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Pott͛s is the tuberculosis of the bone and joints. It is a localized destructive disease caused by Mycobacterium tuberculosis. It is also known as tuberculous
spondylitis. It is usually secondary to an extraspinal source of infection. It can͛t be transmitted to others unless the organisms are exposed and aerosolized by
debridement or surgical manipulation. Most occurs most frequently in spinal column (Pott͛s disease) and in bone and joint structure surrounding the hip and knee.
Most common and dangerous form.
Person with compromised immune system have increased risk because there is depression of natural defense mechanism that normally prevent dissemination of
tuberculosis from primary lesion. Additional risk factors are untreated TB, DM, and ESRD with hemodialysis treatment. Goal for management includes general health
must be improved and deformities must be minimized. Multi-drug approach is generally selecting from Isoniazid, Refampicin, Pyrazinamide, Ethambutol,
Streptomycin or Cyclovirin to prevent development of a bacterial population resistance. Surgical management includes ADSF (Anterior Decompression Spinal Fusion)
which prevents vertebral collapse and neurologic sequelae and to drain any abscess that may have formed, application of knight taylor brace, head halter traction
are used initially to manage the muscle spasm and pain.
cc Ê PAc
Pc
ame: RCP
Age: 13 years old
Birthday: September 23, 1996
Address: 0497 Lanuza Camp, Barangay Tagpas Binangonan Rizal
Date of Admission: July 20, 2010
Diagnosis: Pott͛s disease
The vertebral column (also called the backbone, spine, or spinal column) consists of a series of 33 irregularly shaped bones, called
vertebrae. These 33 bones are divided into five categories depending on where they are located in the backbone. The first seven
vertebrae are called the cervical vertebrae. Located at the top of the spinal column, these bones form a flexible framework for the
neck and support the head. The first cervical vertebrae is called the atlas and the second is called the axis. The atlas' shape allows
the head to nod "yes" and the axis' shape allows the head to shake "no".
The next twelve vertebrae are called the thoracic vertebrae. These bones move with the ribs to form the rear anchor of the rib cage.
Thoracic vertebrae are larger than cervical vertebrae and increase in size from top to bottom.
After the thoracic vertebrae, come the lumbar vertebrae. These five bones are the largest vertebrae in the spinal column. These
vertebrae support most of the body's weight and are attached to many of the back muscles.
The sacrum is a triangular bone located just below the lumbar vertebrae. It consists of four or five sacral vertebrae in a child, which become fused into
a single bone after age 26. The sacrum forms the back wall of the pelvic girdle and moves with it.
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The bottom of the spinal column is called the coccyx or tailbone. It consists of 3-5 bones that are fused together in an
adult. Many muscles connect to the coccyx.
These bones compose the vertebral column, resulting in a total of 26 movable parts in an adult. In between the vertebrae
are intervertebral discs made of fibrous cartilage that act as shock absorbers and allow the back to move. As a person
ages, these discs compress and shrink, resulting in a distinct loss of height (generally between 0.5 and 2.0cm) between the
ages of 50 and 55.
When looked at from the side, the spine forms four curves. These curves are called the cervical, thoracic, lumbar, and
pelvic curves. The cervical curve is located at the top of the spine and is composed of cervical vertebrae. ext come the
thoracic and lumbar curves composed of thoracic and lumbar vertebrae respectively. The final curve called the pelvic or sacral curve is formed by the
sacrum and coccyx. These curves allow human beings to stand upright and help to maintain the balance of the upper body. The cervical and lumbar
curves are not present in an infant. The cervical curves forms around the age of 3 months when an infant begins to hold its head up and the lumbar
curve develops when a child begins to walk.
In addition to allowing humans to stand upright and maintain their balance, the vertebral column serves several other important functions. It helps to
support the head and arms, while permitting freedom of movement. It also provides attachment for many muscles, the ribs, and some of the organs
and protects the spinal cord, which controls most bodily functions.
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cc Ê Pathophysiology
Untreated Primary TB
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Inhibits DA dependent Maintenance phase treatment Hypersensitivity, jaundice, severe GI disturbance pseudo §Ê Assess lung sounds and
polymerase, decreases of all forms of pulmonary and hepatic disease membranous colitis, influenza, character and amount of
replication extra pulmonary tuberculosis like symptoms skin reactions sputum periodically
cosinophilia, transient leukopenia during therapy.
thrombocytopenia purpura, §Ê Assess laboratory and
shock headache, ataxia, visual chest x-ray test,
disturbances. therapeutic effectiveness
and adverse reaction.
