General Objective:

This case presentation seeks to enhance the students knowledge with regards to the patients general health and disease condition, its pathophysiology, possible complications, treatment plan and medical regimen. It also seeks to assimilate the students skills through application of several nursing interventions and medical management. Furthermore, this case presentation intends to improve the students attitude by conveying open-mindedness and utilizing therapeutic communication all throughout the activity.

Specific Objectives:
Within a week of thorough study of this specific case, the student nurses aim to achieve the following objectives in this case presentation: Accurately present a thorough general health assessment of the client which includes physical assessment and family history taking. Effectively discuss and elaborate actual signs and symptoms of the specific diagnoses exhibited by the client. Thoroughly discuss, explain, and elaborate the nature of disease process. Effectively provide appropriate and proper nursing diagnoses in line with the clients medical condition. To discuss the pathophysiologic mechanism of the disease process of Spinal cord injury secondary to Potts disease, placing emphasis on how the complications and the disease etiology relate and sync with each other. To accurately explain the various laboratory examinations that is required for the detection of the disease and how significant remarks or findings relate to this disease. To site various drugs required for the treatment of the disease in giving a client-based analysis on the said pharmacologic treatment. To evaluate the presenting clinical manifestations based on overall condition with emphasis placed on the alterations. Skillfully formulate nursing care plans for the different problems identified. Appropriately provide nursing interventions according to the standards of nursing practice. Effectively apply the learned concepts and theories of the disease and the management Effectively appraise the effectiveness and efficacy of nursing interventions rendered to the client. Impart the outcome of the rendered nursing interventions. Convey the significance of clients response to the rendered nursing interventions. To be able to give health teachings regarding the prevention and cure of the Spinal cord injury secondary to Potts disease.

INTRODUCTION
A. BACKGROUND OF THE STUDY
I. Incidence, race, gender, age, ration and proportion

20- 30% of the 172,483 cases in the Philippines has Pott's disease People who are affected are African American, Hispanic American, Asian American and foreign born individuals Most common in males than women In the Philippines 75% of children are affected ( 2 : 1 ) = Male: Female

II.

Rationale for choosing the case

The group has decided to choose the case of Ms. G with a diagnosis of Acute Spinal Cord Injury Incomplete SL T4, secondary to pathologic fracture of T11-T12 secondary to Potts disease because it was the kind of illness that is common among children even in adults in terms of orthopedic cases and one of the cause why many people became hospitalized and died. It risen dramatically, and for us its an interesting case.

III.

Significance of the study

The significance of this study is to enhance the knowledge, to develop skills and the right attitude of the student nurses in giving care for the patient with spinal cord injury secondary to Potts disease, its importance and implication. This study will serve as guidelines in providing nursing care to those who have the same disease.

These are other significance of the study that would support the above statement: To understand the underlying facts about spinal cord injury secondary to Potts disease Determine the nursing history: personal data, health history, and physical assessment of the patient To illustrate the anatomy, physiology and pathophysiology of the affected organ (vertebral column) To discuss and determine manifestation and complication To develop an effective skill managing a proper care based on the specific signs and symptoms the patient is experiencing and the results of laboratory examination. Formulate a drug study on the case To provide the patient nursing care plan and discharge plan to assure the total wellness

IV.

Scope of limitation
This case study was conducted at Philippine Orthopedic Center, Quezon City Manila in a

12 year old patient with spinal cord injury secondary to Potts disease. The group gathered the data by conducting interview with the patient and family members. The group also conducted assessment regarding the patient's health status by observing her especially the vertebral column and level of functioning of the lower extremities of the patient in order to validate the signs and symptoms of the disease. For the duration our study, we started our visit last May 24, 2011 and ended May 27, 2011 for 2 consecutive days. The group wasn't able to acquire more days for observation due to our lack of time to conduct it.

V.

Theoretical Framework
For the theoretical framework, we used the 21 nursing problems according to Faye Glenn Abdellah. She defined nursing as broadly grouped into 21 nursing problem areas to guide care and promote the use of nursing judgment. 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.

