DAVAO MEDICAL SCHOOL FOUNDATION, INC.

MEDICAL SCHOOL DRIVE, BAJADA, DAVAO CITY

COLLEGE OF NURSING

IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS
IN NCM 103 RLE

CASE STUDY
POTTS DISEASE

SUBMITTED TO:

GREMMA W. BARATAS, RN, MN

CLINICAL INSTRUCTOR

SUBMITTED BY:

ISRAEL G. DELMINDO, ST. N

DATE SUBMITTED:

APRIL 22, 2017

TABLE OF CONTENTS

I. INTRODUCTION....................................................................................................1-2

A. Background of the study.........................................................................................1

B. Significance of the study.........................................................................................2
C. Relevance of the study...........................................................................................2

II. OBJECTIVES(General and Specific objectives) .................................................3-4

III. Anatomy and Physiology..............................................................................5-12
IV. DEFINITION OF TERMS......................................................................................13
V. ETIOLOGY.............................................................................................................14
VI. PATHOPHYSIOLOGY..........................................................................................15
VII. PROGNOSIS.......................................................................................................16
VIII. SYMPTOMATOLOGY........................................................................................17
IX. LABORATORY (DIAGNOSTIC) TESTS.........................................................18-23
X. MEDICAL AND SURGICAL TREATMENT)..........................................................24
XI. NCP.................................................................................................................25-27
XII. DISCHARGE PLANNING (METHOD)...........................................................28-29

A. Medication.................................................................................................................
B. Exercise....................................................................................................................
C. Treatment..................................................................................................................
D. Health Teaching........................................................................................................
E. Out-patient order.......................................................................................................
F. Diet............................................................................................................................

XVII. RECOMMENDATIONS.....................................................................................30
XVIII. BIBLIOGRAPHY/REFERENCES....................................................................31
INTRODUCTION

A. BACKGROUND OF THE STUDY

Pott disease, also known as tuberculous spondylitis, is one of the oldest demonstrated
diseases of humankind, having been documented in spinal remains from the Iron Age in
Europe and in ancient mummies from Egypt and the Pacific coast of South America. In
1779, Percivall Pott, for whom the disease is named, presented the classic description
of spinal tuberculosis.

Since the advent of anti-tuberculous drugs and improved public health measures, spinal
tuberculosis has become rare in industrialized countries, although it is still a significant
cause of disease in developing nations. Tuberculous involvement of the spine has the
potential to cause serious morbidity, including permanent neurologic deficits and severe
deformities. Medical treatment or combined medical and surgical strategies can control
the disease in most patients.

1
SIGNIFICANCE OF THE STUDY

This study will be a significant endeavor in understanding this condition, it will

help the students and clinical instructors in gaining more knowledge that will help them

deal with future similar cases. By being able to encounter this case and study it,

students will become more competent and expectedly will be more confident with

themselves. Furthermore this research will provide recommendations on how to plan

and proper nursing interventions for the said case.

RELEVANCE OF THE STUDY

I found this case to be interesting and challenging on my part as a student nurse

since its my first time to encounter it. I am amazed with this case because it is

interesting and is rarely seen on a daily basis. It helped me gain new knowledge about

this study. With this study it will help not only me but other students to learn about this

study

2
OBJECTIVES

GENERAL OBJECTIVE:

At the end of my 1 day exposure in the Southern Philippines Medical Center,

Ortho ward, I will be able to acquire knowledge and reliable information about Potts

Disease in order for us students to become knowledgeable; be able to demonstrate

competent nursing care that will address our patients condition; and to demonstrate

right attitude and provide quality nursing care.

SPECIFIC OBJECTIVES:

This case study is made to achieve the following reasons:

1. Establish rapport with our patient as well as her significant others to gain trust
and cooperation.

2. Collect significant information regarding our patients conditions as well as the

family history, past and present health history.

3. Evaluate clients data according to the nursing and developmental theory.

4. Describe the structures and normal function of the body organs involved.

5. Trace the Pathophysiology of the disease process and its enduring

symptomatology

3
6. Review and interpret medical order and results of possible laboratory
examination that the client has undergone.

