TETANUS

CERIA NURHAYATI
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.
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
 Bersihan jalan napas in efektif b.d. terkumpulnya liur di dalam rongga
mulut (adanya spasme pada otot faring).
 Defisit nutrisi 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)
 Risiko tinggi gangguan pertukaran gas b.d. penurunan oksigen di otak.
 Risiko cedera 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