Abdellah's typology was divided into three areas:

(1) The physical, sociological, and emotional needs of the patient; (2) The types of interpersonal relationships between the nurse and the patient (3) The common elements of patient care. Abdellah's Typology of 21 Nursing Problems: To promote good hygiene and physical comfort To promote optimal activity, exercise, rest, and sleep To promote safety through prevention of accidents, injury, or other trauma and through the prevention of the spread of infection To maintain good body mechanics and prevent and correct deformities To facilitate the maintenance of a supply of oxygen to all body cells To facilitate the maintenance of nutrition of all body cells To facilitate the maintenance of elimination To facilitate the maintenance of fluid and electrolyte balance To recognize the physiologic responses of the body to disease conditions To facilitate the maintenance of regulatory mechanisms and functions To facilitate the maintenance of sensory function To identify and accept positive and negative expressions, feelings, and reactions To identify and accept the interrelatedness of emotions and organic illness To facilitate the maintenance of effective verbal and nonverbal communication

 To promote the development of productive interpersonal relationships To facilitate progress toward achievement of personal spiritual goals To create and maintain a therapeutic environment To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs To accept the optimum possible goals in light of physical and emotional limitations To understand the role of social problems as influencing factors in the cause of illness

VI.

Related Literature
POTTS DISEASE

Definition Is a grave disorder that produces destruction of the vertebrae, the disease can cause inflammation of the bones and collapse of the vertebrae resulting to compression of the spinal cord and nerve. Usually occurring on the thoracic vertebral region. The disease may occur and in childhood and adulthood. AKA: TB of the spine, Davids disease Risk factors 1. 2. 3. 4. Endemic tuberculosis Poor-socio economic conditions HIV infection Poor nutritional status

Predisposing factors 1. 2. 3. 4. Home environment condition Family history of pulmonary tuberculosis Nutritional status History of trauma

Signs and Symptoms a. b. c. d. e. f. Complication a. b. c. d. Abscess Spine deformities Neurologic deficits Paraplegia Back pain Night sweats Weight loss Loss of appetite Fatigue and general malaise Pain and stiffness of the spine

Diagnostic tests a. Laboratory Tuberculin skin test Erythrocyte sedimentation rate Acid fast bacilli b. Imaging studies

X-ray CT- scan MRI Nursing diagnoses Acute pain Disturbed body image Self- care deficit Nursing Intervention a. b. c. d. e. f. g. Assess pain Assess range of movements in all extremities Promote beds rest Advise and emphasize proper diet Advise increase fluid intake Maintain skin integrity Patients education

Medical management a. b. c. d. Immobilize the spine Control of the infection Minimize the deformity Build up resistance of the patient through V-itamins I-soniazid P-yrazinamide E-thambutol R-ifampicin S-treptomycin Surgical Management Anterior spinal decompression Spinal fusion Spinal Cord Injury Definition It refers to the injury to the spinal cord that is caused by trauma instead of a disease. Trauma to the spine can occur at any level button most commonly occurs in the cervical and lower thoracic-upper lumbar vertebrae. AKA: Cord Compression, Cord curvature Classification of SCI Complete injury no function below the neurological level Incomplete injury retains some sensation or movement below the level of the injury Spinal cord injury without radiographic abnormality damage inside the column Spinal cord injury with radiographic abnormality damage on both column and cord Causes:

a. b. c. d. e. Risk factors a. b. c. d.

A motor vehicle accident Acts of violence Falls Sports and recreation injuries Diseases

Age Gender Alcohol Drugs

Predisposing factors a. Trauma b. Sports activities Signs and Symptoms CERVICAL (NECK) INJURIES When spinal cord injuries occur in the neck area, symptoms can affect the arms, legs, and middle of the body. The symptoms may occur on one or both sides of the body. Symptoms can include: Breathing difficulties (from paralysis of the breathing muscles, if the injury is high up in the neck) Loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms) Numbness Sensory changes Spasticity (increased muscle tone) Pain Weakness, paralysis

THORACIC (CHEST LEVEL) INJURIES When spinal injuries occur at chest level, symptoms can affect the legs: Loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms) Numbness Sensory changes Spasticity (increased muscle tone) Pain Weakness, paralysis

Injuries to the cervical or high thoracic spinal cord may also result in blood pressure problems, abnormal sweating, and trouble maintaining normal body temperature. LUMBAR SACRAL (LOWER BACK) INJURIES When spinal injuries occur at the lower back level, varying degrees of symptoms can affect one or both legs, as well as the muscles that control your bowels and bladder: Loss of normal bowel and bladder control (you may have constipation, leakage, and bladder spasms)