Generic name: Isoniazid
Classification: Antituberculosis
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Inhibits RA synthesis, Pulmonary and extra pulmonary Should not be given to patients Various skin eruptions, fever, ÚÊ Assess lab. Test: sputum,
decreases tubercle bacilli tuberculosis(TB) Lupus vulgaris with drug induced liver disease lymphadenopathy and vasculitis, chest x-ray before
replication hypersensitivity, /V, treatment
gastrointestinal disturbances, ÚÊ Monitor liver and renal
liver dysfunction, peripheral function: ALT, AST,
neuropathy and anemia bilirubin, BU, creatine
output, urinalysis, uric
acid
ÚÊ Asses CS often: affect
mood, behavioural
changes
Generic name: Pyrazinamide
Classification: Antituberculosis
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Mechanism unknown, highly Treatment of active tuberculosis Acute liver disease porphyria, Dose related hepatoxicity, /V, ÚÊ Assess pt.s condition
specific and antibacterial for in adult and selected children peripheral renritis, history of anorexia, thrombocytopenia. before therapy and
mycobacterium tuberculosis drug-induced hepatitis, acute Sicleroblastic anemia with regularly thereafter to
gout, hypersensitivity and crythroid hyperplasia, monitor drugs
pregnancy vacnolation of erythrocytes, effectiveness.
increase serum iron ÚÊ Monitor serum uric acid
concentration gout, which may be elevated
and cause gout
symptoms
ÚÊ Regular assess renal
status: input-output
ratio, urinalysis and
specific gravity
ÚÊ Regular assess for
hepatotoxicity:
decreased appetite,
jaundice, dark urine and
fatigue
ÚÊ Assess pt.s and family͛s
knowledge of drug
therapy
Generic name: Ethambutol hydrochloride
Classification: Antituberculosis
MECHAISM OF ACTIO IDICATIO COTRAIDICATIO ADVERSE EFFECT URSIG COSIDERATIO
Inhibits the synthesis of Treatment of pulmonary -contraindicated with allergy to CS: optic neuritis, fever, ÚÊ Administer with food if GI
metabolism in growing tuberculosis in conjunction with ethambutol optic neuritis malaise, headache, dizziness, upset occurs
mycobacterium cells, impairing at least one other anti- -use cautiously with impaired mental confusion, disorientation ÚÊ Administer in sinlge daily
cell multiplication, and causing tuberculotic renal function lactation, hallucination, peripheral neuritis dose, must be used in
cell death. pregnancy, visual problems. combination with the
GIT: anorexia, /V, Abdominal other antituberculosis
pain, transient liver impairment drug
ÚÊ Arrange for follow up of
liver and renal function
test, CBC,
ophthalmologist
examination
Generic name: Streptomycin
Classification: Anti-infective
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Cytotoxic: inhibits DA Metastatic islet cell carcinoma ÚÊ Contraindicated with CS: lethargy, confusion, ÚÊ Obtain baseline
synthesis leading to cell death of the pancreas allergy to streptomycin: depression information before and
partially through the production hematopoietic depression: GI: /V, diarrhea, hepatotoxicity during treatment
of intra stand cross-links in DA pregnancy, lactation GU: Renal toxicity ÚÊ Complete C & S testing
cell cycle non-specific ÚÊ Use cautiously with Other: infertility, Cancer, before and after drug
impaired renal or hepatic inflammation at injection site therapy to identify if
function correct treatment has
been initiated
ÚÊ Identify urine output: if
decreasing. otify
physician; also increased
BU, creatinine , urine
CrCl< 80 mL/min
ÚÊ Monitor for bleeding;
echymosis bleeding
germs, hematuria, stool
guaiac daily if on long
term therapy.