7. Identify the different signs and symptoms, as well as the presentation of its
etiology and contributing factors in the development of this condition

8. Make effective nursing care plans that address the present and possible needs.

9. Enumerate clients medications which include both therapeutic and the adverse
effects

10. Present discharge plan for clients condition.

4
Anatomy and physiology

Bones. Composed of osseous tissue, bones are divided into

two types: compact bone, which is hard and dense and makes up
the shaft and outer layers, and spongy bone, which contains
numerous spaces and makes up the ends and centers of the
bones. Osteoblasts and osteoclasts are the cells responsible for
the continuous process of creating and destroying bone.
Osteoblasts form new bone tissue, and osteoclasts break down
bone tissue. Bones also contain red marrow ,which produces blood
cells, and yellow marrow,which is composed mostly of fat.The
outer covering of bone, called the periosteum, contains
osteoblasts and blood vessels that promote nourishment and
formation of new bone tissue.
Bones vary in shape and include long bones (Fig. 20.2), such
as the humerus and femur; short, at bones, such as the sternum
and ribs; and bones with irregular shapes, such as the hips and
vertebrae.

5
 Muscles. The body is composed of skeletal, smooth, and
cardiac muscle.Made up of fasciculi (long muscle bers) that are
arranged in bundles and joined by connective tissue, skeletal
muscles attach to bones by way of strong ,brous cords
called tendons. Ligaments are dense, exible, strong bands of
brous connective tissue that tie bones to other bones.
Cartilage is dense connective tissue consisting of bers
embedded in a strong, gel-like substance.Cartilage lacks nerve
innervation,blood vessels,and lymph vessels, so it is insensitive to
pain and regenerates slowly and minimally after injury.
Regeneration occurs primarily at sites where the articular
cartilage meets the synovial membrane. Cartilage may be brous,
hyaline, or elastic.

6
 Fibrous cartilage forms the symphysis pubis and the
intervertebral discs.Hyaline cartilage covers the articular bone
surfaces (where bones meet at a joint) ,connects the ribs to the
sternum, and is found in the trachea, bronchi, and nasal
septum.Elastic cartilage is located in the auditory canal, the
external ear, and the epiglottis.
Joints. The joint or articulation is the place where two or more
bones meet. Joints provide range of motion (ROM) for the body
parts and are classied three ways: by the degree of movement
they permit, by the connecting tissues that hold them together,
and by the type of motion the structure permits. Figure 20.3
illustrates the brous and cartilaginous joints and Figure 20.4 the
synovial joints.

A joint is the structure of human body where two or more bones are held together
in order to allow various types of movements and moldings in the rigid bony
human skeleton. A joint is not exclusively for bones, there can be three different
types of joints on the basis of what structures are involved in making it.

A joint can exist between

1. Two bones (for example the shoulder joint that exists between the scapula and
the humerus).

2. A cartilage and a bone (for example the joint that exists between the ribs and the
costal cartilages).

3. A cartilage and a cartilage (for example the joint between the 6th and the 7th
costal cartilage.

7
 Types of joints
Source: The visual dictionary
Types of joints

Joints occur at numerous places in the body and they differ in structure and
function. They are classified as Immovable joints and Movable joints.

Immovable joints:

They are also known as fixed joints. They are those joints in which the relative
movements of the bones forming the joint do not occur. In such joints the bones are
in actual contact with one another without any type of cartilage in between them
for example the joints of the bones of cranium as well as those of the face which
fix teeth into jaws.

Movable joints

Movable joints are sometimes called synovial joints. These are the joints in which
the bones forming the joints are capable of movements with one another. The
opposing surface of the bones of a moveable joint is separated by a piece of
cartilage called the articular cartilage. According to the range of movement the
movable joints are further divided into two kinds; partially moveable joints and
freely moveable joints.

Partially moveable joints: These joints have a very limited range of movement
for example the joint between the vertebrae and the joints of the cranium and hip
bones.

