St.

Augustine School of Nursing

JB Crystal building Quirino Highway Lagro Quezon City

COLLEGE OF NURSING A CASE STUDY FOR

Spinal Cord Injury s/t Potts Disease

In partial Fulfillment for the requirements in

RELATED LEARNING EXPERIENCE Presented at: St. Augustine School of Nursing

Presented by: Salcedo Ma. Aileen

CNA 2
Presented to: Ms. Emmie Solacito RN _______________________ Aug. 21 2011

TABLE OF CONTENTS

I. Table of Contents II. Acknowledgement III. Introduction 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. Drug Study VIII. Nursing management

ACKNOWLEDGEMENT

We wish to express our heartfelt gratitude and appreciation to our beloved parents/guardians for all the support and helping in every way possible to create the conditions that had permitted me the freedom to accomplish this study. Likewise, we want too deeply thank our mentors who have always push, help and inspired us throughout this endeavor. To our friends and colleagues, we would like to extend our heartfelt thank for every little thing that you have contributed to us in order to finish this case study. To our clinical instructor, thank you for guiding us on what to do, not only in fulfilling this case study, but also for allowing us to experience firsthand in handling patients. To Ms. RM, our patient for allowing us to study her case, for without her this case study would not be possible. Thank you very much Ms. Rm from the bottom of our heart. To the institution, Health Care Development Center, for allowing us to experience and to be exposed to this hospital. our great honor that we have serve here even in a short period of time but the experience will become one of our future foundation as nursing aide, my deepest gratitude and ever sincere thanks to this institution. To the nurses, doctors and staff of the above mentioned institution, thank you very much for the patience for accommodating us and let us handled your ever precious patients. Above all, to GOD ALMIGHTY, who has created all good things in this world, His eternal source of inspiration and saving graces, we heartily dedicate this humble contribution for the betterment of the future procedures and to the service to mankind.

INTRODUCTION

A spinal cord injury (SCI) refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence. Spinal cord injuries are described at various levels of "incomplete", which can vary from having no effect on the patient to a "complete" injury which means a total loss of function. Treatment of spinal cord injuries starts with restraining the spine and controlling inflammation to prevent further damage. The actual treatment can vary widely depending on the location and extent of the injury. In many cases, spinal cord injuries require substantial physical therapy and rehabilitation, especially if the patient's injury interferes with activities of daily life. Spinal cord injuries have many causes, but are typically associated with major trauma from motor vehicle accidents, falls, sports injuries, and violence. Research into treatments for spinal cord injuries includes controlled hypothermia and stem cells, though many treatments have not been studied thoroughly and very little new research has been implemented in standard care. In our patients case she got her injury by accidentally falling down causes her back to be injured. Tuberculosis (TB) of the spine also known as Potts disease, Potts Caries, Davids disease, Tuberculosis spondylitis and Potts 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. Potts 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. A person with Potts disease often develops kyphosis, which results in a hunchback. This is often referred to as Potts curvature. In some cases, a person with Potts disease may also develop paralysis, referred to as Potts paraplegia, when the spinal nerves become affected by the curvature. A person who has been diagnosed with

Potts 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 Potts 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 themost common method used to screen for tuberculosis, though blood tests, bone scans, bone biopsies, and radiographs may also be used to confirm the disease

PATIENTS PROFILE

Patient name Age Gender Address Civil Status Religion Birthday Birth place Attending physician

: : : : : : : : :

Ms. RM 15 years old Female Caloocan Ciyt Single Roman Catholic July 30 1996 Manila, Fabella DR. Herradura, Calina, Agrario and Dr.

Mary Date of Admission Time of Admission Chief complaint Admitting Diagnosis : : : : numbness of the back SCI. INC SLT8 2 Potts disease on t4-t9 AIA-B Treatment given/ Procedure done: S/P ABS X-ray, CT Scan, CBC November 23 2009

Medical History

A. History of Present Illness:

This is a case of B.P., who was admitted for the first time last November 23 2009 with a chief complaint of numbness of the back. 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 Flu allergy

C. Family Medical History ( ( ( ( + ) HPN - ) DM + ) Lung Cancer + ) Kidney( infection )

D. Personal and Social History: Low vegetable diet

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 supplyof oxygen 6) To facilitate maintenance of nutrition 7) To facilitate maintenanceof 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

OBJECTIVES
General objectives:

As we are exposed in handling this Potts Disease case, we are hoping to discuss and enhance our understanding about the disease and also to impart such knowledge to the reader of this case study. To be able to help the client having this disease and who are prone to this disease to gain more knowledge about the sources, manifestation, complication and possible intervention about Potts Disease after they have finished reading this case study.

Specific objectives:
1. To be able to define the disease itself and manifestation. 2. To be able to formulate an effective nursing intervention about the manifestation of Potts Disease. 3. To be able to impart knowledge to the possible readers of this case study.

PATHOPHYSIOLOGY
Pott disease is usually secondary to an extra spinal source of infection.

The basic lesion is a combination of osteomyelitis and arthritis. The area usually affected is the anterior aspect of the vertebral body adjacent to the subchondral plate.

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 and kyphosis. The spinal canal can be narrowed by abscesses, granulation tissue, or direct dural invasion. This leads to spinal cord compression and neurologic deficits.

Kyphotic deformity occurs as a consequence of collapse in the anterior spine. Lesions in the thoracic spine have a greater tendency for kyphosis than those in the lumbar spine.

The collapse is minimal in cervical spine because most of the body weight is borne through the articular processes.

Healing takes place by gradual fibrosis and calcification of the granulmatous tuberculous tissue. Eventually the fibrous tissue is ossified, with resulting bony ankylosis of the collapsed vertebrae.

Paravertebral abscess formation occurs in almost every case. With collapse of the vertebral body, tuberculous granulation tissue, caseous matter, and necrotic bone and bone marrow are extruded through the bony cortex and accumulate beneath the anterior longitudinal ligament.

These cold abscesses gravitate along the fascial planes and present externally at some distance from the site of the original lesion.

In the lumbar region the abscess gravitates along the psoas fascial sheath and usually points into the groin just below the inguinal ligament.

In the thoracic region, the longitudinal ligaments limit the abscess, which is seen in the radiogram as a fusiform radiopaque shadow at or just below the level of the involved vertebra.

Thoracic abscess may reach the anterior chest wall in the parasternal area by tracking via the intercostal vessels. 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. Spinal cord injuries are most often traumatic, caused by lateral bending, dislocation, rotation, axial loading, and hyperflexion or hyperextension of the cord or cauda equina. Motor vehicle accidents are the most common cause of SCIs, while other causes include falls, work-related accidents, sports injuries, and penetrations such as stab or gunshot wounds. SCIs can also be of a non-traumatic origin, as in the case of cancer, infection, intervertebral disc disease, vertebral injury and spinal cord vascular disease.

Nursing Management

There are three main areas to consider when treating patients suspected of having spinal cord injury. Care involves: - Preventing increasing and permanent damage to the spinal cord; - Managing the spinal shock phase; - Managing the reflex phase. The early administration of steroids may help prevent 'secondary injury', that is, injury related to reversible factors such as tissue edema and ischemia.