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Yuni Permatasari Istanti
PENDAHULUAN
 Tetanus mrp penyakit infeksius dg
angka kematian cukup tinggi
 Angka kejadian di negara berkembang
cukup tinggi
 Penyakit ini tersebar di seluruh dunia,
terutama pada daerah resiko tinggi
dengan cakupan imunisasi DPT yang
rendah
TETANUS
 Tetanus mrp penyakit
infeksius yang mempunyai
karakteristik meningkatnya
muscle tension dan
spasms yang disebabkan
oleh produksi the
neurotoxin tetanospasmin.
 Tetanospasmin is released
by the bacteria Clostridium
tetani.
 The bacteria is commonly
found in soil. It enters the
body through a cut or
wound.
 Reservoir utama kuman ini adalah tanah
yang mengandung kotoran ternak
sehingga resiko penyakit ini di daerah
peternakan sangat tinggi. Spora kuman
Clostridium tetani yang tahan kering
dapat bertebaran di mana-mana.
Port of entry
 Luka tusuk, gigitan binatang, luka bakar
 Luka operasi yang tidak dirawat dan
dibersihkan dengan baik
 OMP, caries gigi
 Pemotongan tali pusat yang tidak steril.
 Penjahitan luka robek yang tidak steril.
Why is there no loss of sensory
function ?
 No loss in sensory
function because it only
affects inhibitory
pathways.
 However, the disease is
very painful because it
affects our natural way to
control pain. The natural
pain controlling
mechanism uses
inhibitory pathways, and
if those inhibitory
receptors are blocked the
NT’s can’t bind to control
pain.
The Course of
Tetanus
 Tetanospasmin is
taken up by motor
neurons in the
peripheral nerve
endings through
endocytosis. It then
travels along the axons
until it reaches the
motor neuron cell
bodies in the spinal
cord, by fast retrograde
transport.
The Course of Tetanus
 Once in the spinal cord, tetanospasmin is
released from the motor neuron. It then
selectively blocks neurotransmitter release at
inhibitory synapses.
 Patofisiologi
Severity of tetanus
 Mild tetanus usually has an incubation period
of at least 2 weeks. Initially, there is local
rigidity of the muscles near the wound, which
progresses to general rigidity. Stiff ness of
the neck and jaws develops slowly and
results in mild trismus. True dysphagia and
paroxysmal spasm are usually not present.
Gradual and complete recov-ery occurs
during the 2-4 weeks following the onset of
symptoms
Cont……. severity
 Moderately severe tetanus has a shorter
incubation period, usually 7–10 days. It is
characterized by severe trismus, dysphagia
caused by pharyngeal muscular spasm, and
general muscle rigidity. Paroxysmal spasms
are mild and short, but they progress slowly
for several days, becoming frequent, painful,
and violent. / ey are not associated with
dyspnea or cyanosis.
Cont……. severity
 Severe tetanus is always characterized by a
short in-cubation period, typically less than 72
hours. Muscular hypertonicitiy is so
pronounced that interference with breathing,
opisthotonos, and board-like abdominal rigidity
are present. / e paroxysmal spasms are fre-
quent, prolonged, violent, and asphyxial.
Patients sur-viving longer than 1 week exhibit
a gradual reduction in the intensity and
frequency of spasms. A decrease in general
rigidity and in residual stiff ness occurs later.
Complete recovery takes place in 2–5 weeks.
Tetanus Complications
 Laryngospasm
 Fractures
 Hypertension
 Nosocomial infections
 Pulmonary embolism
 Aspiration pneumonia
 Death
MANAGEMENT OF
TETANUS
three objectives of management of tetanus are:
(1) to provide supportive care until the
tetanospasmin that is fi xed in tissue has
been metabolized;
(2) to neu-tralize circulating toxin; and
(3) to remove the source of tetanospasmin.