Numbness Pain Sensory changes Spasticity (increased muscle tone) Weakness and paralysis

Complication Urinary tract problem Bowel management difficulties Pressure sores Deep vein thrombosis Lung and breathing problems Autonomic dysreflexia Spasticity Pain Diagnostic test a. b. c. d. e. MRI Myelography Somatosensory Spine X-ray Ct-scan

Nursing diagnoses Risk for injury Risk for infection Impaired physical mobility Nursing intervention a. Assess airway, breathing, circulation b. Perform a quick head to toe assessment c. Immobilize the patient in the position found until help arrive Acute care 1. 2. 3. 4. 5. 6. 7. 8. 9. Maintain optimum respiratory function Maintain fluid & electrolyte balance and nutrition Maintain immobilization and spine alignment Prevent complications of immobility Maintain urinary elimination Monitor temperature control Prevent infection Perform ROM, exercise to maintain muscle tone Turn the position often to prevent pneumonia, embolism, & skin breakdown

Medical management a. Pharmacologic therapy High dose corticosteroids (methylprednisole) b. Respiratory therapy

Oxygen administration Diaphragmatic pacing (electric stimulation of the phrenic nerve Surgical management a. Laminectomy excision of the posterior arches and spinous processes of a vertebra

B. CLINICAL SUMMARY
I. GENERAL DATA PROFILE
NAME: Patient G ADDRESS: Blk. 26, Lot 10 Teachers vil. San Jose del Monte, Bulacan BIRTHDAY: December 10, 1999 BIRTHPLACE: Bataan SEX: Female AGE: 12 years old RELIGION: Roman Catholic NATIONALITY: Filipino DATE OF ADMISSION: April 28, 2011 ADMITTING DIAGNOSIS: Potts disease T11-T12 with neurologic

II. CHIEF COMPLAINT:

Prior to admission, the patient experience weakness of both lower extremities

III. NURSING HISTORY:

1. History of the Present Illness: Present condition started 3 months PTA, when accidentally hit her back after tumbling. She experienced on and off lower back pain described as sharp with pain scale of 9/10, non radiating, aggravated by supine position and relieved by standing position. This was associated with on and office fever and chills. There was no numbness or weakness noted. Patient took Paracetamol500 mg. /tabs every 4 hrs. which provided temporary relief of symptoms. No consultation done. Patient was able to ambulate independently at this time. Patient had spontaneous voiding and normal bowel movement. 2. Past Medical History: a. Childhood Illnesses -no asthma, no heredofamilial disease -(+) mumps (2008)

b. Immunizations -fully immunized (BCG, DPT, OPV, Hepa B, Measles) c. Allergies -no known allergies

D. FAMILY HISTORY

Grandfather Grandmother (A&W) (A&W) *UTI Grandfather Grandmother

Uncle A (A&W)

Uncle B (A&W)

Father 48y/o (A&W)

Aunt A (A&W)

Uncle C (A&W)

Aunt A (Unknown)

Mother 46y/o (A&W)

Aunt B (A&W)

Sister 1 (A&W) 18y/o

Sister 2 (A&W) 16y/o

PATIENT SCI 2 to Potts disease 12y/o

Sister 3 (A&W) 10y/o

LEGEND: Male Deceased Female Deceased Female ( Alive & Well)

Male ( Alive & Well)

E. SOCIAL HISTORY Psychosocial Theory according to Erik Erikson

STAGE

AGE

CENTRAL TASK

CHARACTERISTICS

School Age

6-12 years old

Industry vs. Inferiority

>Emerging confidence in own abilities. >Taking pleasure in accomplishments.

PSYCHOSOCIAL THEORY ACCORDING TO ERIK ERIKSON: According to this theory, school age primary developmental task is one of contributing factor in competency. When a person makes a contribution during this period, school age children do what is best for them to accomplish something. Based on our interview with the client, we found out that the theory of Erikson correlates with the information weve gathered from the patient. She has her own family and she study hard and go to school during school hours. According to Sigmund Freuds Developmental Stage STAGE AGE CHARACTERISTICS IMPLICATION

Genital

11-13 years old

>Energy is directed toward full sexual maturity and function and development of skills needed to cope with the environment

>Encourage separation from parents, achievement of independence and decision making

According to this theory, the genital stage correlates to her age because she was her own peers with the same and opposite sex. When it comes to decision making, she ask for his fathers opinion too. According to Jean Piagets Cognitive Development STAGE AGE CHARACTERISTICS INTERPRETATION

Concrete Operational

6-12 years old

The child begins to apply logic thinking, understands spatiality and reversibility.

