SLH Case Analysis Tetanus Stage III Placino

Manuel S.
Enverga University Foundation

Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES
COLLEGE OF NURSING ALLIED HEALTH SCIENCES
In partial fulfilment of the requirements for

Related Learning Experience at
NCM 104A Communicable Disease Nursing
INDIVIDUAL CASE ANALYSIS

Diagnosis: Tetanus Stage III S/P PTB Tx (10 years ago)
Submitted by:
Placino, Siena Kathleen V.
Submitted to:
Clinical Instructor
Dr. Dario V. Sumande RN, MAN, PhD
Date of Submission:
08/28/19
Manuel S. Enverga University Foundation
Lucena City
I. Chief Complaint/ Diagnosis

a. Chief Complaint: nail puncture
b. Diagnosis: Tetanus Stage III S/P PTB Tx (10 years ago)
II. History of Illness
a. 1 month prior to confinement, patient accidentally stepped on a nail with his
left foot – self-medicated by washing the wound. No aggravated fever. 1 day
prior to confinement, patient suddenly, felt stiffness on his jaw and body pain.
Decided to seek consult at provincial hospital (Marinduke) but needed to be
admitted at a general tertiary hospital (SLH) where consult and treatment are in
the present institution.
b. 4 days prior to admission: (+)dysphagia, (+)difficulty opening mouth; 2 days
prior to admission (+) progressive trismus and (+) abdominal spasm, (+)
muscle spasm (respiratory, laryngeal, abdominal muscle spasms)
c. Upon admission, patient had a (+) rigid abdomen, (+) rigid extremities, (+)
risus sardonicus, (+)trismus/ lock jaw, (+)opisthotonus, (+) convulsions/
seizure activity; frequency = >10x per day, duration= apx. 10 minutes,
(+)headache; (-) bowel movement from admission until present, decreased
bowel sounds (-) passage of stool.
III. Background of the Disease
According to Centers for Disease Control and Prevention,
Tetanus is different from other vaccine-preventable diseases because it does not

spread from person to person. The bacteria are usually found in soil, dust, and manure
and enter the body through breaks in the skin — usually cuts or puncture wounds
caused by contaminated objects.
Tetanus is an infection caused by a bacterium called Clostridium tetani. Spores of

tetanus bacteria are everywhere in the environment, including soil, dust, and manure.
The spores develop into bacteria when they enter the body.
Common Ways Tetanus Gets Into Your Body
The spores can get into the body through broken skin, usually through injuries from
contaminated objects. Tetanus bacteria are more likely to infect certain breaks in the
skin. These include:
 Wounds contaminated with dirt, poop (feces), or spit (saliva)

 Wounds caused by an object puncturing the skin (puncture wounds), like a nail or
needle
Lucena City
 Burns
 Crush injuries
 Injuries with dead tissue.
People often call tetanus “lockjaw” because one of the most common signs of this
infection is tightening of the jaw muscles. Tetanus infection can lead to serious
health problems, including being unable to open the mouth and having trouble
swallowing and breathing.
Symptoms
 Jaw cramping
 Sudden, involuntary muscle tightening (muscle spasms) – often in the
stomach
 Pain muscle stiffness all over the body
 Trouble swallowing
 Jerking or staring (seizures)
 Headache
 Fever and sweating
 Changes in blood pressure and heart rate
Complications
 Uncontrolled/ involuntary tightening of the vocal cords (laryngospasm)

 Broken bones (fractures)
 Infections gotten by a patient during a hospital visit (hospital-acquired
infections)
 Blockage of the main artery of the lung or one of its branches by a blood
clot that has travelled from elsewhere in the body through the bloodstream
(pulmonary embolism)
 Pneumonia, a lung infection, that develops by breathing in foreign
materials (aspiration pneumonia)
 Breathing difficulty, possibly leading to death (1 to 2 in 10 cases are fatal)
Diagnosis – Doctors can diagnose tetanus by examining the patient and looking
for certain signs and symptoms.
Treatment – Tetanus is a medical emergency requiring:
 Care in the hospital

