TETANUS

• Tetanus


  An acute illness caused by toxin of the tetanus bacillus
• Other Term


  Lock Jaw
• Tetanus


  • It is usually systemic; less commonly, it is localized
• Etiologic Agent


  Clostridium tetani
• Source of Infection


  • Soil
  • Feces
• Mode of Transmission


  1. Transmission occurs when spores are introduced in the body through

  2. Dirty wound

  3. Injecting drug use

  4. Abdominal surgery
• Incubation Period


  3 to 21 days depending on the site of the wound and the extent of contamination
• Clinical Manifestation


  • Localized:
  • Spasm
  • Increased muscle tone in the wound
  • Generalized:
  • Marked muscles hypertonicity
  • Hyperactive deep tendon reflexes
  • Tachycardia
  • Profuse sweating
  • Low-grade fever
  • Painful, involuntary muscle contractions:
  • Neck and facial muscles
  • Lockjaw (trismus)
  • Painful spasms of masticatory muscles
  • Difficulty opening the mouth
  • Risus sardonicus
  • Arched-back rigidity
  • Board-like abdominal rigidity
  • Intermittent tonic seizures lasting several minutes, which may result in cyanosis and sudden death by asphyxiation
• Diagnostic Tests


  • Clinical features
  • Blood cultures and tetanus antibody tests are often negative, only a third patients have a positive wound culture
  • Cerebrospinal fluid pressure may rise above normal
• Treatment Modalities


  • Drainage of ski abscesses
  • Administration of antibodies
  • Metronidazole (first-line agent)
  • Pen G
  • Administration of tetanus immunoglobulin (TIG)
  • Sedatives
  • Patients with severe, generalized or rapidly progressing muscle spasm should be intubated sedated and paralyzed if necessary
  • Manage autonomic instability
  • Labetalol
• Complications


  • Atelectasis
  • Pneumonia
  • Pulmonary emboli
  • Acute gastric ulcers
  • Seizures
  • Flexion contractures
  • Cardiac Arrhythmias
• Nursing Management


  • Maintain an adequate airway and ventilation to prevent pneumonia and atelectasis
  • Suction often and watch for signs of respiratory distress
  • Maintain an IV line for medications and emergency care, if necessary
  • Monitor for arrhythmias
  • Record intake and output accurately and check vital signs often
  • Keep the patient's room quiet and dimply & Warm visitors not to upset or overly stimulate the patient
  • Give muscle relaxants
  • Perform passive-range-of-motion
  • Provide adequate nutrition to meet the patient's increased metabolic needs
  • Stress the importance of maintaining active immunization with a booster dose of tetanus toxoid every 10 years
  • Teach the patient or family about proper wound care