The child is increasingly social and able to apply rules however thinking is still concrete.

According to Sullivans Life Stages

STAGE

AGE

CHARACTERISTICS

INTERPRETATION

Preadolescence

8-12 years old

>Move to genuine intimacy with friend of the same sex. >Move away from a family as a source of satisfaction in relationships.

Capacity for attachment, love and collaboration emerges or fails to develop.

F. ENVIRONMENT/LIVING CONDITION The environment where he lives can be found in Bulacan. The place is clean and suitable for living. They live in a bungalow with two bedrooms and one toilet outside the house all inaccessible to wheelchair. Regarding the hospital environment at Philippine Orthopedic Center where she was confined, it is a good place to stay on for her safety but the ventilation and lighting interferes with her sleep pattern and resting period.

G. PHYSICAL ASSESSMENT Admission (April 28, 2011) PARAMETERS General Appearance ACTUAL FINDINGS >Conscious and Coherent >Not in cardio - respiratory distress INTERPRETATION >The patient is well cooperative. >The general appearance is normal. Normal

Anthropometrics Skin

Ht: 37 Wt: 25kg . No rashes; with good skin turgor

The patient is free from dehydration.

HEENT

Pink palpebral conjunctiva, white sclera, no tonsillopharyngeal congestion, no nasoaural discharges.

Normal

Chest/Lungs

Symmetrical chest expansion, no retractions, clear breath sounds

Normal

Heart

Adynamic precordium, normal heart rate, no murmurs Full and equal pulses, no edema, no cyanosis Full ROM to both lower extremities, actively, pain-free

Normal

Musculo-skeletal (upper and lower extremities)

Normal

Back

There is presence of palpable gibbus in Due to hypoplasia or wedging of the thoracic area specifically T11 and one or more lower thoracic or T12. upper thoracic.

(May 24, 2011) PARAMETERS NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION

General Appearance

-Clean in appearance and well-groomed -Cooperative

-Clean in appearance and well-groomed -Cooperative

The patient is well cooperative.

Anthropometrics

Ht: 37

Wt: 25kg

Ht: 37 ; Wt: 23kg

Loss of appetite- sign of potts disease. The patient is slightly dehydrated.

Skin

-With good skin turgor

-With fair skin turgor

Hair

-Evenly distributed hair -Thick hair

-Evenly distributed hair -Thick hair

Normal

Nails

-With good capillary refill of 1-2 seconds -With pinkish nail beds -With clean and short nails -Mouth uniform consistency; absence of nodules and masses -Rounded smooth skull contour -Symmetrical facial movement

-With good capillary refill of 1-2 seconds -With pinkish nail beds -With clean and short nails -Mouth uniform consistency; absence of nodules and masses -Rounded smooth skull contour -Symmetrical facial movement

Normal

Skull and Face

Normal

Eyes

-No eye discharge -No eye discharge -With pinkish conjunctiva -With pinkish conjunctiva -(+) blink reflex -(+) blink reflex -Auricle color same as facial skin -Auricle are mobile firm and not tender -Able to hear on both ears -No edema and discharge -Auricle color same as facial skin -Auricle are mobile firm and not tender -Able to hear on both ears -No edema and discharge

Normal

Ears

Normal

Mouth

-Pinkish lips -With pink gums -No foul odor -With symmetrical contour

-Pinkish lips -With pink gums -No foul odor -With symmetrical contour

Normal

Musculo-skeletal (upper -Symmetrical and lower extremities) -No atrophy -With full range of motion

(+) tingling sensation on both feet and (+)weakness noted

Lower extremities are affected due to evident spinal cord injury and nerve compression.

Abdomen

-No abdominal distention -Symmetrical contour

-No abdominal distention -Symmetrical contour There is presence of palpable gibbus in the thoracic area specifically T11 and T12.

Normal

Back

Flat

Due to hypoplasia or wedging of one or more lower thoracic or upper thoracic.