8
Freely moveable joints: These joints allow the free movements between the
articulating bones. In such joints the articular surfaces are often clothed with
cartilage which reduces the friction between the two surfaces of bones making the
joint. It is covered by a synovial membrane. This membrane often constitutes a
closed sac. The sac contains lubricating synovial fluid which also reduces friction
in the joint where it is found. Such freely moveable joints are classified further into
three classes according the degree of movement that they allow. These types are
Hinge joints, Ball and Socket joints and the Pivot joints.

Hinge joints: This type of joints allows the backward and forward movement in
only one plane.

Ball and socket joints: In these types of joints the movement is vast virtually
occurring in every plane.

Pivot joints: In these joints rotation is the only possible movement.

9
10
 Bursae. Bursae are small, disc-shaped synovial uid sacs
located at points of friction around joints.They act as cushions,
thereby reducing the stress to adjacent structures, and facilitate
movement. Two examples of bursae are the prepatellar bursa (in
the knee) and the subacromial bursa (in the shoulder).
Interaction with Other Body Systems. The neurological and
respiratory systems contribute to maintaining musculoskeletal
functioning. A problem in any of these systems may affect the
functioning of the musculoskeletal system.
Neurological System. The neurological system is responsible for
coordinating the functions of the skeleton and muscles. If your
patient has neurological complaints, combine the musculoskeletal
and neurological assessments because the spinal cord and nerves
originate from the spine and innervate the musculoskeletal
structures of the back and the extremities. A dysfunction in the
neurological system is often reected as pain, abnormal
movement, or paresthesias in the extremities and/or back.The
patients gait may provide information on muscular weakness or
neurological disease.
Back pain is a major source of disability in the United States.
A large proportion of the population complains of back pain at one
time or another,with the most common complaint being low back
pain radiating into the hip and down the leg.This pain is usually of
neurological origin and emanates from the sciatic nerve. Pain may
also be caused by arthritic disease of the spine or hip or muscle
spasm of the lower back. Understanding the anatomy of the back
and spinal nerve tracks will help you determine the pains origin.
Respiratory System. The respiratory system depends on the
thorax, bony structures, and muscles of the chest to protect the
lungs and assist with breathing.The accessory
muscles,which include the sternocleidomastoid,anterior serrati,
scalene, trapezius, intercostal, and rhomboid muscles, come into
play when a person is involved in aerobic activities or when the
body has intrapulmonary resistance to air movement (e.g.,
chronic pulmonary lung disease). These accessory muscles
enhance ventilation by increasing chest expansion and lung size
11
during inspiration. Intercostal muscles also coordinate rib
movement; external intercostal muscles pull the ribs up and
out,and internal intercostals pull the ribs down and inward.
Contraction of these muscles facilitates air movement into the
lungs by decreasing intrathoracic pressure. As these muscles
relax, exhalation occurs as the lung recoils. Abdominal muscles
can also assist with deep breathing, tachypnea (rapid
breathing), exercise, coughing, and sneezing. An intact thoracic
cage and normal accessory and abdominal muscles are necessary
for respiratory function.A musculoskeletal injury or problem in
these areas can result in altered respiratory functioning.

