St.

Anthony College of Roxas City

San Roque Extension, Roxas City
5800 Capiz, Philippines
Bachelo of Science in !using
4C- 2011
"E"A!#S
Su$%itte& $y'
Xy-Za Roy Marie D. Albaa
Glorie Anne D. Anisco
Khris John V. Balbuena
Charmaine Cheryl Iris V. Bellosillo
Joanna Keih D. Baui!as
A"ril Rose D. Benie#
Karen Kay D. Bulan
$hiehon A. %erraris
Marie Ann B. Ma!banua
%ree Van Roy &aclibar
Su$%itte& to'
Ms. 'ila C. Valles( R)
Clinical Instructor
INTRODUCTION
(
TETANUS
Comes from the Greek word tetanus meaning taut and teiteim which
means to stretch. It is also called lockaw. It is a serious infectious disease of
the ner!ous s"stem in which to#in causes se!ere muscle s$asm. It is a medical
condition characteri%ed &" a $rolonged contraction of skeletal muscle fi&ers.
It is caused &" a &acterium Clostridium tetani. Infection generall" occurs
through wound contamination and often in!ol!es a cut or dee$ $unctured
wound. Tetanus is often associated with rust' &ut this conce$t is somewhat
misleading. The C.Tetani is an Anaero&ic &acteria which sur!i!es in an
en!ironment that lacks o#"gen' thus with or without rust a $erson ma" ha!e a
tetanus once C. Tetani enters the wound. Contaminated wounds are the site
where tetanus &acteria multi$l". (ee$ wounds or those with distalli%ed tissue
are $articularl" $rone to tetanus infection. The tetanus to#in affects the site of
interaction &etween the ner!e and the muscle that it stimulates' this region is
called the neuromuscular unction. The tetanus to#in am$lifies the chemical
signals from the ner!e to the muscles to tighten u$ in a continuous contraction
or s$asm. This results in either locali%ed or generali%ed muscle s$asm.
The incu&ation $eriod ranges from ) to *+ da"s' usuall" a&out , da"s. In
general the further the inur" site is from the central ner!ous s"stem' the longer
the incu&ation $eriod. The shorter the incu&ation $eriod' the higher the chance
of death. In neonatal tetanus' s"m$toms usuall" a$$ear from - to +- da"s after
&irth' a!eraging a&out . da"s. /n the &asis of clinical findings' three different
forms of tetanus ha!e &een descri&ed. 0ocal tetanus is an uncommon form of
the disease' in which $atients ha!e $ersistent contraction of muscles in the
same anatomic area as the inur". These contractions ma" $ersist for man"
weeks &efore graduall" su&siding. 0ocal tetanus ma" $recede the onset of
generali%ed tetanus &ut is generall" milder. /nl" a&out +1 of cases are fatal.
Tetanus can &e $re!ented &" !accination with tetanus to#oid. A &ooster is
needed e!er" +2 "ears after $rimar" immuni%ation.
In the 3hili$$ines the incidence rate of tetanus is +* out of ,4' *-+'4*..
Objectives
)
General objectives:
This case stud" is designed for the student nurses to &ecome
$racticed' well5informed and mannered in deli!ering holistic care for $atients
diagnosed with Tetanus.
Specific Objectives:
Skills
To demonstrate the !ision6mission of the school which is ser!ice
oriented' research moti!ated' technolog" ena&le and 7incentian
ins$ired.
Im$l" a$$ro$riate medical nursing management for Tetanus.
Knowlede
(iscuss the anatom" and $h"siolog" of the Ner!ous s"stem.
(efine Tetanus. 0earn a&out maor etiologic its causes' identif" its
clinical manifestations and risk factors.
8e familiar with the $atho$h"siolog" of Tetanus.
8e ac9uainted with the different drugs' its actions' and $erform
o&ligator" nursing res$onses for each.
3lan for a suita&le nursing care
!ttit"de
Esta&lish a nurse5$atient interaction through e#changing of
thoughts and information
Institute &ond &etween the student nurse and the $atient.
!N!TO#$ !ND %&$SIO'OG$
*
Nervo"s S(ste)
The nervo"s s(ste) is an organ s"stem containing a network of s$eciali%ed
cells called neurons that coordinate the actions and transmit signals &etween
different $arts of its &od". The ner!ous s"stem consists of two $arts' central and
$eri$heral. The central ner!ous s"stem contains the &rain' and s$inal cord. The
$eri$heral ner!ous s"stem consists of sensor" neurons' clusters of neurons called
ganglia' and ner!es connecting them to each other and to the central ner!ous
s"stem. These regions are all interconnected &" means of com$le# neural
$athwa"s. The enteric ner!ous s"stem' a su&s"stem of the $eri$heral ner!ous
s"stem' has the ca$acit"' e!en when se!ered from the rest of the ner!ous s"stem
through its $rimar" connection &" the !agus ner!e' to function inde$endentl" in
controlling the gastrointestinal s"stem.
The Central Nervo"s S(ste) is the &od":s information head9uarters' ultimatel"
regulating nearl" all &od" functions. The CNS includes;
T*e +rain < 3rocesses incoming information from within the &od"' and
outside the &od" &" wa" of the sensor" ner!es of sight' touch' smell' sound' and
taste. Commands are then sent &ack throughout the &od". The &rain also stores
and $rocesses language' communication' emotions' thoughts' dreams' and
memories. In other words' the &rain is where all thinking and decision5making
takes $lace.
T*e Spinal Cord < Is the main $athwa" for information connecting the &rain
and $eri$heral ner!ous s"stem. It e#tends from the &rain a&out +, inches down
+
the &on" s$inal column' which ser!es as its $rotection. The s$inal cord is a tu&e
made u$ of ner!e fi&ers. Electrical im$ulses tra!el through the ner!es and allow
the &rain to communicate with the rest of the &od".
The %erip*eral Nervo"s S(ste) is res$onsi&le for the remainder of the &od". It
includes cranial ner!es =ner!es emerging from the &rain>' s$inal ner!es =ner!es
emerging from the s$inal cord> and all the maor sense organs. The 3NS includes;
T*e So)atic Nervo"s S(ste) ,SNS- < ?es$onsi&le for all muscular
acti!ities that we consider !oluntar" or that are within our conscious control.
T*e !"tono)ic Nervo"s S(ste) ,!NS- < ?es$onsi&le for all acti!ities
that occur automaticall" and in!oluntaril"' such as &reathing' muscle contractions
within the digesti!e s"stem' and heart&eat. The com$onents of the ANS work
together to create a &alanced res$onse to outside stimuli
+
. The ANS includes;
o T*e S()pat*etic S(ste) < Stimulates cell and organ function. The
s"m$athetic s"stem is acti!ated &" a $ercei!ed danger or threat' !er" strong
emotions such as fear' anger or e#citement' &" intense e#ercise' or when
under large amounts of stress. 8asicall"' an"thing the &od" $ercei!es as an
emergenc" will trigger a $rotecti!e res$onse. /nce initiated' it s$eeds u$ heart
rate' increases the acti!it" of the sweat and adrenal glands' slows down the
digesti!e s"stem and sends &lood to the skin and muscles@ all of which $re$are
the &od" for a fight or flight res$onse.
o T*e %aras()pat*etic S(ste) < Inhi&its cell and organ function. The
$aras"m$athetic s"stem slows down heart rate' resumes digestion' and
increases rela#ation throughout the &od". This rest and digest res$onse
counteracts the fight or flight res$onse and hel$s the &od" recu$erate after a
crisis is o!er. A $ersonAs normal resting heart rate is determined &" the
$aras"m$athetic s"stem. If &lood $ressure is too high or &lood car&on dio#ide
le!els are too low' this s"stem slows the heart down and lowers its out$ut.
NEU?/BUSCU0A? SCSTEB
The com&ination of the ner!ous s"stem and the muscles' working together to
$ermit mo!ement' is known as the neuromuscular s"stem. Neuromuscular
disorders include motor neuron diseases' neuro$athies and muscular d"stro$hies.
The brain controls the mo!ements of skeletal =!oluntar"> muscles !ia
s$ecialised ner!es.
