culture and susceptibility, and DNA amplification.
• Biopsy- biopsy of bone lesions is a safe procedure that also allows therapeutic drainage
of large paraspinal abscesses.
• PCR studies- amplify species-specific DNA sequences which is able to rapidly detect and
diagnose several strains of mycobacterium without the need for prolonged culture.
b. How would you explain the importance of the test to his mother through health teachings,
to alleviate her anxiety?
• I would start by saying that; ‘All of the blood tests and other approaches in the patient’s
workup are all necessary to the planning of care that will be given to the patient. In order
to fully manage the disease, us nurses and other members of the healthcare team has to
cover all of our basis to know how far has the disease progressed and carefully carry all
the essential interventions that will help your son’s recovery’. Reassuring the patient’s
family/loved ones is a part of being a nurse, it’s one of its important many roles to be the
advocate for not only the patient but most especially the family.

2. The mother is advised that her son will have to undergo rehabilitation once healing is
imminent
a. What is the main idea of this procedure and its significance, compared to medication
management?
• Patients with Pott's disease often undergo spinal fusion or spinal decompression
surgeries to correct their structural deformity and prevent further neurological
complications. There are no established guidelines which dictate treatments that will
yield positive outcomes in such patients. However, treatment regimens should
address each patient individually, focusing on any impairments, functional
limitations and/or disabilities with which they present. Rehabilitation does not
reverse or undo the damage caused by disease or trauma, but rather helps restore the
individual to optimal health, functioning, and well-being. Rehabilitation is a crucial
component to improve the quality of life of these patients.
b. How would you prepare a four-year-old patient prior to the procedures?
• It is somewhat difficult to explain to a person who is not knowledgeable in the medical
field with jargons that are hard to translate in layman’s terms. But it is more challenging
explaining it to an innocent child who knows about his pain but does not actually know
what is going on. The hospital may seem like a large and frightening place to them. They
may be overwhelmed from meeting so many new people at once. Also, the unfamiliar
equipment may seem scary. The preschoolers tend to have active imaginations and short
 attention spans. They may not be able to remember everything you tell them. Give them
information slowly so there is less chance of overwhelming them. Do not be surprised if
they ask you the same questions more than once. As a nurse, keeping our emotions under
control must be done with mastery, keeping it real and professional is hard but it is
important that we must show compassion. Choosing our words carefully but in the
simplest term can help prepare a child for the treatment he will receive. Using play items
or toys can help him understand more.

3. The doctor informed the mother that his son needs to wear a brace during his admission.
a. What kind of brace would be suitable for this child?
• A suitable kind of brace for the patient would be a Rigid back brace because these braces
are typically prescribed for low back pain and instability. These are stiff braces. They
usually consist of rear uprights that contour to the lumbar (lower) spine and pelvis, along
with thoracic bands. There are also fabric straps on the braces that provide pressure in the
front.
b. Why does he need to wear the brace, will it improve his condition, how?
Spinal cord compression in Pott’s disease is usually caused by paravertebral abscesses which can
also develop calcifications or sequestrate within them. Back pain is the earliest and most
common symptom. Patients with Pott’s disease usually experience back pain for weeks before
seeking treatment and the pain caused by spinal TB can present as spinal or radicular. Bracing
may also be beneficial with an open reduction and internal fixation limb. A back brace prevents
unnecessary movements that further damage the back. This helps align your spine and strengthen
the patient’s back muscles. Back braces also take support away from the vital areas of your back,
such as the spine, invertebral discs, and vertebrae.

ACTIVITY#2:
1. Anticipating the patient’s current condition, construct a plan of care, prioritizing 5
problems you might expect to occur to the patient (5 NCP)

o *NCP’s on separate file*

2. Discuss the importance of their cooperation and construct health teaching and its
importance.
o An important role for nurses in all settings is health education. In nursing
education programs, much emphasis is given in the classroom and in the clinical
practice setting about the importance of patients or clients understanding
their health care requisites in order to restore, maintain, or promote health. Health
education is a major aspect of health promotion activity. Thru this, as health
educators, we can increase health awareness among people, thus lead to change in
behavior. To be a good educator, we must be role model to them, because what
students see on us, may have an impact of their behavior and learning. Health
teaching is important because the patient will be discharged sooner or later, and
there are interventions that family member could do to alleviate the symptoms or
basic first aid. Health education can also increase a community’s economy by
decreasing health care spending and lost productivity caused by preventable
illness. Many programs designed to help members of community conflict these
 expensive health issues not only increase individual health but also give a good
return on investment for communities. As nurses, we need to function as patients’
advocates and discuss therapy in terms that patients will understand, including
what the treatment protocol involves, what serious and nonserious adverse events
are likely to occur, and to ensure that patients want to receive this treatment, or
any other treatment for that matter. The patient has the right to decline therapy.
The only way patients can make treatment decisions is by making sure that
patients are adequately informed, so that they can actively participate in the
decision-making process about their care.