Developmental, Cultural, and Ethnic Considerations

Infants and Children. Before birth, a skeleton forms in the
fetus; it is rst composed of cartilage and then later ossies into
true growing bone. After birth ,bone growth continues rapidly during
infancy and then steadily during the childhood years. Another
growth spurt occurs for both boys and girls during adolescence.
Long bones increase in diameter by depositing new bone tissue
around the shafts. Lengthening occurs at the epiphyses,which are
specialized growth centers (growth plates) located at the ends of
long bones.Any injury or infection at these growth plates puts the
12
growing child at risk for bone deformity.Longitudinal growth of the
bones continues until closure of the epiphyses,which occurs at
age 20.
Skeletal contour changes are also apparent in infants and
children. At birth, the spine has a single C-shaped curve. At 3 to 4
months of age, an infant is able to raise his or her head from the
prone position, allowing the development of the anterior curve in
the cervical neck region. As development progresses and the
infant is able to stand and walk, the anterior curve develops in the
lumbar region. This occurs between 12 and 18 months of age. A
toddler stands with feet wide apart to provide balance as he or
she learns to walk.
The school-age child usually stands with the normal adult
curvature,which should continue until old age. Throughout
childhood, the skeleton continues to grow linearly; muscles and
fat are responsible for signicant weight increases. Individual
muscle bers continue to grow as the child grows, with a marked
growth period noted during adolescence. At this time, muscles are
responding to increased growth hormone ,adrenal androgens, and
testosterone in boys. Muscles vary in growth rate, size, and
strength, depending on genetic factors, nutritional status, and
amount of exercise.
Common knee deviations in children include genu varum
(bowlegs) and genu valgum (knock knees). In a child with genu
varum, the knees are approximately 5 cm apart and the medial
malleoli touch when the child stands. This variation is common
during the rst years when the child is beginning to
walk,but usually does not persist beyond 2 to 3 years. When genu
valgum is present in a child, the knees touch and the medial
malleoli are 7.5 cm or more apart when the child is standing.
These deviations are considered normal for a child aged 2 to
312 years and may persist until age 7.
Toddlers often have potbellies and lordosis (accentuated
lumbar curve). This posture is normal and helps the child adjust to
the change in the center of gravity. It should disappear as the
child grows. Spinal deformities in children may be
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structural,but more commonly are caused by poor posture.
Scoliosis (lateral curvature) may become apparent during
adolescence,with girls at a higher risk than boys.The spine does
not grow straight, and the shoulders and iliac crests are not the
same height.Assessing for scoliosis is an important component
when working with adolescents.

14
 Definition of Terms

Joints These are where two bones interconnect. Each joint reflects a compromise
between stability and range of motion. For example, the bones of the skull are very
stable but with little motion, whereas the shoulder joint allows for a full range of
motion but is a relatively unstable joint.
Tendons These attach muscle to bone.
Ligaments These attach bone to bone.
Skeletal muscles These muscles contract to pull on tendons and move
the bones of the skeleton. In addition to producing skeletal movement, muscles
also maintain posture and body position, support soft tissues, guard entrances and
exits to the digestive and urinary tracts, and maintain body temperature.
Nerves Nerves control the contraction of skeletal muscles, interpret
sensory information, and coordinate the activities of the body's organ systems.
Cartilage This is a type of connective tissue. It is a firm gel-like
substance. The body contains three major types of cartilage: hyaline cartilage,
elastic cartilage, and fibrocartilage.
Hyaline cartilage is the most common type of cartilage. This type of
cartilage provides stiff but somewhat flexible support. Examples in adults include
the tips of ribs (where they meet the sternum) and part of the nasal septum.
Another example is articular cartilage, which is cartilage that covers the ends of
bones within a joint. The surfaces of articular cartilage are slick and smooth, which
reduces friction during joint movement.
Elastic cartilage provides support but can tolerate distortion without
damage and return to its original shape. The external flap of the ear is one place
where elastic cartilage can be found.
Fibrocartilage resists compression, prevents bone-to-bone contact, and
limits relative movement. Fibrocartilage can be found within the knee joint,
between the pubic bones of the pelvis, and between the spinal vertebrae.
Cartilage heals poorly, and damaged fibrocartilage in joints such as the knee can
interfere with normal movements. The knee contains both hyaline cartilage and
fibrocartilage. The hyaline cartilage covers bony surfaces and fibrocartilage pads in
the joint prevent contact between bones during movement. Injuries to the joints can
produce tears in the fibrocartilage pads, and the tears do not heal. Eventually, joint
mobility is severely reduced.