Lucena City
 Immediate treatment with medicine called human tetanus immune

globulin (TIG)
 Aggressive wound care
 Drugs to control muscle spasms
 Antibiotics
 Tetanus vaccination
Prevention
Vaccination and good wound care are important to help prevent tetanus
infection. Doctors can also use a medicine to help prevent tetanus in cases
where someone is seriously hurt and doesn’t have protection from tetanus
vaccines.
 Good Wound Care

o Don’t delay first aid of even minor, non-infected wounds like
blisters, scrapes, or any break in the skin.
o Wash hands often with soap and water or use an alcohol-based
hand rub if washing is not possible.
 Vaccination – Being up to date with your tetanus vaccine is the best tool
to prevent tetanus. Protection from vaccines, as well as prior infection, do
not last a lifetime. This means that if you had tetanus or got the vaccine
before, you still need to get the vaccine regularly to keep a high level of
protection against this serious disease.
Lucena City
Pathophysiology of Tetanus
Lucena City
Lucena City
Lucena City
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Treatment
1. HTIG (Human tetanus Immunoglobulin): 3000-6000 units/IM
2. ATS (Anti tetanus Serum): 5000-10000 units/ ½ IV ½ IM
3. Antibiotics: Inj. Penicillin G 200000/kg in 4 divided Doses for 2 weeks
4. Sedation: Inj. Diazapam 0.1 – 0.2 mg/kg/ 4 hourly
Inj. Medazolam 1mg/ kg
5. Neuromuscular Blocking Agents:
Inj. Pancuronium Bromide
IV Infusion. Atracurium Besylate
6. Supportive Care:
 Isolation, Avoid Stimulation
 Vital monitoring( Respiratory Rate, SPO2)
 Oral Suctioning
 Keep Nil Per Oral, Feed after 5 days
 Place Nasogastri tube,
 Hydration
 Intake of 3500-4000 Calories and at least 150g of protein

Lucena City
IV. Labs and Diagnostics (Results and Interpretations)
Complete Blood Count Results: 08/19/2019
Test Value Reference

White Blood Cell 5.67 4.0-10.0
Red Blood Cell 4.15 4.5-6.2
Hematocrit 0.35 0.40-0.50
Hemoglobin 113.0 130-180
MCV 83.9 82-98
MCH 27.2 28-33
MCHC 32.5 33-36
Platelet Count 230 150-400
RDW 14 11.4-14.0
Differential Count:
Neutrophil 65.7 55-65
Lymphocyte 21.3 25-35
Eosinophil 0.5 2.0-4.0
Monocyte 12.0 3.0-8.0
Basophil 0.5 0-1.0
Interpretation:
 Red blood cell, Hematocrit and Hemoglobin levels are lower than average; most likely
due to impairment of the patient’s ability to procure adequate amounts of food secondary
to lockjaw – inability to masticate; therefore inadequate nutritional intake causes an
relative anemia in the patient.
 Neutrophil count is increased secondary to the presence of bacterial infection
(Clostridium tetani ) – Neutrophils specialize in fighting off bacterial and fungal invasion
of the human body.
 Monocyte count is increased – Monocytes specialize in protecting tissue-specific
immunity and is increased because the body’s immune system is developing antibodies
for Clostridium tetani.
Complete Blood Count: 08/23/2019

MCV 83.3 82-98
MCH 28.0 28-33
MCHC 33.6 33-36
Lucena City

RDW 13 11.4-14.0
Differential Count:
Monocyte 8.9 3.0-8.0
Basophil 0.2 0-1.0
Interpretation:
of the human body.
 Lymphocyte count is low – most likely because the disease process is causing the
patient’s immune system to spend its energy producing more neutrophils; other cells of
the immune system are therefore not produced as much, especially since lymphocytes
specialize in killing off viruses and tumour cells, both of which are not present during the
bacterial invasion of Clostridium tetani.
 Monocyte count is increased – Monocytes specialize in protecting tissue-specific
immunity and is increased because the body’s immune system is developing antibodies
for Clostridium tetani.
Complete Blood Count: 08/25/2019

