Nursing Care Plan for Tetanus

Nursing Assessment for Tetanus


History of present illness: the existence of serious injuries and burns and inadequate immunization.

  • Respiratory System: dyspnea, and cyanosis asphyxia due to contraction of the respiratory bibs.
  • Cardiovascular System: dysrhythmias, tachycardia, hypertension and bleeding, the body temperature initially 38-40 ° C or febrile up to the terminal 43-44 ° C.
  • Neurologic System: irritability (early), weakness, convulsions (late), paralysis of one or several nerves of the brain.
  • Urinary System : urine retention (bladder distention and no urine output / oliguria)
  • Digestive System: constipation due to no bowel movements.
  • Integument and muskuloskletal System: tingling at the site of wound pain, sweating (hyper-hydration), was originally preceded trismus, spasm of the facial muscle contractions to increase the eyebrows, risus sardonicus, stiff muscles and difficulty swallowing.
  • If this continues there will be a status of general convulsions and seizures.
Source : http://nursing-assessment.blogspot.com/2012/05/nursing-assessment-for-tetanus.html

Nursing Diagnosis for Tetanus

Nursing Diagnosis for Tetanus

1. Ineffective airway clearance

2. Ineffective Breathing Pattern

3. Hyperthermia

4. Altered Nutrition: Less than body requirements

5. Risk of fluid and electrolyte imbalance

6. Risk for injury

7. Knowledge deficient

8. Disturbed sleep pattern

Source : http://nandanursingdiagnosis.blogspot.com/2012/05/nursing-diagnosis-for-tetanus.html

Hyperthermia Nursing Care Plan for Tetanus

Nursing Care Plan for Tetanus - Nursing Diagnosis : Hyperthermia and Interventions Hyperthermia Definition: The body temperature rises above the normal range. Characteristics : Increase in body temperature above the normal range Attacks or convulsions (seizures) Skin redness Increase respiratory rate Tachycardia Hands felt warm to the touch Tetanus is an infectious disease which is caused due Clostridium tetani bacterium. Tetanus is transmitted through the environment and not from person to person contact....

Ineffective Airway Clearance Nursing Care Plan for Tetanus

Tetanus is caused by gram positive, obligate anaerobic bacteria: Clostridium tetani which affects skeletal muscles."Gram positive" means that the bacteria has a thick cell wall, while "obligate anaerobe" means that the bacteria can't survive in the presence of oxygen and survive using anaerobic respiration (without oxygen). Causes: Bacterium Clostridium tetani. Contamination of a puncture wound, e.g.: a piercing. Ear infections as bacteria may enter through ear.Using unsterile equipment in surgery or other similarly invasive...

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