Neurons send signals to other cells as electrochemical wa!es tra!elling along
thin fi&res called a#ons' which cause chemicals called neurotransmitters to &e
released at unctions called s"na$ses. A cell that recei!es a s"na$tic signal ma" &e
e#cited' inhi&ited' or otherwise modulated. Sensor" neurons are acti!ated &"
$h"sical stimuli im$inging on them' and send signals that inform the central
ner!ous s"stem of the state of the &od" and the e#ternal en!ironment. Botor
neurons' situated either in the central ner!ous s"stem or in $eri$heral ganglia'
connect the ner!ous s"stem to muscles or other effector organs. Central neurons'
which in !erte&rates greatl" outnum&er the other t"$es' make all of their in$ut and
5
out$ut connections with other neurons. The interactions of all these t"$es of
neurons form neural circuits that generate an organismAs $erce$tion of the world
and determine its &eha!ior. Along with neurons' the ner!ous s"stem contains other
s$eciali%ed cells called glial cells =or sim$l" glia>' which $ro!ide structural and
meta&olic su$$ort.
If "ou want to mo!e $art of "our &od"' a message is sent to
$articular neurons =nerve cells>' called u$$er motor neurons.
U$$er motor neurons ha!e long tails =axons> that go into and
through the &rain' and into the s$inal cord' where the"
connect with lower motor neurons. At the s$inal cord' the
lower motor neurons in the s$inal cord send their a#ons !ia
ner!es in the arms and legs directl" to the muscle the"
control.
A t"$ical muscle is ser!iced &" an"where &etween D2 and *22 =or more> lower
motor neurons. Each lower motor neuron is su&di!ided into man" tin" &ranches.
The ti$ of each &ranch is called a $res"na$tic terminal. This connection &etween the
ti$ of the ner!e and the muscle is also called the neuromuscular unction.
The electrical signal from the &rain tra!els down the ner!es and $rom$ts the
release of the chemical acet"lcholine from the $res"na$tic terminals. This chemical
is $icked u$ &" s$ecial sensors =rece$tors> in the muscle tissue. If enough rece$tors
are stimulated &" acet"lcholine' "our muscles will contract.
./ital Infor)ation.
Na)e: Br. E.8.
,
!e: .,
Se0: Bale
!ddress: (ulangan 3ilar' Ca$i%
Civil Stat"s: Barried
Reliion: ?oman Catholic
Occ"pation: Eish$ond o$erator
Date and Ti)e !d)itted: Fune D' *2+2@ ++;D2 am
1ard: SC0 )*,
C*ief Co)plaint: (ifficult" of swallowing
2inal Dianosis: Tetanus Stage )@As$iration 3neumonia' G3N Stage I
!ttendin %*(sician: (r. ?. G
C'INIC!' !SS3SS#3NT
N"rsin &istor(
/ne week &efore admission' $atient e#$erience a massi!e toothache
and was relief &" $ain relie!ers. Ge did not &other to ask for consultation
&ecause he &elie!es that it will su&sides in due time. - da"s after ac9uiring
the dental $ro&lem' he com$lained of difficult" in swallowing foods. The
$atient and famil" disregard to seek consultation not until the" thought that
Br. E8 was ha!ing a mild stroke. Ge was !er" weak and was una&le to o$en
his mouth. Ge can no longer eat foods' and his famil" are scared for his
health thus the" $rom$ted for admission in Fune .' *2+2.
%ast &ealt* %roble)
Br. E.8. has no histor" of $ast hos$itali%ation. Sometimes he
e#$erienced mild fe!er' coughs' and cold &ut managea&le and treated with
o!er the counter drugs like $aracetamol and solmu#. Ge has no known
allergies to food' drugs and animals.
2a)il( &istor(
Gis father died &ecause of old age and his mother died of $ulmonar"
infection. /n the other hand' his elder sister is known to &e h"$ertensi!e and
the second si&ling has goiter.
2!#I'$ G3NOGR!#
-
%.B.
.l& age
A.B.
Pul%on
ay
infectio
n
C.B.
85
/P!
*.B.
80
0oite
%.B.
+eanus
B
'eends

2e)ale #ale %atient Deat*
%atterns of 2"nctionin
%attern &o)e &ospitali4ation
8
+reat*in %attern No res$irator" $ro&lems. Gas
ne!er com$lained of an"
&reathing difficult".
?es$irator" rates &ecame
ra$id' shallow &reaths are
noted. (ifficult" of &reathing
is alwa"s claimed.
Circ"lation Claimed to ne!er &een had a
83 check5u$ &efore
hos$itali%ation.
The a!erage 83 is +-26+22
mmGg during hos$ital sta".
Sleepin %attern Usuall" slee$s at H $m and
wakes u$ at D am. ,5+2 hour
slee$ duration. Uses two
$illow and comforter
Slee$s at +2 $m and wakes
u$ at 4 am. Uses one $illow
and &lanket. (istur&ed slee$
is usuall" com$lained
whene!er e#cessi!e stimuli
is o&ser!ed.
Drinkin %attern Usuall" drinks ,5+2 glasses
of water a da".
Iith NGT' cannot tolerate to
drink water &ecause of lock
aw.
3atin %attern Eats three times a da". Ge
eats more car&oh"drate'
!egeta&les and ade9uate
$rotein. Br. E.8 isn:t fond of
using eating utensils since he
is sta"ing on his $ond' he
eats using his &are hands.
Ge was &een on $arenteral
feeding and has NGT u$on
admission. An /TE +422
calories is di!ided into 4
e9ual feedings e!er"da".
3li)ination
%atterns
a5 +owel
(efecates once dail" in
ade9uate amount' golden
&rown in color.
(efecates for a&out *5)
times a week.
b5 Urination Urinates normall"
a$$ro#imatel" )5D# a da" in
an ade9uate amount.
Iith urinar" incontinence' a
week after his first
admission' he onl" $asses
-2 cc of urine. Ge was then
inserted with fole" catheter
attached to uro&ag with an
ade9uate amount' "ellowish
in color.
%ersonal *(iene
Gis dail" o& as a $ond
o$erator re9uires a dirt" and
hea!" tasks. Takes a &ath
dail" &ut isn:t fond of
&rushing his teeth.
Borning care done with oral
care of &actedol. Using
cotton and tongue
de$ressor.
1
Recreational and
30ercise
Gis walks from house to the
fish $ond which took almost
)2 mins. is what the"
considered to &e his dail"
e#ercise. Ge drinks alcohol
and $la" tong5its with his
friends.
No recreational acti!ities.
Cannot tolerate to stand or
sit. 3assi!e ?/B e#ercises
done.
+rief Social6 C"lt"ral and Reliio"s +ackro"nd
a5 3d"cational +ackro"nd
E.8. finishes his elementar" education in (ulangan Elementar" School
and his secondar" education reaches u$ to )
rd
"ear in (ulangan National Gigh
School. Ge ne!er had the chance to stud" in college &ecause of financial
constraints.
b5 Occ"pation
Ge is a fulltime fish$ond o$erator' who manages their own famil":s
fish$ond. Ge s$ends most of his time on his $ond which was *2 mins. awa"
from their residence.
c5 Reliio"s %ractice
Br. E.8 is a ?oman Catholic. Ge does not attend Sunda" mass
regularl" since he is usuall" at his fish$ond' &ut his famil" claims that he
alwa"s $ra".
d5 3cono)ic Stat"s
Br. E.8 &elongs to a middle class grou$' he has no fi# economic
income for the" onl" had a 9uarterl" har!est. 8ut the" claim that it was
enough to su$$ort the whole famil". Gis two daughters are also working
a&road which also hel$s them financiall".
Clinical Inspection
75 /ital sins
TJ),.*
o
C CR8 +2- &$m
+%J +-26+22 mmGg RR8 )2 &$m
). &ei*t 8 4:+
*. 1ei*t8 ,, kg
%&$SIC!' !SS3SS#3NT
(0
General !ppearance
Br. E.8.' .4 "ear5old male' with $oor $osture and gait.
Ge is l"ing on &ed on a semi5 fowlers $osition. Ge is
lethargic and irrita&le. Ge cannot res$ond to 9uestions
well and is not well oriented. Bainline I7E; 3NSS +0 is
attached at the left &asilic !ein running at *2 cc6hr.
Urinar" catheter is well attached in the urethra with
uro&ag in $lace. /* at - 03B !ia nasal cannula is in
$lace. No edema noted.
Skin
&air
Nails
Skin is &rown in com$le#ion' warm' and dr" with $oor
skin turgor. No $allor and edema.
Gas a short &lack hair mi#ed with gra" ones' well
distri&uted. No $resence of flakes' lice or lesions noted.
Nails are short and clean. Are $ink in color and slightl"
cur!ed with smooth and rounded edges. No clu&&ing of
fingers noted.
&ead
2ace
Gead is normoce$halic' no $al$a&le nodules or masses
noted. lesions are not noted.