H. Patterns of Functioning Functional health pattern Health management pattern Before hospitalization During hospitalization Interpretation

Patients have clean environment indoors and some hazardous materials outside, which makes it accident prone. Patient usually eats junk food and drinks carbonated beverages often more than she drinks water. Patient prefers eating junk food than meals being served in her house by her mother. Patient has a low appetite before hospitalization. Patient drinks one glass of water a day. Patient is thin Ectomorph

Patient has a clean environment.

Patients environment before hospitalization is the one that affected & inflicted the patients condition

Nutritional/ Metabolic a. Number of meals a day. b. Appetite c. Glass of water/ day d. Body built e. height and weight

Patient eats what is being served, usually vegetables, meats and fruits.

Patient eats three times a day as they are served.

Patients diet before might have an effect the patients condition. Have a fair appetite during hospitalization. Her fluid intake is not sufficient and might lead to other possible complications.

Patient has normal appetite.

Patient drinks a glass of water every meal. Three glasses a day. Patient is thin. Patient urinates twice day 350 ml and defecates once a day Hard stool. She has no difficulty on passing stool and urine. Patients only exercise is turning from side to side and stretching of limbs. And doing divisional activities like coloring. Patient elimination pattern is not yet normal because of decrease in activity and effect of the disease process.

Elimination

Patient has regular urination and irregular bowel movement. Patient defecates once every 3rd day

Activity and exercise

Patient usually plays outside and serves as her daily exercise. Then eats junk foods with friends

She doesnt have enough exercise for her age to strengthen her ROM.

Roles and relationship

Patient has good relationship with all the family members and playmates.

Patient has good relationship with her family. Her communication is lessened due to unfamiliarity to copatients. Patient has good religious beliefs and verbally stated that she prays at times.

Patient has good relationship to her mother but has limited socialization and communication with co-patients.

Values and beliefs

Patient has good religious beliefs as a Roman Catholic and goes to church regularly. She perceives herself in a positive way; she is a good daughter and a good sister.

Patient has faith in God before and during hospitalization

Self-perception/selfconcept

She perceives herself in a positive way; she is a good daughter and a good sister.

She still values himself and views everything in a positive manner despite of her condition. She still values himself and views everything in a positive manner despite of her condition.

Self-perception/selfconcept

She perceives herself in a positive way; she is a good daughter and a good sister.

She perceives herself in a positive way; she is a good daughter and a good sister.

I. Course in the Ward 4-28-11 Doctor ordered to admit client to ward of choice after consent was secured, to monitor clients I&O every shift. The ordered medications were isoniazid, rifampicin, and pyrazinamide. Ordered to start to infuse d5.03 NACl 500 KVO. Placed patient to DAT diet. Admitting diagnosis was SCI inc. secondary to potts disease T11-T12. The nursing interventions were admitting the client to the children's ward, turning the client every two hours this was to prevent formations of pressure sore, monitored the I&O to have baseline data and provided deep breathing, explained the different drug indications and side effects and coughing exercises to promote lung expansion. 4-30-11/ 5-1-11 Doctor ordered IVF of d5.3 NaCl X KVO. The nursing interventions were to infuse ordered IVF and regulated it as ordered to inscribe the correct amount of the fluid. 5-2-11 Client complained of pain @ lower back, doctor prescribed and ordered Mefenamic 250mg 1tab q8 for pain. Interventions was to give the medication for pain, at the prescribed time to prevent overdose and citing the indications to keep the patient informed on the medications that she takes.

