The document discusses tetanus toxoid vaccine and patient positioning. It provides details on tetanus toxoid, including its history, mechanism of action, dosing schedule, administration site and side effects. It then covers various surgical positions like supine, prone and lithotomy, describing their uses and risks to the patient, such as pressure injuries or nerve damage. Patient safety and comfort are emphasized as goals of proper positioning during medical procedures.

3.  What is immunization & national EPI schedule.
 What is tetanus toxoid & history of tetanus toxoid
vaccine.
 What is ATS and its uses.
 What is dose and mechanism of action of TT vaccine.
 What is the Immunization schedule of TT and side
effects of vaccine.
 What is site of administration of vaccine and its
Booster dose.
 What are the positions of patients given during
hospital stay.
 Defining the patients positions as well as their risks.

4. is the process by which an
individual's immune system becomes
fortified against an infectious agent (known as
the immunogen).
 Active immunization is done by exposing a
human, or an animal, to an immunogen in a
controlled way, its body can learn to protect
itself: this is called active immunization.
 Passive immunization is direct introduction
of these elements into the body, instead of
production of these elements by the body
itself.

6.  Following vaccination, 95% of people are
protected from diphtheria, 80% to 85% from
pertussis, and 100% from tetanus. Globally
deaths from tetanus in newborns decreased
from 787,000 in 1988 to 58,000 in 2010, and
34,000 deaths in 2015 (a 96% decrease from
1988).
 In the 1940s, before the vaccine, there were
about 550 cases of tetanus per year in the
United States, which has decreased to about 30
cases per year in the 2000s. Nearly all cases
are among those who have never received a
vaccine, or adults who have not stayed up to
date on their 10-year booster shots.

7. It is an infection caused by bacteria
called Clostridium Tetani.
When these bacteria enter the body, they
produce a toxin that causes painful muscle
contractions.
Another name for tetanus is “lockjaw”.
It often causes a person's
neck and jaw muscles to
lock, making it hard to
open the mouth or swallow.

8. Tetanus antiserum was developed
in 1890, with its protective effects lasting
a few weeks. The tetanus toxoid vaccine
was developed in 1924, and
came into common use
for soldiers in World War II.
Its use resulted in a 96%
decrease in the rate of
tetanus.

9.  Toxoids are inactivated bacterial
toxins. They retain the ability to stimulate
the formation of antitoxins, which are
antibodies directed against the bacterial
toxin. ATS is a solution of purified
antibodies prepared from Equine Blood.
 The use of antitoxin gives protection for 1
to 3 weeks only. While tetanus vaccine
gives long time immunity and is cheaper
and practically free from reactions

10. Anti Tetanus Serum (ATS) Tetanus Toxoid (TT)
ATS is an anti-tetanus serum that can
be used for both prevention and
treatment of tetanus.
TT is a tetanus toxoid used for both pre and post-
exposure prophylaxis in tetanus. It is only used for
prevention.
It is obtained from hyperimmunized
horse blood.
It is gotten from an inactivated Clostridium tetani
toxin.
It has a faster onset of action than TT
Has low onset of action as it goes into the blood and
stimulates immunity. The body immunity will produce
antibodies against Clostridium tetani
1250 units are given, it is increased to 1500 units in
cases of wounds older than 24 hours
0.5 ml is given at different intervals
Passive immunity against tetanus in a tetanus-prone
wound.
Active immunization against tetanus, neonatal
tetanus, and tetanus-prone wound management

11.  INDICATION
Tetanus Antitoxin is used for prophylaxis and
treatment of Tetanus. Tetanus Antitoxin use is also
recommended in case of surgical operations
involving reopening of old scars, piles and fistule
and those in which fecal contamination is likely.
 ROUTE OF ADMINISTRATION
Either subcutaneous or intramuscular route of
administration.
• DOSAGE
Each dose is 1.0 ml

12.  Prophylactic Use:
 Tetanus antitoxin is given as prophylaxis to the persons at
risk with infected wounds, wounds contaminated with soil
or mud, deep or punctured wounds and wounds with
devitalizing tissue damages. A dose of 1,500 IU should be
given subcutaneously or intramuscularly as early as
possible after the wound is received. In severe wounds, the
dose may be doubled and the antitoxin injected in two or
three places around the wound.
 Along with prophylactic passive immunization, it is
advisable to initiate active immunization with adsorbed
Tetanus toxoid.
 Therapeutic Use:
 For therapy, large doses 100,000 - 200,000 IU of antitoxin
should be given very slowly by intravenous route followed
by smaller weekly doses intramuscularly as required. Some
physicians prefer a smaller initial dose of 20,000 IU or so
intramuscularly. Active immunization may be initiated when
the patient is cured of the illness.