MCV 83.8 82-98
MCH 27.3 28-33
MCHC 32.6 33-36
RDW 13 11.4-14.0
Differential Count:
Monocyte 7.2 3.0-8.0
Lucena City
Basophil 0.5 0-1.0

Interpretation:
of the human body.
 Lymphocyte count is low – most likely because the disease process is causing the
patient’s immune system to spend its energy producing more neutrophils; other cells of
the immune system are therefore not produced as much, especially since lymphocytes
specialize in killing off viruses and tumour cells, both of which are not present during the
bacterial invasion of Clostridium tetani.
Radiological/Ultrasound/ CT Scan Findings: 08/19/2019
Radiological/Ultrasound/ CT Scan Findings:

 There are fibrohazed opacities seen in the right upper lobe.
 Heart is not enlarged. Diaphragm & sulci are intact.
 Visualized osseous structures are unremarkable.
Impression:
 PTB, LEFT, UPPER LOBE
Arterial Blood Gas Analysis Result: 08/19/2019
TEST NAME RESULT REFERENCE RANGE

pH 7.416 7.35- 7.45
pCO2 36.2 mmHg 35-45 mmHg
pO2 129.1 mmHg 70-100 mmHg
SO2 98.8% 92.0-98.5%
HCO3 22.8 mmol/L 22-26 mmol/L
Interpretation:
 High pO2 signifies good prognosis of the disease - Oxygen saturation determines
effectiveness of muscle relaxants.
Clinical Chemistry Result: 08/19/2019
SI UNIT CONVENTIONAL UNIT

TEST NAME RESULT REFERENC RESULT REFEREN
E RANGES CE
Lucena City
RANGES
Random Blood Sugar 5.70 mmol/L 102.70 mg/dl
Blood Urea Nitrogen 4.30 mmol/L 3.2-7.1 12.05 mg/dL 9-20
Creatinine 74.00 umol/L 71-133 0.84 mg/dL 0.8-1.5
Albumin 40.00 g/L 35-50 4.00 g/dL 3.5-5.0
Sodium 144.00 mmol./L 137-145 144.00 mEq/L 137-145
Potassium 4.00 mmol/L 3.5-5.1 4.0 mEq/L 3.6-5.1
Total Calcium 2.09 mmol/L 2.10-2.55 0.00 mg/dL 8.4-10.2
SGOT/ AST 37.00 U/L 17-59 37.00 U/L 17-59
SGPT/ ALT 18.00 U/L <50 18.00 U/L <50
Interpretation:
 Decrease in total calcium is the rationale behind the clinical manifestations of muscle
spasms and seizure activity in tetanus patients (ie. hypocalcemia induces tetany – muscle
spasms).
Urinalysis (Microscopic/Chemical Examination): 08/17/2019
Test Result Reference

Routine Physical Examination
Color Light Yellow Lt. Yellow – Amber
TRANSPARENCY (Clarity) Clear Clear
Chemical Analysis
Glucose NEGATIVE ≤ 5.5mmol/L
Bilirubin NEGATIVE ≤ 5 mmol/L
Ketone NEGATIVE ≤ 0.4 mmol/L
Specific Gravity 1.020 1.005 – 1.035
Blood NEGATIVE ≤ 9/uL
Ascorbic Acid NEGATIVE ≤ 0.5 mmol/L
Creatinine 1.1 mmol/L (TRACE) ≤ 1.0 mmol/L
pH 5.5 5.00-8.00
Protein 0.2 g/L (TRACE) 0.1 g/L
Urobilinogen 17 umol/L (+1) ≤ 4umol/L
Nitrite NEGATIVE NEGATIVE
Leukocytes 15/uL (TRACE) ≤ 14/uL
MicroAlbumin 30 mg/dL (+1) ≤ 10 mg/L
Calcium 5 mmol/L (TRACE) ≤ 2.4 mmol/L
URINE SEDIMENT
ANALYSIS BY AUTO
PARTICLE
SEDIMENTATION
RBC 1 (NORMAL) 0-2
WBC 5 (TRACE/RARE) 0-4
Lucena City
Squamous Epithelial Cells 35 (NORMAL 0-82