Eace is wrinkled due to old age. =K> Eacial grimace and
locking of aw noted.
3(es
3ars
Nose
#o"t*
Anicteric sclerae with $u$ils round and &lack in color
which constricts from -mm5*mm. Gas &risk reaction to
light. No cataract noted. Slightl" $ale conuncti!a noted.
To$ of $inna is aligned with the outer corners of &oth
e"es@ si%e is normal and e9ual@ similar in color to face@
=5> discharges and swelling' with $oor acuit" to whis$er
!oice. Cerumen not noted.
Iith $resence of cilia. Gas no discharges nor sinusitis.
Nasal cannula attached to &oth nostrils at -03B. NGT is
attached =0>.
0i$s are dr" with cracking and slightl" $ale oral mucosa
was noted. Iith no inflammation of tonsils. Gas $oor
dention' with &leeding gum and halitosis.
Neck
+reast
Upper 30tre)ities
(istention of ugular !ein noted.
8reast are firm. No mass $al$ated.
8oth arms are weak. Can $erform $assi!e mo!ements
onl".
C*est
?es$irator" rate of *-5)- &reaths6min' shallow &reaths
in uniform rh"thm.
Respirator( S(ste) /ccasional cough noted with whitish s$utum.
Iith su$$lemental /* L -03B. Iell tolerated with /*
saturation ranging from H.5HH1.
Crackles is usuall" heard.
Cardiovasc"lar A$ical $ulse at the left midcla!icular line a!eraging at ,4
((
S(ste) &$m. Ski$ &eats not noted u$on auscultation.
Gastrointestinal
S(ste)
A&dominal $ain noted. Iith se!eral attem$ts of &owel
mo!ements.
Genito."rinar(
S(ste)
Urinar" catheter =Erench +-> intact on urethra and
attached to uro&ag.
3asses "ellow colored urine in minimal amounts.
#"sc"loskeletal
S(ste)
?estless at few times. Ga!e &een on sei%ure attacks.
Bo!ements are weak. Cannot tolerate standing. A&le to
sit on wheelchair. Iith weak handgri$.
G3N3R!' !%%R!IS!'
'!+OR!TOR$ R3SU'TS
Fune 2D' *2+2
()
Speec* S$eaks in nati!e language.
Ge $resentl" can not talk
due to illness.
'an"ae Can s$eak onl" Giliga"non
when he was still a&le to
talk.
&earin Gas $oor acuit" to
whis$ered !oice.
#ental stat"s Ge is lethargic and
irrita&le.
3)otional
Stat"s
Una&le to e#$ress
emotions.
%rotein #etabolites and 3lectrol(tes
Test Res"lts Nor)al /al"es
Sinificance of
!bnor)al Res"lt
Creatinine GI +4+., umol60
.+.2 < +)).2
umol60
Ba" &e due to
deh"dration.
Sodium 0/ +)-.D mmol60 +)..2 < +-D.2
mmol60
G"$onatremia ma"
result from
inade9uate sodium
intake or e#cessi!e
sodium loss due to
$rofuse sweating.
Fune 24' *2+2
'ipids and lipoproteins
Test Res"lts Nor)al /al"es
Sinificance of
!bnor)al Res"lt
Cholesterol
GI D.*+ mmol60
2.22 < D.*2
mmol60
Indicates
G"$ercholesterolemia
leading to
G"$ertension
(irect G(0C
0/ 2.,4 mmol60
+.22 < +.42
mmol60
Fune +4' *2+2
&e)atolo(
Test
Res"lts
Nor)al
/al"es
Sinificance of
!bnor)al Res"lt
Gematocrit
0/ 2.)+ !ol. =fr>
2.-* < 2.D*
0ow Gct suggest anemia'
or hemodilution
Gemoglo&in 0/ +2) g60 +)2.2
A decreased !alue of
hemoglo&in can &e caused
&" low red &lood cell count'
&" a lack of hemoglo&in in
the er"throc"tes' which
also indicates fluid
retention.
?ed 8lood Cell
Count
0/ ).4+ #
+2M+*60
-.* < D.- #
+2M+*60
Indicates fluid o!erload.
Ihite 8lood Cell
Count
GI ++.H #
+2MH60
- < +2 #
+2MH60
An ele!ated I8C count
indicates infection due to
traumati%ed tissue.
Segmenters GI 2.,4 2.D2 < 2.4D
An ele!ated !alue
=neutro$hilia> occurs in
res$onse to &acterial
infection.
Eosino$hils 2.2+ 2.2+ < 2.2- Normal
0"m$hoc"tes 0/ 2.2. 2.*D < 2.)2
A decreased !alue occurs
with im$aired l"m$hatic
drainage.
Bonoc"tes GI 2.24
2.2* < 2.2D
An ele!ated !alue occurs in
res$onse to infection.
3latelet
),2 # +2MH60
+-2 < -22 # Normal
(*
+2MH60
Fune +4' *2+2
Urinal(sis
Test Res"lts Nor)al /al"es
Sinificance of
!bnor)al Res"lt
Color
3ale straw
Straw to dark
"ellow Normal
Trans$arenc" Ga%" clear
?eaction $G 4.2 -.D < ,.2
S$. Gra!it" +.2*2 +.22) < +.2)2
3rotein trace negati!e 3rotein in the urine
=$roteinuria> ma"
indicate
h"$ertension.
Glucose negati!e negati!e
Normal
Amor$h. U63 few
?8C 6 h$f GI ++ < *2 6 h$f 2 < ) 6 h$f Indicates &leeding
I8C 6 h$f * 5. 6 h$f 2 < D 6 h$f
Normal E$ithelial Cells /ccassional None
8acteria Boderate None
Ceast cells man" None
Fune ,'*2+2
T%S!,)ini./ID!S-
7I(AS T3SA is intended for use with a 7I(AS =7ITEN Immuno(iagnostic Assa" S"stem> instrument as
an automated en%"me5linked fluorescent immunoassa" =E0EA> for the 9uantitati!e measurement of
total $rostate s$ecific antigen in human serum. The 7I(AS T3SA assa" is indicated as an aid in the
management of $atients with $rostate cancer and as an aid in the detection of $rostate cancer in
conunction with digital rectal e#amination =(?E> in men age D2 "ears or older. 3rostate &io$s" is
re9uired for diagnosis of $rostate cancer.
(+
Test
Res"lts Nor)al /al"es
Sinificance
of !bnor)al
Res"lt
T3SA 95:7);)l
normal; 25
)..*mg6ml
Increased
result shows
$rostatic
im$airment
Fune .'*2+2
CT SC!N Cranial %law
(5
Test
I)pression
Ne"rocrani")
3lain a#ial tomogra$h" section of the head shows no
definite focal $arendr"mal lesions or an" a&normal
h"$erdense collection.
The midline structures are undis$laced with the
interhemis$heric fissure centered on the midline.
The cere&rum shows slightl" widened cortical
sulcation.
The cere&ral !entricles are $rominent.
There are no signs of increased intracranial
$ressure.
The $osterior fossa' &rainstem and sellar region
a$$ear normal.
The $etromastoids' &on" cal!anium and included
or&its or $aranasal sinuses are unremarka&le.
INT3R%R3T!TION:
Cere&ral Atro$hic Changes.
Fune +.'*2+2
C&3ST <.R!$
I)pression
8ilateral $neumonia with $rogression in
the left.
0eft $leural effusion.
8ronchiectasis right lung &ase.
Atheromatous and tortuous aorta.
(e#troscoliosis' thoracic s$ine.
(,
#3DIC!TIONS
N!#3 O2 DRUG
and DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
O)epra4ole
*2mg + ta& 8I(
+rand Na)e:
3rosec
Su$$resses gastric
acid secretion &"
s$ecific inhi&ition of
the h"drogen5
$otassium AT3ase
en%"me s"stem at the
secretor" surface of
the gastric $arietal
cells@ &locks the final
ste$ of acid
$roduction.
GE?(' fre9uent
heart&urn.
+. Geadache
*. Nausea
). 7omiting
-. (iarrhea
D. Consti$ation
4. A&dominal 3ain
.. Elatulence
,. (r" mouth
G"$ersensiti!it" to
ome$ra%ole and its
com$onents.
+.Administer drug &efore
meal is ser!e.
). Bonitor for an" urinar"
elimination such as $ain
or discomfort associated
with urination.
*. If se!ere diarrhea is
o&ser!ed' drug ma"
need to &e
discontinued.