Medical administration
 Antibiotik
 Penicillin recommended dose is 100,000–200,000
IU/day intramuscularly or intravenously for 7–10
days  produce convulsion
 Metronidazole  Rectal administration of
metronidazole is rapidly bioavail-able and
produces fewer spasms than repeated intrave-
nous or intramuscular injections
 Sedative
 Short-acting barbiturates such as secobarbital
and phenobarbital are useful in sedating patients
with mild tetanus. Initial doses of 1.5–2.5 mg/kg
for children or 100–150 mg intramus-cularly for
adults
 Phenobarbital may be given in a dose of
120–200 mg intravenously
 Diazepam may be added in divided doses
up to 120 mg/dayprevent or control
seizures.
 Chloropromazine, given every 4–8 hours in
doses from 4–12 mg in the infant to 50–150
mg in the adult, ma
PREVENTION
 Imunisasi
 ATS profilaksis
Recommended and Minimum Ages and
Intervals Between Vaccine Doses
NURSING CARE PLAN
 ASSESSMENT
 Riwayat kehamilan prenatal. Ditanyakan apakah
ibu sudah diimunisasi TT.
 Riwayat natal ditanyakan. Siapa penolong
persalinan karena data ini akan membantu
membedakan persalinan yang bersih/higienis
atau tidak. Alat pemotong tali pusat, tempat
persalinan.
 Riwayat postnatal. Ditanyakan cara perawatan
tali pusat, mulai kapan bayi tidak dapat menetek
(incubation period). Berapa lama selang waktu
antara gejala tidak dapat menetek dengan gejala
kejang yang pertama (period of onset).
Assessment cont……
Riwayat imunisasi pada tetanus
anak. Ditanyakan apakah sudah
pernah imunisasi DPT/DT atau TT
dan kapan terakhir
Riwayat psiko sosial.
○Kebiasaan anak bermain di mana
○Hygiene sanitasi
Assessment cont….
 Pemeriksaan fisik.
 Pada awal bayi baru lahir biasanya belum ditemukan
gejala dari tetanus, bayi normal dan bisa menetek
dalam 3 hari pertama. Hari berikutnya bayi sukar
menetek, mulut “mecucu” seperti mulut ikan. Risus
sardonikus dan kekakuan otot ekstrimitas. Tanda-
tanda infeksi tali pusat kotor. Hipoksia dan sianosis.
 Pada anak keluhan dimulai dengan kaku otot lokal
disusul dengan kesukaran untuk membuka mulut
(trismus).
 Pada wajah : Risus Sardonikus ekspresi muka yang
khas akibat kekakuan otot-otot mimik, dahi
mengkerut, alis terangkat, mata agak menyipit, sudut
mulut keluar dan ke bawah.
Assessment cont….
 Opisthotonus tubuh yang kaku akibat kekakuan
otot leher, otot punggung, otot pinggang, semua
trunk muscle.
 Pada perut : otot dinding perut seperti papan.
Kejang umum, mula-mula terjadi setelah
dirangsang lambat laun anak jatuh dalam status
konvulsius.
 Pada daerah ekstrimitas apakah ada luka tusuk,
luka dengan nanah, atau gigitan binatang.
 Nursing diagnosis
 Ketidakefektifan jalan nafas b.d. terkumpulnya liur di dalam
rongga mulut (adanya spasme pada otot faring).
 Gangguan nutrisi kurang dari kebutuhan tubuh b.d.
peningkatan kebutuhan kalori yang tinggi, makan tidak
adekuat.
 Gangguan perfusi jaringan b.d. penurunan sirkulasi
(hipoksia berat).
 Koping keluarga tidak efektif b.d. kurang pengetahuan
keluarga tentang diagnosis/prognosis penyakit anak
 Gangguan komunikasi verbal b.d. sukar untuk membuka
mulut (kekakuan otot-otot masseter)
 Risti gangguan pertukaran gas b.d. penurunan oksigen di
otak.
 Risti injuri b.d. kejang spontan yang terus-menerus (kurang
suplai oksigen karena adanya oedem laring).