15
ETIOLOGY

Tuberculosis begins in the lungs when you inhale air that contains Mycobacterium
tuberculosis (Mtb), or the bacteria that causes TB. This can develop into Pott's
disease if the infection spreads from the lungs to the spine. Mtb infects the joints of
the spine, causing a form of spinal arthritis. If two contiguous joints become infected,
the disc of cartilage between them cannot receive the nutrients it needs to live. The
disc dies and collapses, leading to a narrowing of the vertebrae, eventual vertebral
collapse and spinal cord damage. If untreated, spinal TB can lead to severe
deformities, nerve damage and even paralysis.
Pott's disease is usually located in the thoracic, or upper, spine. Early signs of
tuberculosis are fever, night sweats and weight loss. Severe back pain is the most
common indication that the TB has spread to the spine.

As the disease worsens, patients will have difficulty standing. They also walk a stiff,
unyielding posture and can have a swelling at the site of the infection that is
associated with numbness or weakness in the legs. If left untreated, Pott's disease
can lead to severe curvature of the spine and paralysis of the legs.

16
Pathophysiology

Potts disease is usually secondary to an extraspinal source of infection. Pott disease

manifests as a combination of osteomyelitis and arthritis that usually involves more than

1 vertebra. The anterior aspect of the vertebral body adjacent to the subchondral plate

is 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, the disk, because it is vascularized, can be the primary site.

Progressive bone destruction leads to vertebral collapse and kyphosis. 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.

17
PROGNOSIS

Current treatment modalities are highly effective against Pott disease if the disorder is
not complicated by severe deformity or established neurologic deficit.
Deformity and motor deficit are the most serious consequences of Pott disease and
continue to be a serious problem when diagnosis is delayed or presentation of the
patient is in advanced stages of the disease.
Therapy compliance and drug resistance are additional factors that significantly affect
individual outcomes.
Paraplegia resulting from cord compression caused by the active disease usually
responds well to chemotherapy. However, paraplegia can manifest or persist during
healing because of permanent spinal cord damage.
Operative decompression can greatly increase the recovery rate, offering a means of
treatment when medical therapy does not bring rapid improvement.
Careful long-term follow up is also recommended, since late-onset complications can
still occur (disease reactivation, late instability or deformity).
Morbidity

Pott disease is the most dangerous form of musculoskeletal tuberculosis because it can
cause bone destruction, deformity, and paraplegia.
Pott disease most commonly involves the thoracic and lumbosacral spine. However,
published series have shown some variation. The lower thoracic vertebrae make up the
most common area of involvement (40-50%), followed closely by the lumbar spine (35-
45%). In other series, proportions are similar but favor lumbar spine involvement.
Approximately 10% of Pott disease cases involve the cervical spine.

18
 SYMPTOMATOLOGY

SIGNS AND RATIONALE

SYMPTOMS
Night sweats Are repeated episodes of extreme perspiration that may soak your
nightclothes or bedding and are related to an underlying medical
condition or illness
Stiff and painful Most acute low back pain results from injury to the muscles,
spine ligaments, joints, or discs. The body also reacts to injury by
mobilizing an inflammatory healing response. While inflammation
sounds minor, it can cause severe pain.
Paraspinal muscle Spasms of skeletal muscles are most common and are often due to
spasms overuse, dehydration, and electrolyte abnormalities. The spasm
occurs abruptly, is painful, and is usually short-lived. It may be
relieved by gently stretching the muscle.

19
DIAGNOSTIC TEST

HEMATOLOGY Result Range Interpretation

Hemoglobin 115.0 155.0 g/L A low hemoglobin count is a
commonly seen blood test
result. Hemoglobin (Hb or Hgb)
is a protein in red blood cells
that carries oxygen throughout
the body.