13. Tetanus vaccine, also
known as tetanus toxoid (TT), is
a toxoid vaccine used to prevent tetanus.
It is on the World
Health Organization's
list of essential medicines.

14. During childhood, five doses are
recommended.
After three doses, almost everyone is
initially immune, but additional doses
every ten years are recommended to
maintain immunity.
A booster shot should
be given within 48 hours of
an injury to people whose
immunization is out of date.

15. Confirming that pregnant women
are up to date tetanus immunization
during each pregnancy can prevent both
maternal and neonatal tetanus.
The vaccine is very safe,
including during pregnancy and in those
with HIV/AIDS.

16. The type of vaccination for this disease is
called artificial active immunity. This type
of immunity is generated when a dead or
weakened version of
the disease enters the
body, causing immune
response which includes
Production of antibodies.
This is beneficial
because it means that if the disease is ever
introduced into the body the immune
system will recognize the antigen and produce
antibodies more rapidly.

17. Because DPT and TT are
administered to children less
than a year old, the recomme-
nded location for injection is the anterolateral
thigh muscle.
However, these vaccines
can be injected into the
deltoid muscle if necessary
in adults.

18. A bump results from a tetanus vaccine
injection.
Common side effects of the
tetanus vaccine include
Fever
Redness
Swelling with soreness or tenderness
around the injection site (one of five
people have redness or swelling).

19. Redness and pain at
the site of injection occur
in between 25% and 85%
of people.
Fever, feeling tired, and minor
muscle pain occurs in less than 10% of
people. Severe allergic reactions occur in
less than one in 100,000 people.

20. Booster shots are
important because lymphocyte production
(antibodies) is not at a constant high
rate of activity.
This is because after the
introduction of the vaccine
when lymphocyte production
is high, production activity
of white blood cells will start to decline. The
decline in activity of the T-helper cells means
that there must be a booster to help keep
the white blood cells active.

22.  Patient positioning is vital to a safe
and effective surgical procedure.
 Proper patient positioning in the
operating room depends on the type and
length of procedure, anesthesia access to
the patient, devices required and other
factors.
 All members of the surgical team
play a significant role in the process and
share responsibility for establishing and
maintaining the correct medical positions
for patients.

23.  Fowler's Position
 High Fowler's Position
 Supine Position
 Jackknife Position
 Kidney Position
 Prone Position
 Lithotomy Position
 Sim's Position
 Lateral Position
 Trendelenburg Position
 Reverse Trendelenburg Position

24. The goals of proper patient positioning
include:
 Maintain the patient's
airway and circulation
throughout the procedure.
 Prevent nerve damage.
 Provide comfort and safety to the patient.
 Prevent soft tissue or musculoskeletal injury.
 One of the main goals of proper patient
positioning is to keep the patient's body as
naturally aligned as possible while providing
the surgical staff access to the surgical site,
and quick, jerky movements should be
avoided.

25. Extrinsic factors may include pressure
intensity and duration and overall effects of
anesthesia.
Intrinsic factors can include the overall
health of the patient, and preexisting conditions such
as respiratory or circulatory disorders, diabetes
mellitus, anemia, malnutrition, advanced age, and
body size.
Additionally, the musculoskeletal system of the
patient may be subjected to stress during patient
positioning. When anesthetics and muscle relaxants
depress pain, pressure receptors and muscle tone,
the normal defense mechanisms cannot guard
against joint damage or muscle stretch and strain.

26. Fowler's position, also
known as sitting position,
is typically used for neuro
surgery and shoulder
surgeries.
The bed angle is between 45 degrees
and 60 degrees.
The beach chair position is used for nasal
surgeries, abdominoplasty, and breast
reduction surgeries.

27. In Fowler's position, the surgical
staff should maintain the head in a neutral
position. The patient's arms should be flexed
and secured across the body, the buttocks
should be padded, and the knees flexed 30
degrees.
RISKS
In Fowler's position, the patient is at an
increased risk for
Air embolism,
Skin injury from shearing and sliding,
and DVT forming in the patient's lower
extremities.

28. In High Fowler's position, the
patient is usually seated (Fowler's
position) at the head end of the operating
table.
The upper half of
the patient's body is
between 60 degrees
and 90 degrees in
relation to the lower
half of their body. The legs of the patient
may be straight or bent.

29. Supine position, also known as Dorsal
Decubitus.
In this reclining position,
the patient is face-up.
The patient's arms should
be tucked at the patient's
sides with a bed sheet, secured with arm
guards to sleds. The arms may be flexed
and secured across the body or extended
and secured on padded arm boards.