!CTION
Antisecretor" drug
3roton 3um$
Inhi&itor
(-
N!#3 O2 DRUG and
DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
#o0iflo0acin
-22mg +ta& /(
+rand Na)e:
A!elo#
8actericidal@
interferes with (NA
re$lication' re$air'
transcri$tion' and
recom&ination in
susce$ti&le gram5
negati!e and gram5
$ositi!e &acteria'
$re!enting cell
re$roduction and
leading to cell death.
Treatment of
Infection caused
&" anaero&ic
&acteria.
+. Geadache
*. Insomnia
). Nausea
-. (iarrhea
Contraindicated with
allerg" to
fluoro9uinolones'
$rolonged OT inter!al'
h"$okalemia.
+. Continue thera$" as
indicated for condition
&eing treated.
*. Administer oral drug -
hr &efore or at least ,
hr after antacids or
other anion5containing
drugs.
). (o not change dosage
when switching from I7
to oral dose.
!CTION
Anti&iotic
Eluoro9uinolone
(8
N!#3 O2 DRUG
and DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
Solfenacin
Dmg +ta&
+rand Na)e:
7ESIcare
Counteracts smooth
muscle s$asm of the
urinar" tract &"
rela#ing the detrusor
and other smooth
muscle through the
action at the
muscarinic
$aras"m$athetic
rece$tors.
Treatment of
o!eracti!e
&ladder with
s"m$toms of
urge urinar"
incontinence'
urgenc"' and
urinar"
fre9uenc".
+. (r" mouth
*. Consti$ation
). Urinar" retention
Contraindicated with
allerg" to drug or an"
com$onent of the drug'
se!ere he$atic
im$airment' urine
retention' gastric
retention' uncontrolled
narrow5angle glaucoma.
+. 3ro!ide fre9uent
small meals if GI
u$set occurs.
*. Esta&lish &owel
$rogram if
consti$ation is a
$ro&lem.
). Esta&lish $recautions
if CNS effects occur.
-. Beasure $ost5!oid
residual urine
!olume if $atient
has difficult" in
!oiding.
!CTION
Buscarinic rece$tor
entagonist
Urinar"
antis$asmodic
(1
N!#3 O2 DRUG
and DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
Ta)s"losin
*D2 mg
8I(
+rand Na)e:
Garnal
8locks the smooth
muscle al$ha+5
adrenergic rece$tors
in the $rostate'
$rostatic ca$sule'
$rostatic urethra'
&ladder neck' leading
to rela#ation' of the
&ladder' and
$rostate' and
im$ro!ing the flow of
urine in cases of 83G.
Adunct in
managing
urethral stones.
+. Somnolence
*. Insomnia
). /rthostatic
h"$otension
-. A&normal
eaculation
D. (ecreased li&ido
G"$ersensiti!it" to
tamsulosin' $rostate
cancer' $regnanc".
+. Administer once a da"'
)2 minutes after the
same meal each da".
*. Bonitor $atient carefull"
for orthostatic
h"$otension@ di%%iness'
and s"nco$e is high with
the first dose. Esta&lish
safet" $recautions as
a$$ro$riate.
!CTION
Al$ha adrenergic
&locker =$eri$heral
acting>
)0
N!#3 O2 DRUG and
DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
'act"lose
*2cc until 8B occurs
9,hours
+rand Na)e:
0actulose
The drug $asses
unchanged into colon
where &acteria &reak
it down to organic
acids that increase
the osmotic $ressure
in the colon and
slightl" acidif" the
colonic contents'
resulting in an
increase in stool
water content' stool
softening' and
la#ati!e action. This
also results in
migration of &lood
ammonia into the
colon contents with
su&se9uent tra$$ing
and e#$ulsion of the
feces.
Treatment of
consti$ation.
+. Transient
flatulence
*. (istention
). Intestinal cram$s
-. 8elching
D. (iarrhea
4. Nausea
Contraindicated with
allerg" to lactulose' low5
galactose diet.
+. (o not administer other
la#ati!e while using
lactulose.
*. Bonitor serum ammonia
le!els.
). Carefull" monitor &lood
glucose le!els in dia&etic
$atients.
!CTION

Ammonia reaction
drug
0a#ati!e
N!#3 O2 DRUG and
DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
)(
Tetan"s I))"ne
Glob"lin
*D26am$ -am$s
dee$ IB =stat>
+rand Na)e:
Tetanus immune
glo&ulin
Su$$lies $assi!e
immunit" to those
indi!iduals who ha!e
low or no immunit" to
the to#in $roduced &"
the tetanus
organism' Clostridium
tetani. The anti&odies
act to neutrali%e the
free form of the
$owerful e#oto#in
$roduced &" this
&acterium
Is indicated for
$ro$h"la#is
against tetanus
following inur"
in $atients
whose
immuni%ation is
incom$lete or
uncertain. It is
also indicated'
although
e!idence of
effecti!eness is
limited' in the
regimen of
treatment of
acti!e cases of
tetanus.
+. Tenderness
*. Buscle stiffness
at inection site
). Urticaria
-. Angioedema
D. Ee!er
4. Chills
.. Chest tightness
,. 3reci$itous fall
in 83
Contraindicated to
$atients with a histor" of
$rior s"stemic allergic
reactions following the
administration of human
immunoglo&ulin
$re$arations' and
se!ere
throm&oc"to$enia or
an" coagulation disorder
that would
contraindicate
intramuscular inections.
+. (o not administer to
$atients with histor" of
allerg" to gamma
glo&ulin or anti
immunoglo&ulin A
anti&odies.
*. Administer * weeks
&efore or ) months after
immune glo&ulin
administration &ecause
anti&odies in the
glo&ulin $re$aration ma"
interfere with the
immune res$onse to the
!accination.
). (o not mi# glo&ulin
with an" other
medications.
-. Bonitor $atient:s !ital
signs continuousl" and
o&ser!e for an"
s"m$toms during IB
!CTION
Immune glo&ulin
))
administration.
D. 3ro!ide comfort
measures or teach
$atient to $ro!ide
comfort measures to
hel$ $atient to co$e with
the discomforts of drug
thera$".
N!#3 O2 DRUG
and DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
)*
Tra)adol
D2mg I7 9, 3?N for
se!ere $ain
+rand Na)e:
Tramal
Treats moderate to
moderatel" se!ere
$ain and most t"$es
of neuralgia'
including trigeminal
neuralgia.
Treatment of
acute to chronic
$ain.
+. Nausea
*. 7omiting
). Sweating
-. Consti$ation
D. (rowsiness
4. ?es$irator"
de$ression
Acute into#ication with
alcohol h"$notics'
analgesics or
$s"chotro$ic' narcotic
withdrawal treatment.
+. (o not take more
medication as a single
dose or take more
doses $er da" than
$rescri&ed &" the
doctor.
). Store this medicine at
room tem$erature'
awa" from heat and
light.
*. (o not sto$ taking
Tramadol without
talking to the doctor
!CTION
Analgesic
u5o$iod
rece$tor antagonist
N!#3 O2 DRUG
and DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
)+
%en G
- mullion 94 ANST
!ia soluset =,5*>
+rand Na)e:
3en G
Inhi&its en%"mes
res$onsi&le for cell
wall s"nthesis of
susce$ti&le
organisms. This
creates an
osmoticall"
unsta&le cell wall
that swells and
&ursts from osmotic
$ressure.
3enicillin G is
reser!ed for
se!ere
infections.
+. Nausea
*. 7omiting
). (iarrhea
-. A&dominal $ain
D. Colitis
4. Anore#ia
-. G"$ersensiti!it"
8. Neuroto#icit"
1. Urticaria'
Su$erinfection
3atients with known
allergies to $enicillin and
h"$ersensiti!it" to
ce$halos$orins
+. Ga!e a anti&iotic
skin test done &efore
gi!ing dose to ensure
h"$ersensiti!it"
reactions.
*. Gi!e &" IB route
onl".
). Continue thera$" for
at least * da"s after
infection has
disa$$eared' usuall" .5
+2 da"s.
-. Use the smallest dose
$ossi&le for IB inection
to a!oid $ain and
discomfort.
!CTION
Anti&iotic
N!#3 O2 DRUG
and DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
)5
#etronida4ole6
D22mg ' I7 9, hrs.
+rand Na)e:
Elag"l
8actericidal; inhi&its
(NA s"nthesis in
s$ecific anaero&es'
causing cell death.
Treatment of
&acterial
infection
=a drug of choice
for Tetanus>
+. Geadache
*. (i%%iness
). Ata#ia
-. 7ertigo
D. Insomnia
4. Eatigue
.. Incontinence
,. GI u$set

Contraindicated with
h"$ersensiti!it" to
metronida%ole@ use
cautiousl" with CNS
disease' he$atic
disease' candidiasis'
&lood d"scrasias.