Amorphous Urate/ phosphates 3 (NORMAL) 0-80
Mucus Threads 3 (NORMAL) 0-82
Interpretation:
 Increased presence of protein in the urine – side effect of current medication –
nonsteroidal anti-inflammatory drugs may induce proteinuria.
 Elevated levels of urobilinogen in the urine – may be induced by restricted hepatic
function or haemolytic anemia secondary to bacterial infection.
 Moderate leucocytosis is a common occurrence in a patient with tetanus.
 Increased MicroAlbumin count in urine - Patients diagnosed with tetanus, especially
stage III cases, develop a loss of control in bowel and bladder elimination – a
microalbumin test is used to detect early signs of kidney damage.
 Increased calcium level in urine – too much calcium secretion in the urine may also
indicate stress or damage on the kidneys.
V. Medications (Action, Indication and Why)
Medication Action Indication Rationale for

Order
Metronidazole Classification: Anti- Asymptomatic and Clostridium
500 mg TIV Q6 x infective; Anti- symptomatic tetani is a
10 days trichomonal; Amebicide; trichomoniasis in females bacteria that
Antibiotic and males; acute intestinal invades the
Synthetic compound with amebiasis and amebic liver human body
direct trichomonacidal and abscess; preoperative causing tetanus
amebicidal activity as well prophylaxis in colorectal – prescribing an
as antibacterial activity surgery, elective antibiotic to
against anaerobic bacteria hysterectomy or vaginal such a patient
and some gram-negative repair, and emergency will fend of
bacteria. appendectomy. IV bacterial
metronidazole is used for invasion.
the treatment of serious
infections caused by
susceptible anaerobic
bacteria in intraabdominal
infections, skin infections,
gynecologic infections,
septicemia, and for both
pre- and postoperative
prophylaxis, bacterial
Lucena City
vaginosis.
(ATS) Anti Classification: tetanus Tetanus 1st line treatment

Tetanus Serum prophylaxis; immune prophylaxis. Adults and for a patient
20,000 u IM (-) serum children age 7 and diagnosed with
ANST older:250 units I.M. For tetanus is ATS
TIG provides passive severe wounds or delay in or Anti-Tetanus
immunity to tetanus. starting prophylaxis, give Serum –
Antibodies remain at 500 units I.M. antibodies that
effective levels for 3 Tetanus will fend off the
weeks or longer. TIG treatment. Adults and bacteria without
protects the patient for the children age 7 and the patient’s
incubation period of most older:Although optimal immune system
tetanus cases. therapeutic doses haven’t needing time to
been established, single develop their
doses of 3,000 to 6,000 own antibodies.
units I.M. have been used.
Dosages should be
adjusted based on severity
of the infection. Don’t give
at same site as toxoid.
Diazepam Drip: Classification: Central Drug of choice for status Common
D5W 250cc + Nervous System; epilepticus. Management manifestations
60mg Diazepam Benzodiazepine of anxiety disorders, for in a patient
Q6 Anticonvulsant; short-term relief of anxiety diagnosed with
Anxiolytic symptoms, to allay anxiety tetanus includes
Diazepam 10mg and tension prior to muscle spasms,
TIV Q6 surgery, cardioversion and convulsions and
Psychotherapeutic agent endoscopic procedures, as seizure activity-
related to an amnesic, and treatment all of which are
chlordiazepoxide; for restless legs. Also used present in the
reportedly superior in to alleviate acute patient at hand –
antianxiety and withdrawal symptoms of therefore,
anticonvulsant activity, alcoholism, voiding prescribing
with somewhat shorter problems in older adults, diazepam- an
duration of action. Like and adjunctively for relief anticonvulsant,
chlordiazepoxide, it of skeletal muscle spasm sedation and
appears to act at both associated with cerebral relaxation will
limbic and subcortical palsy, paraplegia, be induced in
levels of CNS. athetosis, stiff-man the patient,
syndrome, tetanus. decreasing
frequency and
Lucena City
duration of
muscle spasms
and seizures.
Paracetamol Classification: Central Fever reduction. Common