 Interventions  NIC
Isolation room
Oxygenation  tracheostomy if
needed
Nutrition
Fluid and electrolyte
Wound care
THANK YOU

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MATERI MANAJEMEN OF PENYAKIT TETANUS.ppt

  • 2. PENDAHULUAN  Tetanus mrp penyakit infeksius dg angka kematian cukup tinggi  Angka kejadian di negara berkembang cukup tinggi  Penyakit ini tersebar di seluruh dunia, terutama pada daerah resiko tinggi dengan cakupan imunisasi DPT yang rendah
  • 3. TETANUS  Tetanus mrp penyakit infeksius yang mempunyai karakteristik meningkatnya muscle tension dan spasms yang disebabkan oleh produksi the neurotoxin tetanospasmin.  Tetanospasmin is released by the bacteria Clostridium tetani.  The bacteria is commonly found in soil. It enters the body through a cut or wound.
  • 4.  Reservoir utama kuman ini adalah tanah yang mengandung kotoran ternak sehingga resiko penyakit ini di daerah peternakan sangat tinggi. Spora kuman Clostridium tetani yang tahan kering dapat bertebaran di mana-mana.
  • 5. Port of entry  Luka tusuk, gigitan binatang, luka bakar  Luka operasi yang tidak dirawat dan dibersihkan dengan baik  OMP, caries gigi  Pemotongan tali pusat yang tidak steril.  Penjahitan luka robek yang tidak steril.
  • 6. Why is there no loss of sensory function ?  No loss in sensory function because it only affects inhibitory pathways.  However, the disease is very painful because it affects our natural way to control pain. The natural pain controlling mechanism uses inhibitory pathways, and if those inhibitory receptors are blocked the NT’s can’t bind to control pain.
  • 7. The Course of Tetanus  Tetanospasmin is taken up by motor neurons in the peripheral nerve endings through endocytosis. It then travels along the axons until it reaches the motor neuron cell bodies in the spinal cord, by fast retrograde transport.
  • 8. The Course of Tetanus  Once in the spinal cord, tetanospasmin is released from the motor neuron. It then selectively blocks neurotransmitter release at inhibitory synapses.
  • 10. Severity of tetanus  Mild tetanus usually has an incubation period of at least 2 weeks. Initially, there is local rigidity of the muscles near the wound, which progresses to general rigidity. Stiff ness of the neck and jaws develops slowly and results in mild trismus. True dysphagia and paroxysmal spasm are usually not present. Gradual and complete recov-ery occurs during the 2-4 weeks following the onset of symptoms
  • 11. Cont……. severity  Moderately severe tetanus has a shorter incubation period, usually 7–10 days. It is characterized by severe trismus, dysphagia caused by pharyngeal muscular spasm, and general muscle rigidity. Paroxysmal spasms are mild and short, but they progress slowly for several days, becoming frequent, painful, and violent. / ey are not associated with dyspnea or cyanosis.
  • 12. Cont……. severity  Severe tetanus is always characterized by a short in-cubation period, typically less than 72 hours. Muscular hypertonicitiy is so pronounced that interference with breathing, opisthotonos, and board-like abdominal rigidity are present. / e paroxysmal spasms are fre- quent, prolonged, violent, and asphyxial. Patients sur-viving longer than 1 week exhibit a gradual reduction in the intensity and frequency of spasms. A decrease in general rigidity and in residual stiff ness occurs later. Complete recovery takes place in 2–5 weeks.
  • 13. Tetanus Complications  Laryngospasm  Fractures  Hypertension  Nosocomial infections  Pulmonary embolism  Aspiration pneumonia  Death
  • 14. MANAGEMENT OF TETANUS three objectives of management of tetanus are: (1) to provide supportive care until the tetanospasmin that is fi xed in tissue has been metabolized; (2) to neu-tralize circulating toxin; and (3) to remove the source of tetanospasmin.
