tetanus, BSc nursing

1. Presented by
Prajnya Elinar Digal
M.Sc (N)Tutor

2. OBJECTIVES
At the completion of the class will be able to :-
• Define tetanus
• Explain epidemiology
• Describe cause
• Enumerate sign and symptoms
• Explain pathophysiology
• Describe complication and management and nursing
management.

3. INTRODUCTION
• An acute disease induced by the
exotoxin of clostridium tetani
and clinically characterized by
muscle rigidity which persists
throughout illness due to rigidity
of muscle of neck and face
,difficulty in opening the
mouth,it is also called lockjaw.

4. EPIDEMIOLOGY
Agent factor:
• Agent- cl.tetani is a gram-positive,anaerobic,spore-
bearing organism.
• Reservoir of infection: soil and dust, found in
intestine of many animals-cattle, horses,goats and
sheep and are excreted in their feces, this spores
survive for years in nature.

5. Host factor:
• Age-5-40 years
• Sex-incidence more in male than female.
• Occupation-agricultural workers.
• Rural –urban defferences: the incidence is much lower in
urban then rural
• Immunity: no age is immune unless protected by previous
immunization.2 injection of tetanus toxoid is highly effective
and lasts for several year.

6. ENVIRONOENTAL AND SOCIAL
FACTORS:
• Tetanus is a positive environmental hazard.its
occurance depends upon man’sphysical and
ecological surroundings.
• MODE OF TRANSMISSION:Infection is acquired by
contamination of wound with tetanus spores.
• Injuries
• Accidents
• Trivial pin pricks

7. Cont…
• Skin abrasion
• Puncture wound
• Burn
• Human bites
• Animal bites and stings
• Unsterile surgery
• Incubation period-6-10 days
• But it may vary from one day to months also.

8. Causes
• Spores of the bacteria that cause tetanus, Clostridium tetani, are found in
soil, dust and animal feces.
• When they enter a deep flesh wound, spores grow into bacteria that can
produce a powerful toxin, tetanospasmin, which impairs the nerves that
control your muscles (motor neurons).
• The toxin can cause muscle stiffness and spasms — the major signs of
tetanus.
• Nearly all cases of tetanus occur in people who have never been
vaccinated or adults who haven't kept up with their 10-year booster shots.
• You can't catch tetanus from a person who has it.

9. RISK FACTOR
• Failure to get vaccinated or to keep up to date with
booster shots against tetanus
• An injury that lets tetanus spores into the wound
• A foreign body, such as a nail or splinter

10. Pathophysiology

11. CILNICAL MENIFESTATION
 Signs and symptoms of tetanus
appear anytime from a few days
to several weeks after tetanus
bacteria enter your body through
a wound.
 The average incubation period is
seven to 10 days.

12. TYPE
According to the cause of disease tetanus is
• TRAUMATIC
• PUERPERAL
• OTOGENIC
• IDIOPATHIC
• TETANUS NEONATORUM

13. DIAGNOSTIC TEST
Laboratory Studies
• Blood counts and blood chemical findings are unremarkable. Laboratory studies
may demonstrate a moderate peripheral leukocytosis.
• A lumbar puncture is not necessary for diagnosis. Cerebrospinal fluid (CSF)
findings are normal, except for an increased opening pressure, especially during
spasms.
• Serum muscle enzyme levels (eg, creatine kinase, aldolase) may be elevated.
• An assay for antitoxin levels is not readily available. However, a serum antitoxin
level of 0.01 IU/mL or higher is generally considered protective, making the
diagnosis of tetanus less likely (though rare cases have been reported to occur
despite the presence of protective antitoxin levels)

14. Cont…
• Wounds should be cultured
• Spatula Test
• Imaging studies of the head and spine reveal
no abnormalities.

15. COMPLICATION
• Broken bones
• Blockage of a lung artery (pulmonary
embolism)
• Death

16. OTHER COMPLICATIONS
• Severe stomach ulcer
• Respiratory emboli
• Arrhythmia

17. PREVENTION

18. • Children should be provided active immunity through DPT
vaccination according to the immunization schedule.
• Pregnant women should be given two injections of tetanus
toxoid.
• In unvaccinated persons, if there are wound or open injuries,
tetanus immunoglobulin should be given within 72 hours.
• Any open wound should be washed with 3% hydrogen peroxide
(H2O2) and dressed with clean dressing.
• Aseptic is used in surgical procedure and delivery. Personal
hygiene should also be taken care.

19. TREATMENT
Mild cases of tetanus can be treated
with:
• tetanus immunoglobuli (TIG), also
called tetanus antibodies or tetanus
antitoxin.
• It can be given as I.Vor I.M.
• metronidazole IV for 10 days
• diazepamoral

20. OTHER TREATMENT
Medications
• Antitoxin. Your doctor may give you a tetanus antitoxin, such as tetanus immune
globulin. However, the antitoxin can neutralize only toxin that hasn't yet bonded to
nerve tissue.
• Antibiotics
• Vaccine
• Sedatives. Doctors generally use powerful sedatives to control muscle spasms.
• Other drugs. Other medications, such as magnesium sulfate and certain beta
blockers, might be used to regulate involuntary muscle activity, such as your
heartbeat and breathing. Morphine might be used for this purpose as well as
sedation.

21. Supportive therapies
• Severe tetanus infection often requires a long stay
in an intensive care setting. Since sedatives can
inhibit breathing, you might temporarily need a
ventilator.

22. • History of present illness: a severe injury, burns
and inadequate immunization.
• Respiratory System: dyspnea, cyanosis and
asphyxia due to respiratory muscle contraction.
• Cardiovascular System : dysrhythmias,
tachycardia, hypertension and bleeding, initially
the body temperature 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.
Nursing management

23. Cont….
• Urinary System : urinary retention (bladder distension
and urine output does not exist / oliguria)
• Digestive System: constipation due to no bowel
movements.
• Integument and muskuloskletal System: pain, tingling
at the site of injury, sweating, initially trismus, muscle
spasms face with increasing contraction eyebrows,
risus sardonicus, stiff muscles and difficulty
swallowing.
• If this continues there will be the status of general
convulsions and seizures.

25. SUMMARIZATION