300mg TIV Q4 Nervous System Agent; Temporary relief of mild clinical
PRN Non-narcotic Analgesic; to moderate pain. manifestations
Antipyretic Generally as substitute for in a patient with
aspirin when the latter is tetanus include
not tolerated or is fever and pain
Produces analgesia by contraindicated. that comes hand
unknown mechanism, in hand with
perhaps by action on seizure activity
peripheral nervous system. and convulsions;
Reduces fever by direct headache is also
action on hypothalamus present.
heat-regulating center with Paracetamol, a
consequent peripheral non-narcotic
vasodilation, sweating, analgesic and
and dissipation of heat. antipyretic will
Unlike aspirin, alleviate all of
acetaminophen has little these signs and
effect on platelet symptoms.
aggregation, does not
affect bleeding time, and
generally produces no
gastric bleeding.
Omeprazole Classification: Gastro- Duodenal and gastric The patient

40mg TIV OD intestinal Agent; Proton ulcer. Gastroesophageal diagnosed with
Pump Inhibitor reflux disease including tetanus is
severe erosive esophagitis experiencing
(4 to 8 wk treatment). abdominal
An antisecretory Long-term treatment of spasms and pain
compound that is a gastric pathologic hypersecretory during
acid pump inhibitor. conditions such as abdominal
Suppresses gastric acid Zollinger-Ellison muscle spasms –
secretion by inhibiting the syndrome, multiple omeprazole
Lucena City
H+, K+-ATPase enzyme endocrine adenomas, and decreasing

system [the acid (proton systemic mastocytosis. In gastrointestinal
H+) pump] in the parietal combination with activity,
cells. clarithromycin to treat providing
duodenal ulcers associated relaxation.
with Helicobacter pylori.
Tetanus Toxoid Classification: Anti- This vaccine is given to Tetanus toxoid

(T.T.) 0.5 ml deep tetanus serum; EPI provide protection is a preventive
IM done 8/22/19 vaccine, Anti-tetanus (immunity) against tetanus measure,
(lockjaw) in adults and increasing the
Clostridium tetani culture children 7 years or older. body’s
is grown in a peptone- Vaccination is the best immunity
based medium containing way to protect against this towards future
an extract of bovine life-threatening disease. tetanus infection
muscle tissue and Vaccines work by causing or re-infection.
detoxified with the body to produce its The more
formaldehyde. Tetanus own protection regular/ frequent
toxoid for intramuscular (antibodies). Tetanus tetanus
injection, is a sterile vaccine is usually first vaccinations one
suspension of alum- given to infants with 2 takes, the greater
precipitated toxoid in an other vaccines for the chance the
isotonic sodium chloride diphtheria and whooping patient has with
solution. cough (pertussis) in a fending off
series of 3 injections. This Clostridium
vaccine is usually used as tetani.
a "booster" vaccine after
this first series. Closely
follow the vaccination
schedule provided by the
health care professional.
Booster injections may be

needed at the time of
injury in older children and
adults if it has been 5-10
years since the last tetanus
vaccine was received.
Lucena City
Booster injections should

