Tetanus

Tetanus
Description:

Tetanus is an infectious disease caused by Clostridium tetani, which produces a potent exotoxin with prominent systemic neuromuscular effects. Tetanus is fatal in up to 60% of unimmunized persons, with death occuring usually within 10 days of onset. When symptoms develop within 3 days, the prognosis is poor.

Tetanus
Causative Agent:

The causative organism of the disease is Clostridium Tetani with the following characteristics: 1.) Anaerobic, gram (+) 2.) Releases 2 types of toxin: a.) Tetanospasmin b.) Tetanolysin

Tetanus
Signs and Symptoms: If tetanus remains localized, signs of onset are spasm

and increased muscle tone near the wound If it becomes systemic or generalized, signs include: -Hypertonicity, hyperactive deep tendon reflexes, tachycardia, profuse sweating, low-grade fever and painful involuntary muscle contractions -Neck and facial muscle rigidity

Tetanus
- Grinning expression(ricus sardonicus) - Board-like abdomen/ abdominal rigidity - Opisthotonos - Intermittent tonic convulsions - Laryngospasms - Fracture of the vertebrae In mild cases, after a period of weeks, spasms gradually diminish in frequency and severity, with trismus being the last symptom to disappear.

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In fatal cases, death usually occurs during the first 10

days of the disease.

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Incubation Period/ Communicability:

The incubation period is four to twenty days.

Normally, the mode of transmission is through punctured wounds contaminated by dust, soil or animal excreta containing Cl. Tetani.

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Treatment: Specific

a. Within 72 hours after a punctured wound, the

patient should receive ATS, especially if the patient does not have any previous immunization (5000 units of tetanus immune globulin) b. Tetanus toxoid, 0.5cc IM, given on standard schedule c. Pen G Na , Diazepam d. Muscle relaxant

Tetanus
e. wound debridement f. give TIG 1-2 hours before debridement g. endotracheal intubation and mechanical ventilation Non-specific a. Oxygen inhalation b. NGT feeding c. Tracheostomy d. Adequate fluid, electrolyte and caloric intake

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Nursing Mgt:

Maintain an adequate airway

Provide cardiac monitoring Maintain IV line for medication and emergency

care, if necessary Carry out efficient wound care Prevent contractures and pressure sores Watch out for urinary retention

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Closely monitor vital signs and muscle tone Provide optimum comfort measures Place patient in semidark environment

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Common Nursing Dx: Altered nutrition: less than body nutrition Impaired physical mobility

Activity intolerance
High risk for infection/complication

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Prevention and Control a. Active immunization with tetanus toxoid for adults

and pregnant women. b. DPT for babies and children

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