  • 15. Medical administration  Antibiotik  Penicillin recommended dose is 100,000–200,000 IU/day intramuscularly or intravenously for 7–10 days  produce convulsion  Metronidazole  Rectal administration of metronidazole is rapidly bioavail-able and produces fewer spasms than repeated intrave- nous or intramuscular injections  Sedative  Short-acting barbiturates such as secobarbital and phenobarbital are useful in sedating patients with mild tetanus. Initial doses of 1.5–2.5 mg/kg for children or 100–150 mg intramus-cularly for adults
  • 16.  Phenobarbital may be given in a dose of 120–200 mg intravenously  Diazepam may be added in divided doses up to 120 mg/dayprevent or control seizures.  Chloropromazine, given every 4–8 hours in doses from 4–12 mg in the infant to 50–150 mg in the adult, ma
  • 18. Recommended and Minimum Ages and Intervals Between Vaccine Doses
  • 19. NURSING CARE PLAN  ASSESSMENT  Riwayat kehamilan prenatal. Ditanyakan apakah ibu sudah diimunisasi TT.  Riwayat natal ditanyakan. Siapa penolong persalinan karena data ini akan membantu membedakan persalinan yang bersih/higienis atau tidak. Alat pemotong tali pusat, tempat persalinan.  Riwayat postnatal. Ditanyakan cara perawatan tali pusat, mulai kapan bayi tidak dapat menetek (incubation period). Berapa lama selang waktu antara gejala tidak dapat menetek dengan gejala kejang yang pertama (period of onset).
  • 20. Assessment cont…… Riwayat imunisasi pada tetanus anak. Ditanyakan apakah sudah pernah imunisasi DPT/DT atau TT dan kapan terakhir Riwayat psiko sosial. ○Kebiasaan anak bermain di mana ○Hygiene sanitasi
  • 21. Assessment cont….  Pemeriksaan fisik.  Pada awal bayi baru lahir biasanya belum ditemukan gejala dari tetanus, bayi normal dan bisa menetek dalam 3 hari pertama. Hari berikutnya bayi sukar menetek, mulut “mecucu” seperti mulut ikan. Risus sardonikus dan kekakuan otot ekstrimitas. Tanda- tanda infeksi tali pusat kotor. Hipoksia dan sianosis.  Pada anak keluhan dimulai dengan kaku otot lokal disusul dengan kesukaran untuk membuka mulut (trismus).  Pada wajah : Risus Sardonikus ekspresi muka yang khas akibat kekakuan otot-otot mimik, dahi mengkerut, alis terangkat, mata agak menyipit, sudut mulut keluar dan ke bawah.
  • 22. Assessment cont….  Opisthotonus tubuh yang kaku akibat kekakuan otot leher, otot punggung, otot pinggang, semua trunk muscle.  Pada perut : otot dinding perut seperti papan. Kejang umum, mula-mula terjadi setelah dirangsang lambat laun anak jatuh dalam status konvulsius.  Pada daerah ekstrimitas apakah ada luka tusuk, luka dengan nanah, atau gigitan binatang.
  • 23.
  • 24.  Nursing diagnosis  Ketidakefektifan jalan nafas b.d. terkumpulnya liur di dalam rongga mulut (adanya spasme pada otot faring).  Gangguan nutrisi kurang dari kebutuhan tubuh b.d. peningkatan kebutuhan kalori yang tinggi, makan tidak adekuat.  Gangguan perfusi jaringan b.d. penurunan sirkulasi (hipoksia berat).  Koping keluarga tidak efektif b.d. kurang pengetahuan keluarga tentang diagnosis/prognosis penyakit anak  Gangguan komunikasi verbal b.d. sukar untuk membuka mulut (kekakuan otot-otot masseter)  Risti gangguan pertukaran gas b.d. penurunan oksigen di otak.  Risti injuri b.d. kejang spontan yang terus-menerus (kurang suplai oksigen karena adanya oedem laring).
  • 25.  Interventions  NIC Isolation room Oxygenation  tracheostomy if needed Nutrition Fluid and electrolyte Wound care