5-3-11/5-4-11 Doctor ordered IVF of d5.3 NaCl x KVO. The nursing interventions were to infuse ordered IVF and regulated it as ordered to inscribe the correct amount of the fluid. 5-05-11 Doctors order was the patient to be placed with a urinary catheter due to pain in urination and bladder distention, discontinue IV and medications for further laboratory test, refer to ROM exercises and the client was to be for SGOT, UA and SGPT. Nursing interventions were to withhold the medications to observe the proper adherence to medication regimen. Requests were forwarded to the lab and the purpose of the procedure was explained to keep the client informed. Explained the purpose of catheterization to the client before doing the procedure. Lastly, patient was instructed to proper ROM exercises to increase overall physical strength. 5-6-11 Doctors order were to follow-up UA result, Flush IFC with NSS OD because of possible infection, give Mefenamic acid 250mg/1tab q6 for pain due to pain in the catheter insertion site and bladder distention, instruct patient to Active range of motion exercises to both hips, knee uncle and foot. Nursing interventions done were flushing of IFC with NSS to prevent clogging of the tube, administered Mefenamic if client complained of pain to prevent overdose of medication. 5-7-11 Doctors order was to discontinue IFC because of pain in catheterization site, measure I&O every shift and to watch out for bladder distention. The nursing intervention done was removing of catheter using the clean method to reduce the risk of infection, measured the I&O to report any changes to the patient. 5-12-11 Doctor ordered for complete blood count, erythrocyte sedimentation rate and C-Reactive protein. The nursing interventions are to provide a request to be forwarded to laboratory. Explain to the patient the importance of the CBC, ESR, and CRP. 5-16-11 Doctor ordered to revised PT orders: Re-evaluation General body condition exercises AROMES to left hip knee & ankle joints with GPS towards ending MRES to right hip, knee, ankle joints with GPS Maintenance exercise to both upper extremities GPS to both Hamstring & Heel cords

5-22-11 Doctor ordered: Referred service consultant to secure consent for mobilization once with brace Will follow up KT brace to PASAF officer Refer accordingly

J. LABORATORY/ DIAGNOSTIC EXAM: April 15, 2011: Test Sodium (ISE) Potassium (ISE) Chloride (ISE) 4.35 meq/L 3.70-5 meq/L Normal Result 141 meq/L Unit 135-148 meq/L INTERPRETATION Normal

103 meq/L

98-107 meq/L

Normal

COMPLETE BLOOD COUNT

Test Hemoglobin Hematocrit

Result 110 g/L 0.35 g/L

Normal Range 110-158 g/L 0.36-0.46 g/L

Interpretation Normal Decreased levels are due to acute blood loss and dehydration.

Leukocyte count Differential Count: Segmenters Lymphocytes Monocytes Eosinophils

7.7

5-10 cell/mm3

Normal

0.58 0.41 0.01

.45-.70% .18-.45% .04-.08% Indicate susceptibility of the client to acquire any form of infection

Platelet Count

684

150-400x10^q/L

Indicates fracture due to trauma

Nursing interventions: The patient is instructed to increase fluid intake to prevent depletion in hematocrit level Maintain proper personal hygiene Importance of hand washing Advised to eat food high in Vitamins. C to enhance immune system Advised to have adequate rest and sleep Strictly adhere to treatment regimen

April 28, 2011 URINALYSIS Physical Characteristics COLOR: light yellow Color: Amber Yellow Pale color indicates diluted urine Normal pH Level: 6 pH Level: 4.5-8

SPECIFIC GRAVITY: 1.010 Microscopic Findings: CELLS: RBC: 0-1/hpf Pus Cells: 1-3/hpf CRYSTAL: Amorphous Urates: ++

1.005-1.030

Normal

1-2hpf N/A

Normal Indicates presence of infection *Presence and accumulation of

None

crystals in urine indicates formation of renal stones

CHEMICAL TEST: Sugar: negative Protein: negative Negative Negative Normal Normal

Nursing interventions: Instructed the patient to increase fluid intake and eat fruits and vegetables high in fluid content such as watermelons, oranges, green leafy vegetables such as lettuce. May 02, 2011 COMPLETE BLOOD COUNT

TEST

RESULT

NORMAL RANGE

INTERPRETATION

Hemoglobin Hematocrit Leukocyte Count Segmenters Lymphocytes Monocytes Eosinophils Platelet Count

104 0.33 15.60 0.57 0.31 0.08 0.04 176

110-158 g/L 0.36-0.46 g/L 5-10 cell/mm3 .45-.70% .18-.45% .04-.08% 0-.04% 150-400x10^q/L

Normal Normal Indicates presence of infection Normal Normal Normal Normal Normal

BLOOD TYPE RH TYPING CRP:

O+ Positive (+) Reactive SEMI-QUANTITIVE 12 mg/L Child: Not usually present Indicates infection and the client is high risk for coronary artery disease and can indicate inflammation in the arterial system and coronary arteries.