+. A!oid use unless
needed.
Betronida%ole ma" &e
carcinogenic.
*. ?educe dosage in
he$atic disease.
!CTION
Anti$roto%oal
N!#3 O2 DRUG and
DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
),
Tel)isartan
-2mg6+*.D' I ta& /(
+rand Na)e:
Bicardis
Selecti!el" &locks the
&inding of angiotensin
II to s$ecific tissue
rece$tors found in the
!ascular smooth
muscle and adrenal
gland.
Treatment of
h"$ertension'
alone or in
com&ination with
other
h"$ertensi!es.
+. (i%%iness
*. Geadache
). nausea
-. !omiting
D. diarrhea
Contraindicated with
h"$ersensiti!it" to
telmisartan.
Use cautiousl" with he$atic
or &iliar" im$airment'
h"$o!olemia.
+. Bonitor heart rate
&elow normal le!el
&efore gi!ing drug.
*. Check effecti!it" of
the drug. Closel"
monitor 83 and heart
rate.
!CTION
Angiotensin II
rece$tor antagonist
Antih"$ertensi!e
N!#3 O2 DRUG and
DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
)-
Dia4epa)
Dmg I7 9,
Acts mainl" at the
lim&ic s"stem and
reticular formation@
mat act in s$inal cord
to $roduce skeletal
muscle rela#ation@
$otentiates the
effects of GA8A' an
inhi&itor"
neurotransmitter.
PBuscle rela#ant;
Adunct for relief
of refle# skeletal
muscle s$asm
due to local
$atholog" or
secondar" to
trauma@
s$asticit" caused
&" u$$er
motoneuron
disorders
P3arenteral;
Treatment of
tetanus
+. (rowsiness
*. (i%%iness
). GI u$set
-. &rad"chardia

Contraindicated with
h"$ersensiti!it" to
&en%odia%e$ines@
$s"choses' acute narrow5
angle glaucoma' shock'
coma' acute alcoholic
into#ication.
Use cautiousl" with elderl"
or de&ilitated $atients@
im$aired li!er or renal
function@ and in $atients
with histor" of su&stance
a&use.
+. Bonitor heart rate
&efore gi!ing drug.
*. Closel" monitor 83.
!CTION
Antie$ile$tic@ An#iol"tic
Skeletal muscle
rela#ant =centrall"
acting>
N!#3 O2 DRUG
and DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
)8
!cet(lc(steine
422g6+ ta& in D2
diluent /(
+rand Na)e:
Eluimucil
Bucol"tic acti!it";
S$lits links in the
muco$roteins
contained in
res$irator" mucus
secretions'
decreasing the
!iscosit" of the
mucus.
Bucol"tic
adu!ant thera$"
for a&normal'
!iscid' or
ins$issated mucus
secretions in
acute and chronic
&roncho$ulmonar"
disease.
+. Increase
$roducti!it" of
cough
*. Nausea
). GI u$set.
Contraindicated with
h"$ersensiti!it" to
acet"lc"steine@ use
caution and discontinue
immediatel" if
&ronchos$asm occurs.
+. Ensure $ro$er
dilution of ta&let.
*. Bonitor heart rate
&efore gi!ing the
drug.
). Bonitor urine
out$ut.
!CTION
Bucol"tic
N!#3 O2 DRUG and
DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
)1
+isacod(l
Su$$ositor" + stick $er
rectum
+rand Na)e:
(ulcola#
The drug $asses
unchanged into the
colon where &acteria
&reaks it down to
organic acid that
increase the osmotic
$ressure in the colon
and slightl" acidif"
the colonic contents'
resulting in an
increase in stool
water content' stool
softening' la#ati!e
action.
Short term relief
of consti$ation
+. Sweating
*. Elushing
). muscle cram$s
-. e#cessi!e
thirst
Contraindicated in cases
of allerg" to these
drugs@ acute a&dominal
$ain.
+. (o not gi!e drug
within + hour of an"
other drugs.
*. ?e$ort sweating'
flushing' muscle
cram$s and
e#cessi!e thirst.
!CTION
0a#ati!e
N!#3 O2 DRUG and
DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
*0
%araceta)ol
D22mg +ta& 9- 3?N
?educes fe!er &"
acting directl" on the
h"$othalamic heat5
regulating center to
cause !asodilation
and sweating which
hel$s diss$ates heat.
?elief of mild to
moderatel"
se!ere $ain and
treatment for
fe!er
+. Nausea
*. GI u$set
). (i%%iness
Contraindicated to
$atients h"$ersensiti!e
to 3aracetamol
+. Gi!e drug with food if
GI u$set occurs.
*. (iscontinue drug if
h"$ersensiti!it"
reactions occur.
). Check for &od"
tem$erature.
!CTION
Anti$"retic
N!#3 O2 DRUG and
DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
*(
2"rose)ide
Dmg I7 now
Inhi&its rea&sor$tion
of the sodium and
chloride from the
$ro#imal and distal
tu&ules oral
ascending lim&
of the loo$ of Genle
leading to Sodium <
rich dieresis.
Treatment for
fluid retention.
+. (i%%iness
*. 7ertigo
). Ieakness
-. Geadache
D. (rowsiness
4. Eatigue
.. /rthostatic
G"$otension
,. Cardiac
Arrh"tmias
Allerg" to drug' Anuria'
Se!ere ?enal Eailure
+. Bonitor 8lood
$ressure for sudden
G"$otension
*. Bonitor the Intake
and /ut$ut.
!CTION
0oo$ (iuretic
N!#3 O2 DRUG
and DOS3
#3C&!NIS# O2
!CTION
INDIC!TION SID3 3223CTS CONTR!INDIC!TIONS NURSING
R3S%ONSI+I'ITI3S
*)
Dio0in
2.*D+ ta& /( =.am>
Increase intra cellular
calcium and allows
more calcium to enter
m"ocardial cell during
de$olari%ation
!ia sodium <
$otassium $um$
mechanism.
Indicated for
arrh"thmias'
a&normal heart
contractilit".
+. Arrh"thmias
*. Geadache
). Ieakness
-. (rowsiness
Allerg" to (igitalis
$re$aration. 7entricular
Tach"cardia' 7entricular
Ei&rilation' Geart
8lock' Sick Sinus
S"ndrome' Acute BI
). Bonitor heart rate
&elow normal le!el
&efore gi!ing drug.
-. Check effecti!it" of
the drug. Closel"
monitor 83 and heart
rate.
!CTION
Cardiac Gl"coside
**
T3<T+OOK DISCUSSION
%!T&O%&$SIO'OG$
T3T!NUS
Tetanus is an acute' often fatal disease
caused &" an e#oto#in $roduced in a wound
&" Clostridium tetani. Clostridium tetani is a
gram5$ositi!e' nonenca$sulated' motile'
o&ligati!el" anaero&ic &acillus. It e#ists in
!egetati!e and s$orulated forms. S$ores are
highl" resistant to disinfections &" chemical
or heat' &ut !egetati!e forms are susce$ti&le
to the &actericidal effect of heat' chemical
disinfectants' and a num&er of anti&iotics.
Clostridium tetani is a nonin!asi!e organism. It is found in soil and in the
intestine and feces of horses' shee$' cattle' dogs' cats' rats' guinea $igs and
chicken. Banure5treated soil ma" contain large num&ers of s$ores too.
Tetanus occurs after s$ores or !egetati!e &acteria gain access to tissues and
$roduce to#in locall". The usual mode of entr" is trough a $uncture wound or
laceration. Tetanus ma" also follow electi!e surger"' &urn wounds' otitis media'
dental infection' a&ortion and $regnanc". Neonatal tetanus usuall" follows infection
of the um&ilical stum$.
In the $resence of anaero&ic conditions' the s$ores germinate.
To#ins'including tetanol"sin =which $otentiates infection> and tetanos$asmin =a
$otent neuroto#in> are $roduced. Tetanos$asmin' often referred to as tetanus
to#in' causes clinical tetanus. The to#in $roduced is disseminated through the
&loodstream and l"m$hatic s"stem. Gowe!er' it does not enter the central ner!ous
s"stem through this route' as it cannot cross the &lood &rain &arrier e#ce$t at the
fourth !entricle. The to#in is e#clusi!el" taken u$ &" the neuromuscular unction'
where it migrates retrograde trans"na$ticall" at the rate .D5*D2mm6da"' a $rocess
which takes )5+- da"s' $rotected from neutrali%ing antito#in' $redominantl" to
inhi&itor" s"na$ses to $re!ent the release of acet"lcholine.