Health Teaching
• Hand Washing- Hands are the main pathways of germ transmission during health
care. Hand hygiene is therefore the most important measure to avoid the
transmission of harmful germs and prevent health care-associated infections.
• Pain Management- There are many ways to alleviate pain therapeutically like
physical therapies, such as heat or cold packs, massage, hydrotherapy and
exercise, even positioning of the body can help relieve the symptoms.
Psychological therapies, such as cognitive behavioral therapy, relaxation
techniques and meditation, or mind and body techniques, such as acupuncture.
• Advise the patient or the patient’s relative to continue to take her prescribe home
medication such as Paracetamol or any NSAIDs for relief of fever and pain.
• Antibiotics as ordered and complete the days required for the patient to comply to
the course of treatment and don’t skip doses.
• Encourage the patient to promote bed rest and enough rest.
• Instruct the patient to visit physicians for follow up check-up in given date.
• Plan healthy, balanced meals and snacks that include the right amount of foods.
• Choose vegetables and fruits rich in vitamin C, such as strawberries or spinach.
For adequate zinc, choose whole grains and consume protein, such as eggs, meat,
dairy or seafood. Some wounds may require a higher intake of certain vitamins
and minerals to support healing. Speak with your healthcare provider before
starting any new supplements.
• Include adequate protein throughout the day. Include a source of protein at each
meal or snack. A sample menu may include scrambled eggs for breakfast, black
bean tacos for lunch, yogurt or cheese for a snack and chicken at dinner.
• Stay well-hydrated with water or other unsweetened beverages

3. Assuming that you noticed that the patient is uncooperative.

a. How would you decide your nursing care, thinking that the patient is still on
process of coping?
• Provide health teaching about the discharge plan of the patient. Reassure and
present facts that the child is okay and should continue treatments at home
with precision. I will mainly focus on the guardian’s
b. What evidence can you present that the patient is having a difficulty in coping?
• The patient’s mother expressed misconceptions about health status, Lack of or
inaccurate follow-through of instructions/behaviors, requests for more
 information, if the patient’s condition has progressed, if the mother is not
ready or hesitant to take her child home, she is questioning members of health
care team. Shows emotional state affecting learning like anxiety.

c. What solutions would you suggest?

• Assess motivation and willingness of patient and care-givers to learn. Adults
must see a need or purpose for learning. Some patients are ready to learn soon
after they are diagnosed; others cope better by denying or delaying the need
for instruction. Learning also requires energy, which patients may not be
ready to use. Patients also have a right to refuse educational services.
• Determine patient's learning style, especially if patient has learned and
retained new information in the past. Some persons may prefer written over
visual materials, or they may prefer group versus individual instruction.
Matching the learner's preferred style with the educational method will
facilitate success in mastery of knowledge.
• Provide physical comfort for the learner. This allows patient to concentrate on
what is being discussed or demonstrated. According to Maslow’s theory, basic
physiological needs must be addressed before patient education.
• Provide an atmosphere of respect, openness, trust, and collaboration. This is
especially important when providing education to patients with different
values and beliefs about health and illness.
• Establish objectives and goals for learning at the beginning of the session.
This allows learner to know what will be discussed and expected during the
session. Adults tend to focus on here-and-now, problem-centered education.
• Give clear, thorough explanations and demonstrations.
• Provide information using various mediums (e.g., explanations, discussions,
demonstrations, pictures, written instructions, computer-assisted programs,
and videotapes). Different people take in information in different ways. Match
the learning style with the educational approach.
• Ensure that required supplies or equipment are available so that the
environment is conducive to learning. This is especially important when
teaching in the home setting.
• Provide positive, constructive reinforcement of learning. A positive approach
allows learner to feel good about learning accomplishments, gain confidence,
and maintain self-esteem while correcting mistakes. Incorporate rewards into
the learning process.

4. What are possible nursing diagnosis you can formulate on this case?
Nursing Diagnosis Justification
Acute Pain related to inflammatory Pain can interfere with a person activity
process on a daily basis, when a person is in
pain they cannot think clearly and it

Impaired Physical Mobility related to
Therapeutic Restrictions of Movement
Imbalanced Nutrition Less Than Body
Requirements Related to Insufficient
Intake
Risk for Infection related to Lowered
Resistance/Suppressed Inflammatory
Process
Disturbed Body Image related to
the Deformities brought about by the
Condition.
can affect the patient’s vital signs that
will develop into complications.
The patient will have to undergo a big
physiological adjustment, which will
develop into other problems. It is under the
Safety needs, the 2nd level of Maslow’s
hierarchy of needs; the security of body.
Safety is an evolutionary need, which is
often manifested in what we refer to as the
“fight or flight” response.
Absorption of nutrients is critical to
proper function of each and every part
of our human body, and in integrative
medicine, assessment of nutrient status
is a central piece of our patient care.
Poor absorption of nutrients can lead to
complications.
Prevention is always better than cure.
Preventing the spread of infection can
help the patient and their family free of
any diseases.
A person begins forming his or her
perceptions of the body’s
attractiveness, health, acceptability and
functionality in early childhood. This
body image continues throughout the
lifespan and receives feedback from
peers, family member, and coaches.

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