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Nursing Care Plan for Tuberculous Spondylitis

Tuberculous spondylitis is a chronic granulomatous inflammation, destructive by mycobacterium tuberculosis. Tuberculous spondylitis is always a secondary infection from a focus elsewhere in the body. Percivall (1973) was the first author of this disease and states that there is a relationship between this disease with spinal deformity that occurs, so the disease is referred to as Pott's Disease. (Rasjad, 1998).

Clinically, tuberculous spondylitis symptoms similar to symptoms of tuberculosis in general, the weakness / lethargy, decreased appetite, weight loss, slightly increased temperature (sub-febrile), especially at night as well as back pain. In children, often accompanied by crying at night. (Rasjad. 1998).

At the beginning of radicular pain that can be found around the chest or abdomen, followed by paraparesis which was advancing more slowly, spasticity, clonus, hyperreflexia and bilateral Babinski's reflex. At this early stage of vertebral deformity has not been found, so there has been no word of pain in the spine. Persistent spinal pain, limited movement of the spinal and neurological complications are a sign of further destruction. Neurologic abnormalities occur in approximately 50% of cases, including the spinal cord due to the emphasis that causes paraplegia, paraparesis, or radix nerve pain. Signs are commonly found among them is the presence of kyphosis (gibbus), swelling in the paravertebral region, and signs of neurological deficits, as already mentioned above.

In tuberculous cervical vertebrae can be found in the back of the head pain, problems swallowing and breathing problems due to retropharyngeal abscess. It must be remembered in the beginning the emphasis from the anterior part so that clinical symptoms arise primarily motor disorders. Sensory disturbances in the early stages rarely found except when the posterior part of the bone is also involved.

Complications of tuberculous spondylitis of the most serious is Pott's paraplegia when appearing at an early stage due to the pressure extradural by pus or Sequester, or invasion of granulation tissue in the spinal cord and when they appear at an advanced stage due to the formation of fibrosis of granulation tissue or adhesions spine (ankylosing) above the spinal canal.

Myelography and MRI is helpful to distinguish the cause of this paraplegia. Paraplegic caused by extradural pressure by pus or Sequester require operative measures by way of decompressing the spinal cord and nerves.

Another possible complication is rupture of the thoracic paravertebral abscess into the pleural empyema causing tuberculosis, whereas in the lumbar spine, the pus will come down to form the iliopsoas muscle psoas abscess which is a cold abscess.

Nursing Diagnosis  for Tuberculous Spondylitis

1. Impaired physical mobility

2. Acute pain: joints and muscles.

3. Disturbed body image

4. Knowledge deficit: about home care.

(Susan Martin Tucker, 1998: 445)