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1.Ê Hyperthermia
2.Ê Impaired Physical Mobility
3.Ê Activity Intolerance
4.Ê Disturbed Body Image
5.Ê Self Care Deficit on bathing, toileting and transferring
6.Ê Risk for impaired skin integrity
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S: Impaired Due to ÚÊ During the ÚÊ Identify causative ÚÊ Diagnosis of pain, ÚÊ During the shift
͞Di niya maigalaw physical vertebral shift the contributing factors nutritional status, the patient had
ang kaliwang kamay mobility related collapse, patient that may restricted and perception able to perform
niya at din na to formation of will be movement restricts movements activities within
nakakatayo͟, as musculoskeletal gibbus in the able to his capacity
verbalized by his impairment and vertebrae perform ÚÊ Assess muscle strength ÚÊ To determine safely and able
mother loss of integrity occurs, leading activities adequate functioning to perform
of bone to stiffness, within his of muscles simple ROM
O: structures. alternation of capacity ÚÊ Assess functional ÚÊ Feelings of exercises on the
ÚÊ Limited range motor safely ability by determining frustration may upper
of motion function. Thus, ÚÊ Within the degree of immobility impede attainment extremities.
ÚÊ Absence of impaired shift the emotional, behavioral, of goals
any physical patient response to problems
movement at mobility may will be of immobility.
lower arise. able to
extremities perform ÚÊ Assist with ÚÊ To promote mobility
and weak left simple repositioning on a and circulation even
upper ROM regular schedule when in bed
extremity exercise
based on ÚÊ Support affected body ÚÊ To maintain position
hand grip. parts using foot of function and
ÚÊ eeds support reduce risk of
assistance presence of ulcers.
with ADL
ÚÊ Muscle
strength of
2/5 on lower
extremities
ÚÊ Muscle
atrophy of
lower
extremity
noted
ÚÊ Mobilized
thru
wheelchair
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S: Hyperthermia Due to invasion of After 1-2 ÚÊ Vital signs taken ÚÊ Serves as baseline data Goal achieved,
͞Mainit ang pakiramdam related to microorganism in hours of and recorded patient͛s temperature
ko͟ infectious and the body it rendering decreased from 39.8϶
inflammatory activates the nursing ÚÊ Remove extra ÚÊ Decrease body to 37.3϶
O: process. inflammatory and care, the clothing temperature through
ÚÊ Weak looking defense patient͛s process of radiation,
ÚÊ Skin warm to mechanism of the body evaporation, and
touch body (leukocytes). temperature ÚÊ Render tepid convection
ÚÊ Flushed skin Leukocytes release will sponge bath
ÚÊ Diaphoretic pyrogens which decrease ÚÊ To help decrease body
ÚÊ eeds assistance elevates body from 39.8϶C temperature through
in performing temperature. to 37.3϶C process of evaporation
ADL ÚÊ Give medication and conduction
ÚÊ Febrile 39.8϶C as ordered like
paracetamol ÚÊ Paracetamol acts on the
heat regulating center,
the hypothalamus which
causes vasodilation and
ÚÊ Encouraged to therefore dissipates
increase fluid heat from the body
intake
ÚÊ To replace lost body
fluids and proper
hydration
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S> ͞ahihirapan Activity intolerance Vertebral collapse After the shift the ÚÊ Assess for muscle ÚÊ To determine After the shift the
akong tumayo ng related to muscle alters the sensory patient will be able strength adequate patient had perform
mag isa dahil weakness on lower and motor function to gradually functioning of activities within his
nanghihina ako͟ extremities of the body resulting perform activities muscles capacity as
to intolerance of within his capacity. ÚÊ Plan care with rest ÚÊ To conserve evidenced by gradual
O> unable to move performing activities. periods between energy range of joint motion
without assistance activities with moderate
> facial grimace assistance.
when moving up ÚÊ Plan for
> body malaise progressive ÚÊ Both activity
> limited ROM increase of activity tolerance and
>Muscle strength level/participation health status
Lower extremities in exercise may improve
2/5 (poor) training, as with progressive
>unable to walk, on tolerated by the training
wheelchair client
> dependent with
bathing, toileting ÚÊ Encourage to eat ÚÊ Protein aids in
and transferring nutritious foods wound healing
such as rich in and cell
proteins and regeneration.
carbohydrates Carbohydrates
yields energy for
ÚÊ Continue physical the body
therapy ÚÊ To improve
muscle strength
and sensory and
motor function
PAPACIFIC UIVERSITY ORTH PHILIPPIES
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