also be given every 10
years even if no injury has
occurred. This injection or
an injection with
tetanus/diphtheria or
tetanus/diphtheria/pertussis
may be used for the
booster.
Lactulose 30cc Classifications: Labeled uses: Prevention The patient is
ODHS Gastrointestinal Agent; and treatment of portal- currently
-9PM- Hyperosmotic Laxative systemic encephalopathy experiencing
(PSE), including stages of decreased
Acidifies colon contents, hepatic precoma and coma, gastric motility
which retards diffusion of and by prescription for – he has been
nonionic ammonia (NH3) relief of chronic negative for
from colon to blood while constipation. bowel
promoting its migration movement from
from blood to colon. In the Unlabeled uses: To restore admission until
acidic colon, NH3 is regular bowel habit post- presently;
converted to non- hemorrhoidectomy; to lactulose, a
absorbable ammonium evacuate bowel in older laxative, induces
ions (NH4) and is then adult patients with severe bowel
expelled in feces by constipation after barium elimination.
laxative action. Decreased studies; and for treatment
blood ammonia in a of chronic constipation in
patient with hepatic children.
encephalopathy is marked
by improved EEG patterns
and mental state (clearing
of confusion, apathy, and
irritation). Osmotic effect
of organic acids causes
laxative action, which
moves water from plasma
to intestines, softens
stools, and stimulates
peristalsis by pressure
from water content of
stool.
Diazepam 10 mg Classification: Central Drug of choice for status Diazepam is
TIV Q8 Nervous System Agent; epilepticus. Management prescribed for
Benzodiazepine of anxiety disorders, for the patient
Lucena City
Anticonvulsant; short-term relief of anxiety experiencing

Anxiolytic symptoms, to allay anxiety seizure activity-
and tension prior to providing relief
surgery, cardioversion and from frequency
Psychotherapeutic agent endoscopic procedures, as and duration of
related to an amnesic, and treatment seizures –
chlordiazepoxide; for restless legs. Also used providing
reportedly superior in to alleviate acute sedation and
antianxiety and withdrawal symptoms of relaxation.
anticonvulsant activity, alcoholism, voiding
with somewhat shorter problems in older adults,
duration of action. Like and adjunctively for relief
chlordiazepoxide, it of skeletal muscle spasm
appears to act at both associated with cerebral
limbic and subcortical palsy, paraplegia,
levels of CNS. athetosis, stiff-man
syndrome, tetanus.
Lucena City
Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Risk for After 4 hours of 1. Keep suction 1. A patient with After 4 hours of
 “Naninigas Aspiration nursing machine aspiration needs nursing
katawan at related to interventions, the available when immediate interventions, goal
tiyan ko, seizure patient will: feeding high- suctioning and partially met - the
parang activity,  Be free of risk patients. If will need further patient
inaatake ba,” decreased signs of aspiration does lifesaving 
as verbalized gastrointestin aspiration occur, suction interventions Demonstrat
by the al motility and risk of immediately such as e on
patient, accumulation aspiration is 2. Inform the intubation. suctioning
“Hindi rin of sputum decreased. physician or 2. Early techniques
ako secondary to  Be able to other health intervention to prevent
makalumod restricted expectorate care provider protects the accumulati
at makakain laryngeal and clear instantly of patient’s airway on of
ng maayos, respiratory secretions noted decrease and prevents secretions
lalo na nung muscle and be free in cough/gag aspiration. in the oral
na-admit, control of aspiration reflexes or Anyone cavity.
hindi ko  Maintain a difficulty in identified as  Maintain a
talaga patent swallowing. being at high risk patent
magalaw airway with 3. Keep head of for aspiration airway
bibig at normal bed elevated should be kept with
panga ko.” breath when feeding NPO (nothing by normal
Objective: sounds and for at least mouth) until breath
 (+)stiffness  Swallow a half hour further evaluation sounds
of food and digest afterward. is completed.  Swallow
 (+)stiffness oral, 4. Position 3. Maintaining a and digest
of jaw nasogastric patients with a sitting position oral,
 (+)body pain or gastric decreased after meals may nasogastric
 (+) rigid feeding level of help decrease or gastric
abdomen without consciousness aspiration feeding
 (+) rigid aspiration. on their side. pneumonia. without
extremities  Be able to 4. This aspiration.
 (+)risus verbalize 5. During enteral positioning  Be able to
sardonicus health feedings, (rescue verbalize
 (+) educations position positioning) health
opisthotonus in patient with decreases the risk educations
 (+) trismus/ accordance head of bed for aspiration by in
lock jaw with elevated 30 to promoting the accordance
 (+)convulsio aspiration 40 degrees; drainage of with
ns/ seizures; precautions, maintain for secretions out of aspiration
frequency as well as 30 to 45 the mouth instead precautions
upon relatives. minutes after of down the , as well as
admission = feeding. pharynx, where relatives.
>10x/day, 6. Instruct both they could be
duration patient and aspirated.
upon relatives of the 5. Keeping
admission= signs and patient’s head
Lucena City
apx. 10 mins. symptoms of elevated helps