In many cases, a low

hemoglobin count is only slightly
lower than normal and doesn't
affect how you feel. If it gets
more severe and causes
symptoms, your low hemoglobin
count may indicate you have
anemia.
Hematocrit 0.36 0.48 Causes of low hematocrit, or
anemia, include: Bleeding
(ulcers, trauma, colon cancer,
internal bleeding) Destruction of
red blood cells (sickle cell
anemia, enlarged spleen)
Decreased production of red
blood cells (bone marrow
supression, cancer, drugs)
RBC 4.20 6.10 x10^6/uL When the hemoglobin count is
low, the body is not able to get
as much oxygen to go
throughout the body.
WBC 5.0 10.0 x10^3/uL An increased production of white
blood cells to fight an infection
MCV 79.40 94.80 fl Mean corpuscular volume
(MCV) is the average volume of
red cells in a specimen. MCV is
elevated or decreased in
accordance with average red
cell size; ie, low MCV indicates
microcytic (small average RBC
size), normal MCV indicates
normocytic (normal average
RBC size), and high MCV
indicates macrocytic (large

20
 average RBC size).
MCHC 32.20 35.50 g/dL The mean corpuscular
hemoglobin concentration, a
measure of the concentration of
hemoglobin in a given volume of
packed red blood cells. It is
reported as part of a standard
complete blood count.
Differential count The blood differential test
measures the percentage of
each type of white blood cell
(WBC) that you have in your
blood. It also reveals if there are
any abnormal or immature cells.
Neutrophil 55.00 75.00 % It is important to realize that an
abnormal increase in one type of
white blood cell can cause a
decrease in the percentage of
other types of white blood cells.
An increased percentage of
neutrophils may be due to: Acute
infection. Acute stress.
Lymphocyte 20 35% Lymphocytopenia is an
abnormally low number of
lymphocytes (a type of white
blood cell) in the blood. Many
disorders can decrease the
number of lymphocytes in the
blood, but viral infections
(including AIDS) and
undernutrition are the most
common.
Monocyte 2 10 % A blood differential test, also
called a white blood cell count
differential, measures the
number of each of the five types
of white blood cells present in
your blood: neutrophils.
lymphocytes. monocytes.
Eosinophil 18% Eosinophils have two distinct
functions in your immune
system. They destroy invading
germs like viruses, bacteria, or
parasites such as Giardia and
pinworm. Eosinophils also
create an inflammatory

21
 response, especially if an allergy
is involved.
Basophil Basophils are produced in your
bone marrow, circulate in the
blood and are the least
abundant of all leukocytes. They
are classified as immune cells
and categorized a granulocytes.
Therefore, the basic function of
this white blood cell is release of
its substances in response to a
foreign invasion.
Platelet Count 150 400 x10^3/uL A platelet count is a lab test to
measure how many platelets
you have in your blood. Platelets
are parts of the blood that help
the blood clot. They are smaller
than red or white blood cells.

Urinalysis Result Range Interpretation

Chemical Analysis
pH A urine pH test can tell
your doctor how acidic
or basic (alkaline) your
urine is using a simple,
painless urine test.
Many diseases, your
diet, and the medicines
you take can affect how
acidic or basic your
urine is. For instance,
results that are either
too high or low can
indicate the likelihood
that your body will form
kidney stones. If your
urine is at an extreme
on either the low or
high end of pH levels,
you can adjust your
diet to reduce the
likelihood painful
kidney stones will form.
In short, your urine pH

22
 is an indicator of your
overall health and
gives your doctor
important clues as to
what is going on in
your body.
Glucose The glucose urine test
measures the amount
of sugar (glucose) in a
urine sample. The
presence of glucose in
the urine is called
glycosuria or
glucosuria.
Protein Urine protein testing is
used to detect protein
in the urine, to help
evaluate and monitor
kidney function, and to
help detect and
diagnose early kidney
damage and disease.
Urine
Flowcytometry
WBC 0 27 /uL Leukocyte esterase is
an enzyme present in
most white blood cells
(WBCs). Normally, a
few white blood cells
(see microscopic
examination) are
present in urine and
this test is negative.
When the number of
WBCs in urine
increases significantly,
this screening test will
become positive.