30. Supine position is commonly used for the
following procedures: intracranial, cardiac,
abdominal, endovascular, laparoscopic,
lower extremity procedures, and ENT, neck
and face.
RISKS
In Supine position, the patient may risk
pressure ulcers and nerve damage.
This position causes extra pressure on the
skin and bony prominences over the
occiput, scapulae, elbows, sacrum, coccyx
and heels.

31. Jackknife position, also known as
Kraske, is similar to Knee-Chest or Kneeling
positions and is often used for colorectal
surgeries.
This type of position
places extreme pressure
on the knees. While
positioning, surgical staff should place
extra padding for the knee area.

32. The kidney position resembles lateral
position, except the patient's abdomen is
placed over a lift in the operating table that
bends the body to allow access to the
retroperitoneal space.
A kidney rest is placed
under the patient at the
location of the lift.

33. In Prone position, the patient is face-
down with their head in a neutral position
without excessive flexion, extension or
rotation.
A face positioner is used
when the patient's head is
in midline. Prone position
is often used for spine and
neck surgeries, neurosurgery, colorectal
surgeries, vascular surgeries, and tendon
repairs.

34.  When a patient is in Prone, pressure should be
kept off of the eyes, cheeks, ears, and breast.
 At a minimum, four members of the surgical
staff should be available when turning a patient
prone.
RISKS
Risks associated with Prone position include
 Bleeding
 Increased Abdominal Pressures
 Compartment Syndrome
 Nerve Injuries
 Cardiovascular Compromise
 Ocular Injuries
 and Venous Air Embolism.

35. In Lithotomy position, the patient
can be placed in either a boot-style leg
holder or stirrup-style position.
This position is
typically used for
gynecology, colorectal,
urology, perineal, or
pelvis procedures..

36. While positioning a patient in this position,
surgical staff should avoid hyperabduction of
the patient's hips and leaning against their
inner thighs.
RISKS
The risks posed to a patient in a
Lithotomy position for a procedure include
 Fractures
 Nerve injuries
 Hip dislocation
 Muscle injuries
 Pressure injuries
 and Diminished lung capacity.

37. The Sims' position is a variation of the
left lateral position.
The patient is usually awake and helps
with the positioning.
The patient will roll to
his or her left side.

38. Body restraints are used to safely
secure the patient to the operating table.
Keeping the left leg straight, the patient will
slide the left hip back and bend the right
leg. This type of position allows access to
the anus.

39. A patient may be positioned in Lateral
position during back, colorectal, kidney,
and hip surgeries.
It's also commonly used during thoracic
and ENT surgeries, and neurosurgery.
Some variations
on this position include
Lateral Kidney, Lateral
Chest and Lateral Jack
-knife positions.

40.  In Lateral position, the patient may be
placed on either their left or right side
depending on the side
of the surgical site.
 A pillow or head
positioner should be
placed under the patient's head with the
depended ear assessed after positioning.
 The patient's physiologic spinal and neck
alignment should be maintained during the
procedure, and a safety restraint should be
secured across the patient's hips.

41. Risks to a patient in Lateral
position include pressure to points on the
dependent side of the body such as ears,
shoulders, ribs, hips, knees and ankles, as
well as
Brachial plexus injury,
Venous pooling,
Diminished lung capacity
and DVT.
A pressure-reducing OR mattress or
tabletop pad should be used as needed.

42. In Trendelenburg position, the
patient is supine on the table with
their head declined below their feet at
an angle of roughly 16°.
Trendelenburg position is typically used
for lower abdominal,
 Colorectal
 Gynecology
 Cardioversion
 Genitourinary surgeries
 and central venous catheter placement..

43.  In this type of position, the patient's arms
should be tucked at their sides, and the
patient must be secured to avoid sliding on
the surgical table.
 The Trendelenburg position should be
avoided for extremely obese patients.
Risks to a patient while in this position
include
Diminished lung capacity,
Diminished tidal volume
Pulmonary compliance,
Venous pooling toward the patient's head,
and sliding and shearing.

44. The Reverse Trendelenburg patients' hip
and knee are not flexed but the head and chest
are elevated at 30° than the abdomen and legs.
Reverse Trendelenburg
position is typically used
for laparoscopic, gallbla-
der, stomach, prostrate
,gynecology, bariatric and head and neck
surgeries.

45. Risks to a patient in this type of position
include
 Deep Vein Thrombosis,
 Sliding and Shearing,
 Perineal Nerve Injury
 and Tibial nerve Injury.
Padded foot boards should be used to
prevent the patient from sliding on the surgical
table and reduce the potential for injury to the
perineal and tibial nerves from foot or ankle
flexion.

46. Tetanus toxiod is the vaccine given for
the prevention of tetanus by producing
antibodies. Site of administration is
anterolateral thigh in children and deltoid
in adults. Where positioning the patients
is important in nursing by provide benefit
to the patients these positions also have
risks.