The to#in acts after the incu&ation $eriod =)5+-> da"s> at se!eral sites within
the central ner!ous s"stem' including $eri$heral motor end $lates' s$inal cord'
&rain and s"m$athetic ner!ous s"stem. The t"$ical clinical manifestations of
tetanus are caused when tetanus to#in interferes with release of neurotrasmitters'
&locking inhi&itor im$ulses.
*+
8lockade of s$inal inhi&ition is $roduced when the to#in acts at the s"na$se
of interneurons of inhi&itor" $athwa"s and motor neurons. General muscle rigidit"
arises from uninhi&ited afferent stimuli entering the central ner!ous s"stem from
the $eri$her". The effect of the to#in on the &rain is contro!ersial@ direct inoculation
can cause sei%ures.
/ne of the man" com$lications from tetanus is res$irator" failure secondar" to
s$asms' o&struction &" secretions' e#haustion and $ulmonar" as$iration.
Cardio!ascular com$lications thought to &e due to h"$eracti!it" of the s"m$athetic
ner!ous s"stem include tach"cardia' with heart rates o!er +,2 &eats $er minute'
se!ere !asoconstriction and h"$ertension. Autonomic d"sfunction is seen as
increased &asal s"m$athetic acti!it" and e$isodes of s"m$athetic o!er acti!it".
Tetan"s S()pto)s
In generali%ed tetanus' the initial com$laints ma" include an" of the
following;
Irrita&ilit"' muscle cram$s' sore muscles' weakness' or difficult"
swallowing are commonl" seen.
Eacial muscles are often affected first. Trismus or lockaw is most
common. This condition results from s$asms of the aw muscles that are
res$onsi&le for chewing. A sardonicsmile 55
medicall" termed risussardonicus 55 is a characteristic feature that results
from facial muscle s$asms.
Buscle s$asms are $rogressi!e and ma" include a characteristic
arching of the &ack known as o$isthotonus. Buscle s$asms ma" &e intense
enough to cause &ones to &reak and oints to dislocate.
Se!ere cases can in!ol!e s$asms of the !ocal cords or muscles
in!ol!ed in &reathing. If this ha$$ens' death is likel"' unless medical hel$
=mechanical !entilation with a res$irator> is readil" a!aila&le.
*5
Co)plications of Tetan"s
In cases of se!ere tetanus infection' a num&er of $ossi&le com$lications can
de!elo$
2ract"res
The re$eated muscle s$asms and con!ulsions that are caused &" a tetanus
infection ma" lead to fractures in the !erte&rae =&ones in the &ack>' as well
as in other &ones. 8one fractures can sometimes result in a condition called
m"ositis ossificans circumscri$ta' which is where &one &egins to form in the
soft tissues' often around a oint.
*,
Sins and s()pto)s in t*e
te0tbook
Sins and s()pto)s
)anifested b( t*e
patient
Irrita&ilit"6 ?estlessness
muscle cram$s
Ieakness
difficult" swallowing
0ockaw
Stiffness
?efle# s$asms
8lood $ressure
tem$erature
Irregular heart &eat
Sweating
Sei%ure
!spiration pne")onia
If "ou ha!e a tetanus infection' muscle rigidit" =stiffness> can make coughing
and swallowing difficult. This can cause as$iration $neumonia to de!elo$.
As$iration $neumonia occurs as a result of inhaling the secretions' or
contents' of the stomach' which can lead to a lower res$irator" tract
infection.
'ar(nospas)
0ar"ngos$asm is where the lar"n# =!oice&o#> goes into a &rief' tem$orar"
s$asm that usuall" lasts for &etween )2542 seconds. 0ar"ngos$asm $re!ents
o#"gen from reaching "our lungs' making &reathing difficult.
Tetanic sei4"res
Tetanic sei%ures are con!ulsions =fits> that are similar to e$ile$tic fits. The"
can occur in se!ere cases of tetanus where the infection has s$read to the
&rain. Someone with a se!ere tetanus infection ma" e#$erience se!ere and
fre9uent tetanic sei%ures.
%"l)onar( e)bolis)
A $ulmonar" em&olism is a serious and $otentiall" life5threatening condition.
It is caused &" a &lockage in a &lood !essel in the lungs that can affect
&reathing and circulation. It is therefore !ital that treatment is gi!en
immediatel" in the form of anti5clotting medication and' if re9uired' o#"gen
thera$".
!c"te renal fail"re
The se!ere muscle s$asms that are associated with a tetanus infection can
cause a condition that is known as rha&dom"ol"sis. ?ha&dom"ol"sis is where
the skeletal muscles are ra$idl" destro"ed' resulting in m"oglo&in =a muscle
$rotein> leaking into the urine. This can lead to acute =se!ere> renal failure
=kidne" failure>.
%reventin tetan"s
Immunisation is the &est wa" to $re!ent a tetanus infection from occurring.
The com$lete course of the tetanus !accination consists of fi!e doses. The
!accine ena&les "our &od" to create anti&odies against the tetanus to#in
=tetanos$asmin>' $ro!iding $rotection from the illness should "ou &e e#$osed
to the Clostridium tetani &acterium in the future.
*-
%at*op*(siolo(

QPatient centeredR
*8
+,+A)-$
Clostridium tetani entes $o&y though
a 2oun&
Anaeo$ic con&itions allo2 ge%ination of spoes
an& po&uction of toxins
"oxins ae po&uce& an& &isse%inate& 3ia $loo& an&
ly%phatics
Tetanospasmin entes the ne3ous syste% peipheally at the
%yeoneual 4unction an& is tanspote& centipetally into
neuons of C!S
5ntefes 2ith neuotans%itte elease to $loc6 inhi$itos
7ea&s to unoppose& %uscle contaction an& spas%
7oc64a2 8BP
Stiffness 8te%peatue
!ec6 igi&ity s2eating
9ysphagia SE5:#RE causing
Restlessness
opisthotonos
Reflex spas%s
Age
Sex
7ifestyle
9ental infection


As$iration 3neumonia
G"$ertension
*1
CONC3%T #!%
+0
5%paie& physical
%o$ility ;t
neuo%uscula
i%pai%ent
.
9istu$e& sleep
patten ;t excessi3e
en3ion%ental
sti%uli
/
#inay
incontinence ;t
$la&&e outlet
o$stuction
0
Altee&
the%oegulation'
/ypethe%ia ;t
tissue tau%a )
o

pesence of C. tetani
1
5%paie&
s2allo2ing ;t
phayngeal
%uscle spas%
2
Acute pain ;t
%uscle igi&ity )
o
unoppose& %uscle
contaction
1
5neffecti3e
$eathing patten ;t
i%paie& lung
%uscle contaction
3
5neffecti3e ai2ay
cleaance ;t
etaine& an&
excessi3e
secetions
4
Cc' 9ifficulty of
s2allo2ing
9x' +eanus
sa!e 3
NURSING C!R3 %'!N
+(
+)
!SS3SS#3NT
NURSING
DI!GNOSIS
%'!NNING INT3R/3NTION R!TION!'3
NURSING
T&3OR$
3/!'U!TION
Subjective
Gatiskog naman siya
kung makibot o
masilawan as
!er&ali%ed.
Objectives:
??J )2&$m
83J +-26+22
mmGg
=K> Eacial grimace
=K> Guarding
=K> dia$horesis
=K> lockaw
=K>muscle s$asm
=K>$eriodontal
infection
=K>h"$ere#tension
of head
Acute $ain r6t
muscle rigidit" *
o
uno$$osed
muscle
contraction
After nursing
inter!entions' will
demonstrate a
reduction in $ain
&eha!iors such as
a&sence of facial
grimace and
guarding.
Independent:
(. Gandled the
client:s &od"
gentl" while
doing nursing
acti!it".
). Binimi%e
mo!ement and
dimmed light
$ro!ided.
). Baintained side
rail u$.
Depedent :
(. Administered
Tramadol D2 mg
I7 as ordered
*. (ia%e$am Dmg
intra!enousl"
gi!en as ordered.
*. Betronida%ole'
D22mg ' gi!en
To $romote
safet" and
allows
e#$erience less
$ain during care
acti!it".
To $romote rest
and a!oid
e#citation of
neurons leading
to muscle
contractions.
To ensure safet"
when sei%ure
and muscle
rigidit" occurs.