When the WBC count

in urine is high, it
means that there is
inflammation in the
urinary tract or kidneys.
The most common
cause for WBCs in

23
 urine (leukocyturia) is a
bacterial urinary tract
infection (UTI), such as
a bladder or kidney
infection.
RBC 0 28 /uL This test is used to
detect hemoglobin in
the urine
(hemoglobinuria).
Hemoglobin is an
oxygen-transporting
protein found inside red
blood cells (RBCs). Its
presence in the urine
indicates blood in the
urine (known as
hematuria). The small
number of RBCs
normally present in
urine usually result in a
"negative" test.
However, when the
number of RBCs
increases, they are
detected as a "positive"
test result.
Epithelial Cells 0 7/uL Epithelial cells in urine
may be a cause for
concern if the numbers
are higher than normal.
The sloughing of
epithelia is quite a
normal process of the
body sheddingdead
cells and creating new
ones. If epithelial cells
are high in your urine it
could signal a problem
with your kidneys or an
infection in your urinary
system. This article will
examine some possible
causes of epithelial
cells in urine and what
urinalysis means.
Cast Urinary casts are

24
 formed only in the
distal convoluted tubule
(DCT) or the collecting
duct (distal nephron).
The proximal
convoluted tubule
(PCT) and loop of
Henle are not locations
for cast formation.
Hyaline casts are
composed primarily of
a mucoprotein (Tamm-
Horsfall protein)
secreted by tubule
cells.
Bacteria Urine is normally
sterile, which means
that it contains no
bacteria. A small
number of bacteria
may be found in the
urine of many healthy
people. This is usually
considered to be
harmless. However, a
certain level of bacteria
can mean that the
bladder, urethra, or
kidneys are infected.

Medical and surgical treatment

25
 At present, systemic treatment consists of anti-tuberculosis medications before and
after surgical debridement of entire focus of infection and successfully reconstructing
the spine is the first line of treatment for Pott Disease or Spinal Tuberculosis.
For management of Pott Disease, the decision making can be typically divided into two
groups of lesions, one with neurologic complications and one without neurological
deficits. In people with neurologic deficits, pharmacotherapy is the first line of treatment
and surgical procedures are pretty rare. In cases with neurologic deficits
pharmacotherapy is the first choice for treatment as well but in these cases combination
of medical and surgical treatments works the best and gives the best outcome

NCP

Assessment Diagnosis Planning Intervention Evaluation

26
Objective: Acute pain r/t After 8 hours 1. Investigate report After 8 hours of
inflammatory of nursing of pain, Noting nursing
Facial mask of process interventions Characteristics, interventions, the
pain the patients location, Intensity. patient will be
will be able to R: Helpful in able to
Self-narrowed incorporate determining pain incorporate
focus relaxation management needs relaxation skills
skills and and effectiveness of and diversional
Fatigue diversional the program. activities into pain
activities into control program
pain control 2. Provide firm
program mattress and
small pillows
R: Soft or sagging
mattress and large
pillows inhibits the
proper body
alignment

3. Suggest patient
assume position
of proper comfort
while in bed or
chair. Promote
bed rest as
indicated
R: In acute phase
total bed rest may be
necessary to limit
pain

4. Encourage
frequent changes
of position
R: Prevents general
fatigue and joint
stiffness.

5. Apply warm or
moist compress
on the affected
area several
times a day.
R: Heat promotes
muscle relaxation
and mobility,

27
decreases pain and
relieves morning
stiffness.

6. Provide gentle
massage
R: Promotes
relaxation and
reduces muscle
tension

7. Encourage use of
stress
management
techniques.
R: Promotes
relaxation, provide
sense of control and
may enhance coping
activities.

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Assessment Diagnosis Planning Intervention Evaluation
Objective: Impaired physical After 8 hours 1. Encourage to After 8 hours of
mobility r/t of nursing change position nursing
Limited range therapeutic interventions every 2 hours interventions The
of motion restrictions of patient will R: To prevent patient has
movement verbalize complications verbalized
Difficulty in understanding understanding of
turning of the situation 2. Schedule the situation and
and treatment activities with treatment regimen
regimen and adequate rest and safety
safety periods measures
measures R: To reduce fatigue

3. Provide regular
skin care.
R: To promote good
hygiene

4. Provide passive
exercises
R: To maintain
muscle integrity

5. Encourage
adequate intake
nutritious foods
R: To maximize
energy production

6. Explain the use of

adjunctive
devices such as
taylor brace.
R: To promote
knowledge and
enhances safety

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DISCHARGE PLANNING

Medication Instruct the patient to comply with the treatment regimen

faithfully.