Nursing Interventions: The patient is instructed to increase fluid intake Maintain proper personal hygiene Importance of hand washing Advised to eat food high in Vitamins. C to enhance immune system Advised to have adequate rest and sleep Strictly adhere to treatment regimen

TEST UREA CREATININE SGOT SGPT SODIUM POTASSIUM CHLORIDE May 06, 2011

RESULT 29.15 0.71 mg/dl 31 18.52 140 meq/L 3.81 meq/L 97.80 meq/L

REFERENCE RANGE 10.22-49.88 0.50-1.30 <31 <32 135-148 3.50-5.30 98-107

INTERPRETATION Normal Normal Normal Normal Normal Normal Normal

TEST SGOT SGPT May 13, 2011

RESULT 22.51 16.57

REFERENCE RANGE <31 <32

INTERPRETATION Normal Normal

COMPLETE BLOOD COUNT

TEST Hemoglobin Hematocrit Leukocyte Count Segmenters Lymphocytes Monocytes Eosinophils Platelet Count

RESULT 116 0.36 5.80 0.45 0.43 0.06 0.04 426

NORMAL RANGE 110-158 g/L 0.36-0.46 g/L 5-10 cell/mm3 .45-.70% .18-.45% .04-.08% 0-.04% 150-400x10^q/L

INTERPRETATION Normal Normal Normal Normal Normal Normal Normal Indicates trauma due to fracture

Instructed the patient to increase fluid intake Promote safety to prevent further injuries

ESR WESTERNGREN METHOD Result Children 61 Normal range 0-10 mm/hr Interpretation Increased due to chronic inflammatory process, infections and nerve damage due to physiologic stress and trauma. Nursing Interventions:
Monitor daily weight and intake and output. Monitor dietary habits and serum albumin levels. Increase fluid intake Use strict aseptic technique for all invasive procedures. Provide adequate rest and sleep Administer prescribed medications

RADIOLOGICS Chest X-ray: No infiltrates, intact diaphragm, no rib fracture, diaphragmatic sulci intact Thoracic spine X-ray: (+) lytic destruction of T11- T12 vertebral bodies, the rest of the spine shows intact vertebral body height with intact IV disc spaces.

II.

CLINICAL DISCUSSION OF THE DISEASE

Vertebral Column

a. ANATOMY AND PHYSIOLOGY

-Forms the longitudinal axis of the skeleton. It is composed of a series of bones called vertebrae and is approximately 28 inches long in the adult. - Humans are born with 33 separate vertebrae. By adulthood, we typically have 24 due to the fusion of the vertebrae in the sacrum. The top 7 vertebrae that form the neck are called the cervical spine and are labeled C1-C7. The upper back, or thoracic spine, has 12 vertebrae, labeled T1-T12. The lower back, or lumbar spine, has 5 vertebrae, labeled L1-L5. The lumbar spine bears the most weight relative to other regions of the spine. The sacrum (S1) and coccyx (tailbone) are made up of 9 vertebrae that are fused together to form a solid, bony unit.

Elements of the Spine A. Vertebrae The vertebrae support the majority of the weight imposed on the spine. B. Intervertebral Disc Between the spinal vertebrae is discs, which function as shock absorbers and joints. They are designed to absorb the stresses carried by the spine while allowing the vertebral bodies to move with respect to each other. Each disc consists of a strong outer ring of fibers called the annulus fibrosis, and a soft center called the nucleus pulposus. The outer layer (annulus) helps keep the disc's inner core (nucleus) intact. C. Facet Joint The facet joints connect the bony arches of each of the vertebral bodies. Facet joints connect each vertebra with those directly above and below it, and are designed to allow the vertebral bodies to rotate with respect to each other. D. Neural Foramen The neural foramen is the opening through which the nerve roots exit the spine and travel to the rest of the body. The foramen creates a protective passageway for the nerves that carry signals between the spinal cord and the rest of the body. E. Spinal Cord and Nerves Functions of the Spinal column Movement Flexibility and mobility Protection of Major Organs Spinal cord protection Shock absorption Bones for attachment (Ligaments, tendons, muscles) Produces red blood cells Mineral storage

b. PATHOPHYSIOLOGY
BOOK BASE Non-modifiable Endemic TB Poor socio-economic condition Immunocompromised Poor nutritional status Modifiable Home environment Family history Nutritional status History of trauma

Exposure to specific microorganism via droplet

Ingestion of bacteria via nasal cavity Proliferated to the meniges through the bloodstream reaching the subarachnoid space.