Treats moderate
to moderatel"
se!ere $ain
It is a muscle
rela#ant. That
hel$s reduce
muscle
contractions
causing $ain.
Treatment of
&acterial
infection caused
0"dia Gall:s
Care Core
Cure
Elorence
Nightingale:s
!nvironment
"#eory
Elorence
Nightingale:s
!nvironment
"#eory
Ernestine
Ieiden&ach:s
Prescriptive
"#eory
Ernestine
Ieiden&ach:s
Prescriptive
"#eory
Ernestine
Ieiden&ach:s
Goal was
)et5
=5> guarding
&eha!ior
+*
++
!SS3SS#3NT
NURSING
DI!GNOSIS
%'!NNING INT3R/3NTION R!TION!'3
NURSING
T&3OR$
3/!'U!TION
Sub jective:
Ginabudlayan
siya mag gin#awa$
as !er&ali%ed &"
the folks.
Objectives:
??J)2 &$m
A?J+*2&$m
=K> crackles
=K>$roducti!e
cough
=K>restlessness
=K> drooling
=K> im$aired
swallowing
S5ra" results
shows 8ilateral
$neumonia and
&ronchiectasis
Ineffecti!e airwa"
clearance r6t
retained and
e#cessi!e
secretions
To maintain a
$atent airwa"
&e a&le to
demonstrate
effecti!e
coughing and
clear &reath
sounds.
Independent:
+. Suctioned
secretions as
needed.
*. Ele!ated head of
the &ed6 change
$osition e!er"
*hours
). Ne$t the
en!ironment
allergen free like
dust.
-. Encouraged dee$
&reathing and
coughing
e#ercise.
D. 3osition head
midline with
fle#ion.
Depedent :
+. Administered
To maintain
$atent airwa" and
$re!ent
as$iration.
To take
ad!antage of
gra!it"
decreasing
$ressure on the
dia$hragm and
enhancing
drainage.
3reci$itators of
allergic t"$e
res$irator"
reactions that can
trigger onset of
acute e$isodes.
To $romote
o#"genation and
ma#imi%e effort.
"o open o
%aintain open
ai2ay.
Is a mucol"tic
7irginia
Genderson:s
%asic Care
Component
Elorence
Nightingale:s
!nvironment
"#eory
Elorence
Nightingale:s
!nvironment
"#eory
7irginia
Genderson:s
%asic Care
Component
Elorence
Nightingale:s
!nvironment
"#eory
Ernestine
Goal was
partiall( )et5
?? decreased to *-
&$m &ut still with
crackles.
+5
+,
!SS3SS#3NT
NURSING
DI!GNOSIS
%'!NNING INT3R/3NTION R!TION!'3
NURSING
T&3OR$
3/!'U!TION
Sub jective:
Ginabudlayan siya
mag gin#awa$ as
!er&ali%ed &" the
folks.
Objectives:
??J)2 &$m
A?J+*2&$m
=K> 0a&ored
&reathing
=K>restlessness
=K> drooling
=K> im$aired
swallowing
=K> nasal flaring
S5ra" results
shows 8ilateral
$neumonia and
&ronchiectasis
Ineffecti!e
&reathing
$attern r6t
im$aired lung
muscle
contraction
To demonstate
a&ilit" to &reathe
comforta&l" as
e!idienced &"
normal res$irator"
rate of +45*2
&$m.
Independent:
+. Suctioned
secretions as
needed.
). Ele!ate head of
&ed6 $laced on
high &ack rest.
). Assisted in
taking control of
&reathing
Dependent:
+. Administered
o#"gen at -0$m
as ordered.
Collaborative:
*. Com&i!ent
ne&uli%ation
done &" $ulmo5
aide.
To maintain $atent
airwa" and $re!ent
as$iration.
Ele!ation of head
ma" decrease
d"s$neic e$isodes.
An u$right $osition
facilitates lung
e#$ansion.
It can &e a hel$ful
techni9ue in
ma#imi%ing
res$irator" function
/#"gen thera$"
hel$s decreased
d"s$nea.
Acts as
&ronchodilator to
$romote effecti!e
airwa" $assage &
0"dia Gall:s
Care Core
Cure
Elorence
Nightingale:s
!nvironment
"#eory
(orothea
/rem:s
Sel'(care
De'icit
Ernestine
Ieiden&ach:s
Prescriptive
"#eory
Ernestine
Ieiden&ach:s
Prescriptive
"#eory
Goal was
partiall(
)et5
?? lowered
down to *-
&$m.
+-
+8
!SS3SS#3NT
NURSING
DI!GNOSIS
%'!NNING INT3R/3NTION R!TION!'3
NURSING
T&3OR$
3/!'U!TION
Sub jective:
)abudlayan siya
magtulon $ as
!er&ali%ed &" the folks.
Objectives:
=K>lockaw
=K>restlessness
=K> drooling
=K> im$aired
swallowing
=K>h"$ere#tesion of
head
=K>gum &leeding
Im$aired
swallowing
related to
$har"ngeal
muscle s$asm
After nursing
inter!ention
$atient will
demonstrate
effecti!e
swallowing without
muscle straining.
D ependent:
+. Nasogastric tu&e
inserted &" ?/(
Ind ependent:
*. 3ro!ided meals in
a 9uiet
en!ironment awa"
from e#cessi!e
stimuli.
). Ga!e suction
e9ui$ment
a!aila&le during
feeding.
-. Ne$t with an
u$right $osition
for +Dmins to an
hour after meal.
5. Instructed famil"
how to monitor
and detect
as$iration after
eating.
To $ro!ide
$arenteral feeding
in ade9uate
amount.
The client can
achie!e a more
effecti!e swallow
&" focusing on
chewing and
mo!ing
foods6fluids to the
&ack of the mouth
where the
swallowing refle#
is triggered.
Eor as$iration
$recaution.
This $osition uses
gra!it" to aid in
the flow of
foods6fluids
through the
eso$hagus.
Eor the famil" to
&e aware for an"
situation so that
we can a!oid
as$iration e!en
when nurses are
not in their room
0"dia Gall:s
Care Core
Cure
Elorence
Nightingale:s
!nvironment
"#eory
7irginia
Genderson:s
%asic Care
Component
Elorence
Nightingale:s
!nvironment
"#eory
0"dia Gall:s
Care Core
Cure
Goal was
partiall(
)et5
A&le to o$en
his mouth.
+1
50
!SS3SS#3NT
NURSING
DI!GNOSIS
%'!NNING INT3R/3NTION R!TION!'3
NURSING
T&3OR$
3/!'U!TION
Sub jective:
Gina lagnat siya$
as !er&ali%ed &"
the folks.
Objectives:
TJ),.*
o
C
=K> &od"
weakness
=K>flushed and
warm skin
=K> sweating
=K> shi!ering
=K>
$eriodontal
trauma
I8CJ++.H #
+2MH60
Altered
thermoregulation;
G"$erthermia r6t
tissue trauma *
o
$resence of
C& tetani
To lower down
&od"
tem$erature to
)..D
o
C after *
hours of nursing
inter!entions.
Independent:
+. Te$id s$onge
&ath done.
*. ?oom:s
tem$erature
cooled down.
). 3ro!ided
thick5wool
&lanket to
$re!ent further
chills.
+. (immed the
light and
$ro!ided a
$eaceful
en!ironment for
rest. Binimi%ed
stimulus.
Depedent :
-. 3aracetamol D22
mg' + ta& gi!en
orall" as ordered.
D. Administered
Betronida%ole
D22 mg
intra!enousl" as
It lower down &od"
tem$erature.
A consistent
tem$erature limits
en!ironmental
effects on
thermoregulation
This will hel$
maintain a normal
&od" tem$erature
and $re!ents
shi!ering.
3romotes rest and
rela#ation ' and
$re!ents from
distur&ances.
Anti$"retic that
treats fe!er' &"
lowering down &od"
tem$.
An anti&iotic used
to treat infection
caused &" anaero&ic
C& tetani&
0"dia Gall:s
Care Core
Cure
Elorence
Nightingale:s
!nvironment
"#eory
Elorence
Nightingale:s
!nvironment
"#eory
Elorence
Nightingale:s
!nvironment
"#eory
Ernestine
Ieiden&ach:s
Prescriptive
"#eory
Ernestine
Ieiden&ach:s
Prescriptive
"#eory
Goal was
)et5
8od" tem$. is
)..)
o
C.
=5> Shi!ering
5(
5)
!SS3SS#3NT
NURSING
DI!GNOSIS
%'!NNING INT3R/3NTION R!TION!'3
NURSING
T&3OR$
3/!'U!TION
Objectives:
Urine !olume6fluid
out$utJ -2 cc
within , hours.