Rationale: this would promote faster recovery and prevention

of relapse.

Instruct to take medication with exact dosage as ordered

Rationale: correct dosage hinders from possible adverse

effects due to overdosing of a certain drug

Explain the side effects of medication

Rationale: to orient or to have knowledge of what possible

side effects to expect upon taking the drugs. Refer for further
reassessment.

Intruct patient to avoid taking medication that are not

prescribed by the physicians.

Rationale:over the counter drugs might cause side effects or

even adverse effects that may worsen status.

Remind the patients significant others for the scheduled

consultsation with the physician

Rationale: in order to determine the effectiveness of the drug.

Take full course of medication

Rationale: to kill microorganisms resistance.

Instruct significant others to refere immediately if there is an

adverse reaction of the drug

Rationale: to discontinue theraphy and to lessen

complications.

Exercise Discuss to the client importance or help client develop a

program of exercise and relaxation techniques as tolerated.

Health Teaching Moreover, a teaching plan that affect clients holistic wellness
should be done in order to maintain an environment that is

30
 conducive for health promotion.
Out-patient Proper referral is best for the health care provider to evaluate
Order condition of the client, whether it is improving or not. Also, for
early diagnosis of any other underlying conditions
Diet Proper execution of clients diet is very important so informing
and instructing client or clients watcher about proper meals to
be given to the client and increasing oral fluid intake is
important. ( Dietary Salt: moderate intake, and high in
cholesterol foods)
Encouraged to increase fluid intake to at least 8-10glasses per
day as tolerated to maintain hydration.
Advised to eat as fruits and green leafy vegetables.

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RECOMMENDATIONS

As nurses, our vital role is to provide health care and deliver services in the
hospital to improve the health status of each individual. This nursing care study is
important for us because it in enables to give the proper health teaching to our chosen
client.
We recommended this case to the following persons and institution for the further
improvement of the study.

TO THE FAMILY:
This study is for the family of our patient to follow the treatment prescribed such
as to take the medications as on time and right dosage and other recommended
measures by the physicians, encourage having adequate rest to hasten the recovery of
the patient. Through the adherence of fulfillment of the suitable medical management,
for the fast recovery of the patient.

TO THE STUDENT:
I recommended this study for the students as a reference for the future cases, in
order to have some based line datas to refer.

TO THE COLLEGE OF NURSING

I recommended this study to our department for giving us a precise details and
an access of further study of this case. We advocate also for giving us an abundance
time to research in order to prevent typographical and grammatical errors.

TO THE SOUTHERN PHILIPPINES MEDICAL CENTER

I recommended this study to Southern Philippines Medical Center for them to
able to evaluate and appreciate the said case and share this as a reference and
information having those patients who has certain condition.

32
BIBLIOGRAPHY/REFERENCES

1. Fundamentals of Nursing Eight Edition, Kozier&Erbs, Pearson, Prentice Hall

2. Nurses Pocket Guide, Diagnoses Prioritized Interventions, and

rationales,MarilynnE.Doenges,Mary Frances Moorhoouse,Alice C. Murr, 13th

edition.

3. Day, R. A., Paul, P., Williams, B., Smeltzer, S. C., & Bare, B. G. (2016). Brunner

& Suddarths Canadian textbook of medical-surgical nursing (3rd Canadian ed.).

Philadelphia: Lippincott Williams & Wilkins

4. gnatavicius, D. D., Workman, M. L., & Henderson, L. (2015). Medical-surgical

nursing: Critical thinking for collaborative care (7th ed.). Toronto: Elsevier

Saunders. (ISBN 978-1-4377-2801-9)

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