Descending proliferation of infection occurs

Mycobacterium tubercle spread from the anterior aspect of vertebral body adjacent to the subchondral plate

Infection spread to the adjacent intervertebral disk GIBBUS Progressive bone destruction Abscess formation

Narrowing of spinal canal Collapse in the anterior spine Spinal cord compression and neurologic deficits

Signs and Symptoms:

Paraplegia

Back Pain Night Sweats Weight loss Loss of appetite Fatigue and general malaise Pain and stiffness of the spine Absces s Spine deformity/ injury

Possible Complications if left untreated:

Kyphosis (Potts curvature)

PATIENT BASE Non- Modifiable socio-economic condition Poor nutritional status Modifiable History of trauma

Exposure to specific microorganism via droplet

Ingestion of bacteria via nasal cavity Proliferated to the meniges through the bloodstream reaching the subarachnoid space.

Descending proliferation of infection occurs

Mycobacterium tubercle spread from the anterior aspect of vertebral body adjacent to the subchondral plate

Infection spread to the adjacent intervertebral disk (+)GIBBUS formation T11-T12 Progressive bone destruction

Thoracic supine x-ray revealed (+) lytic destruction of T11T12 vertebral bodies.

Narrowing of spinal canal Collapse in the anterior spine Signs and Symptoms: Back Pain Weight loss Fatigue and general malaise Pain and stiffness of the spine

Abscess formation

Spinal cord compression and neurologic deficits

Complications
Kyphosis (Potts curvature)

Spine deformity/ injury

Paraplegia

III.

Nursing Process Ranking 1 Rationale The patients primary complaint body malaise and muscle weakness. We ranked this as first priority because decreased mobility can cause different kinds of complication (bed sores, decreased ROM) The patient has impaired physical mobility, as a result she has self-care deficit. We ranked this as second priority because this problem is a result of the primary problem We ranked this as third priority because as mentioned, it is only a risk it is possible threat to the clients condition. Only prevention is the needed intervention

Problem Impaired physical mobility related to decreased muscle strength as manifested by limited ROM and limited ability to perform gross fine motor skills

Self-care deficit related to musculoskeletal impairment

Risk for impaired skin integrity related to physical immobilization

DISCHARGE PLAN
M-edication: Encourage significant others to continue medications as prescribed by the physician. With a strict emphasis on explaining the mechanisms of action of the drugs, the prescribed dosage, side effects, proper timing of intake of drugs and importance of continuing the medications.

E-nvironment/ E-xrecise Clients environment must be clean to prevent emergence of other diseases, environmental factors that includes excessive stress such as emotional stress to the patient must be avoided. Encourage significant others to have a gradual passive ROM to the patient because it will promote blood circulation and to improve muscle strength in order to promote total range of motion.

T-reatment: Instruct the significant others to consult first the physician in anything that will help the patient in his conditions like physical activities that she must follow and most especially her diet. Encourage the significant others to compliance on further treatment for the proper maintenance and gain of optimal health.

Health teachings: Importance to maintain proper personal hygiene Strict adherence to medications to promote wellness. Increase fluid intake to prevent infection and dehydration importance of proper nutritious food to maintain healthy body. Immediate report to the physician for any abnormalities to note any complications.

O-ut-patient Compliance to medical check-up and therapeutic regimen to reduce or prevent risk of recurrence of the disease condition. Instruct patient to continue medications as prescribed. Follow up check-up: a week after discharge.

D-iet Suggest the significant others to let the patient eat healthy food because it helps the patient feel better and have more energy. Tell the significant others the importance of following diet and food restrictions. The patient may also consult to a dietary physician to know what are the correct dietary intake she must maintain. Increase in high fiber foods such as fruits and green leafy vegetables to prevent constipation, increase in Vitamin C food to boost immune system and increase in fluid intake to prevent dehydration.

Case Presentation
Acute Spinal Cord Injury Incomplete secondary to Potts Disease
Presented to: Mrs. Jennifer Palacpac Presented by: Group 1
Alina, Armi Alcantara, Keith Austin Baria, Wilmalyn Caagbay, Kristine Mae Enriquez, Shielah Anne Marie Jabrica, Belenia Plata, Jerome Racelis, Kristel Joyce Rosillas, Bien Jannus DATE PRESENTED: June 1, 2011