 Frequency aspiration keep food in
presently = 3- stomach and
5x/day; decreases
duration incidence of
presently= <1 aspiration.
minute 6. Information
 (+)headache helps in
 (+)dysphagia appropriate
 (+)muscle assessment of
spasm high-risk
(respiratory, situations and
laryngeal and determination of
abdominal when to call for
muscle further
spasm) evaluation.

SLH Case Analysis Tetanus Stage III Placino

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Manuel S.

Enverga University Foundation

COLLEGE OF NURSING ALLIED HEALTH SCIENCES

In partial fulfilment of the requirements for

INDIVIDUAL CASE ANALYSIS

Placino, Siena Kathleen V.

I. Chief Complaint/ Diagnosis

According to Centers for Disease Control and Prevention,

Tetanus is different from other vaccine-preventable diseases because it does not

Tetanus is an infection caused by a bacterium called Clostridium tetani. Spores of

Common Ways Tetanus Gets Into Your Body

 Wounds contaminated with dirt, poop (feces), or spit (saliva)

 Uncontrolled/ involuntary tightening of the vocal cords (laryngospasm)

Treatment – Tetanus is a medical emergency requiring:

 Care in the hospital

 Immediate treatment with medicine called human tetanus immune

 Good Wound Care

1. HTIG (Human tetanus Immunoglobulin): 3000-6000 units/IM

2. ATS (Anti tetanus Serum): 5000-10000 units/ ½ IV ½ IM

3. Antibiotics: Inj. Penicillin G 200000/kg in 4 divided Doses for 2 weeks

4. Sedation: Inj. Diazapam 0.1 – 0.2 mg/kg/ 4 hourly

Inj. Medazolam 1mg/ kg

5. Neuromuscular Blocking Agents:

Inj. Pancuronium Bromide

IV Infusion. Atracurium Besylate

 Isolation, Avoid Stimulation

 Vital monitoring( Respiratory Rate, SPO2)

 Keep Nil Per Oral, Feed after 5 days

 Place Nasogastri tube,

 Intake of 3500-4000 Calories and at least 150g of protein

IV. Labs and Diagnostics (Results and Interpretations)

Complete Blood Count Results: 08/19/2019

Test Value Reference

Complete Blood Count: 08/23/2019

Test Value Reference

Platelet Count 217 150-400

Complete Blood Count: 08/25/2019

Test Value Reference

Basophil 0.5 0-1.0

Radiological/Ultrasound/ CT Scan Findings: 08/19/2019

Radiological/Ultrasound/ CT Scan Findings:

Arterial Blood Gas Analysis Result: 08/19/2019

TEST NAME RESULT REFERENCE RANGE

Clinical Chemistry Result: 08/19/2019

SI UNIT CONVENTIONAL UNIT

Urinalysis (Microscopic/Chemical Examination): 08/17/2019

Test Result Reference

Squamous Epithelial Cells 35 (NORMAL 0-82

V. Medications (Action, Indication and Why)

Medication Action Indication Rationale for

(ATS) Anti Classification: tetanus Tetanus 1st line treatment

Paracetamol Classification: Central Fever reduction. Common

Omeprazole Classification: Gastro- Duodenal and gastric The patient

H+, K+-ATPase enzyme endocrine adenomas, and decreasing

Tetanus Toxoid Classification: Anti- This vaccine is given to Tetanus toxoid

Booster injections may be

Booster injections should

Anticonvulsant; short-term relief of anxiety experiencing

Assessment Diagnosis Planning Intervention Rationale Evaluation

apx. 10 mins. symptoms of elevated helps

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