=K> &od"
weakness
=K> muscle rigidit"
CreatinineJ GI
+4+., umol60
T3SAJ..)+mg6ml
Urinar"
incontinence
r6t &ladder
outlet
o&struction
After nursing
interventions,
will void urine
volume of at
least 30 cc
every hour.
D ependent:
+. Eole" Catheter
inserted as ordered.
). Administered
Tamsulosin *2cc
intra!enousl" as
$rescri&ed.
*. Solfenacin Dmg
+ta& gi!en !ia NGT
as ordered.
Independent:
+. Im$lement
measures to ensure
the $atenc" =e.g.
kee$ tu&ing free of
kinks' kee$
collection &ag &elow
&ladder le!el>
). Encourage fluid
intake in small
amount fre9uentl".
). 3ro!ide an
en!ironment that
encourages
To $romote ade9uate
urine elimination.
Gel$s to manage
urethral stones and
im$ro!es the flow of
urine
Smoothen urethral
muscle and relie!ed
s"m$toms of urge
urinar" incontinence
Baintaining $atenc"
of the indwelling
catheter $re!ents
urinar" incontinence
(rinking a large
amount of fluid at one
time results in ra$id
filling of the &ladder
which increases
$ressure in the
&ladder and the
su&se9uent risk of
incontinence
En!ironmental factors
ma" contri&ute to
functional
7irginia
Genderson:s
%asic
Component
Ernestine
Ieiden&ach:s
Prescriptive
"#eory
Ernestine
Ieiden&ach:s
Prescriptive
"#eory
Florence
Nightingales
Environmental
Theory
0"dia Gall:s
Care Core
Cure
Florence
Nightingales
Environmental
Goal was
)et5
Urine
out$utJ)22 cc
after , hours
5*
5+
!SS3SS#3NT
NURSING
DI!GNOSIS
%'!NNING INT3R/3NTION R!TION!'3
NURSING
T&3OR$
3/!'U!TION
Sub jective:
*adali siya
makibot sa
gasulod ga tiskog
naman siya #indi
siya katulog $ as
!er&ali%ed &" the
folks.
Objectives:
=K> too much
!isitors
=K> distur&ed
slee$
=K> Ieakness
=K> 0ethargic
=K> Irrita&le
=K>
h"$ere#tension
of head
=K> &od"
stiffness
(istur&ed slee$
$attern r6t
e#cessi!e
en!ironmental
stimuli
After nursing
inter!entions'
will a&le to ha!e
undistur&ed
slee$ with long
inter!als.
Independent:
+. Nee$ en!ironment
9uiet for slee$ing'
eliminate noise.
*. 3erform nursing
$rocedures all at
the same time if
$ossi&le &efore
$atient to go to
slee$.
). Adusted lighting &"
dimming the lights.
Dependent:
(. Administered
(ia%e$am D2mg
intra!enousl"
3ro!ides more
rela#ing and
comforta&le
en!ironment for
slee$ing.
?educes distur&ances
in slee$ing.
0ight ma" alter or
distur& $atient:s
slee$.
Acts as muscle
rela#ant and an
an#iol"tic.
Florence
Nightingales
Environmental
Theory
7irginia
Genderson:s
%asic
Component
Florence
Nightingales
Environmental
Theory
Ernestine
Ieiden&ach:s
Prescriptive
"#eory
Goal was
)et5
Sle$t at long
inter!als
undistur&ed.
Disc*are %lannin
Br. E.8:s famil" decided to go home e!en though he was not in good
condition' and the" ha!e signed a (ABA5 (ischarged Against Bedical Ad!ice.
Ne!ertheless the following discharge $lanning was formulated;
#3DIC!TIONS
The following medications must &e com$l";
5Betronida%ole D22mg + ta& 9, =+2am < 4$m < *am>
5Acet"lc"steine =Eluimucil>> 422g 6 + ta& in D2cc /(
5Telmisartan =Bicardis> -2mg + ta& /(
5Tramadol D2mg + ta& 9- 3?N for se!er $ain
5/me$ara%ol =3rosec> *2mg 6 + ta& 8I(
5(igo#in 2.*Dg + ta& /( =.am>
5Bo#iflacin =A!elo#> -22mg + ta& /(
55
!SS3SS#3NT
NURSING
DI!GNOSIS
%'!NNI
NG
INT3R/3NTION R!TION!'3
NURSING
T&3OR$
3/!'U!TI
ON
Sub jective:
Di na siya
ka#ulag mayad
indi pare#as
sadto $ as
!er&ali%ed &"
the folks.
Objectives:
=K> &od"
weakness
=K>?eluctan
ce to
attem$t
mo!ement.
=K>0imited
range of
motion.
(ecreased
muscle
strength.
Im$aired
$h"sical
mo&ilit"
r6t
neuromusc
ular
im$airment
.
After 16
hours !
days 6"!
shift#
of nursing
interventio
ns, the
$atient will
maintain or
increase
strength
and
function of
affected or
com$ensat
ory
%ody $art.
Independent :
+. E!aluate
or
continuousl"
monitor
degree of
$ain.
*. Baintain
&ed rest or
chair rest
when
Indicated.
Schedule
acti!ities
$ro!iding
fre9uent rest
$eriods and
uninterru$ted
night time
slee$.
3. Assist with
active or
$assive range
of motion.
-. Encourage
$atient to
maintain
u$right
and erect
$osture
when sitting'
standing' or
walking.
0e!el of acti!it"
or e#ercise
de$ends on
$rogression and
resolution
S"stemic rest
during cute
attacks and
im$ortant
throughout all
$hases of
disease to
reduce fatigue
and im$ro!e
strength
&aintains or
im$roves 'oint
function, muscle
strength, and
general
stamina.
Ba#imi%es oint
function'
maintains
mo&ilit" that
can $reci$itate
acute attack.
7irginia
Genderson:
s
%asic
Componen
t
Florence
Nightingale
s
Environmen
tal Theory
Gildegard
3e$lau:s
Interperso
nal "#eory
o' )ursing
Florence
Nightingale
s
Environmen
tal Theory
Goal
was not
)et5
=K> &od"
weakness

3<3RCIS3 !ND !CTI/IT$
5Ad!ise folks to assist the $atient in doing $assi!e range of motion
5Instructed folks to a!oid stressful acti!ities for $atient
50et the folks $ro!ide health" h"giene to the $atient
5Encourage to seek $s"chological su$$ort and social grou$ thera$"
TR3!T#3NT
Ne&uli%ation treatment must &e resume u$on discharge and continuous
/#"gen thera$" is needed &" Br. E.8
&O#3 T3!C&INGS
.Educate the folks a&out what is Tetanus and on how to take the $rescri&ed
medication of the $atient
5Ad!ice the folks to let the $atient slee$ in long inter!als and a!oid to much
stressor to the $atient
5Teach the folks on what are the $ossi&le side effects and effects of the
medication to the $atient
OUT %!TI3NT 2O''O1.U%
Br. E.8:s condition re9uires thorough medical attention' he shall ha!e a
recommended return !isit at the hos$ital. Ge was encouraged to com$l" $atient
follow5u$.
DI3T
Br. E.8 was discharged with NGT attached for his $arenteral feeding. An /TE
+422 cal shall &e di!ided into 4 e9ual feedings
S%IRITU!'IT$
Ad!ise folks to seek s$iritual hel$ from $riests' nuns an" religious
organi%ation mem&er the" know in the societ" for s$iritual counseling
+I+'IOGR!%&$
Smelt%er' S.' 8are' 8.' Ginkle' F. T Chee!er' N. =*22,>. %runner +
Suddart#,s "extbook o' *edical(Surgical )ursing --
t#
!d& 0i$$incott
Iilliams T Iilkins.
Seele"' ?.' Ste$hens' T. T Tate' 3. =*22.>. !ssentials o' .natomy +
P#ysiology /
t#
!d. BcGraw5Gill.
8ickle"' 0. =*22.>. %ates, Pocket Guide to P#ysical .ssessment +
0istory "aking 1
t#
!d. 0i$$incott Iilliams T Iilkins
5,
Narch' A. =*22H>. 2334 5ippincott,s )ursing Drug Guide. 0i$$incott
Iilliams T Iilkins.
/cta!iano' E. T 8alita' C. =*22,>. "#eoretical 6oundations o' )ursing:
"#e P#ilippine Perspective& Ultimate 0earning Series
www.wiki$edia.org
www.doh.go!.$h
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