Tetanus

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TETANUS
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Presented by Megietoh
Anuahetseh Pepime
(Bsc Nursing science)

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OUTLINE
 Introduction
 Transmission
 Clinical presentation
 Treatment
 Nursing management
 Prevention
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Introduction
• An estimated 34,700 tetanus deaths occurred worldwide, most in South Asia
and Sub-Saharan Africa and rarely reported
 More then half of neonatal deaths are due to neonatal tetanus
making it a crucial area for surveillance
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Introduction
 Tetanus 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.
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Transmission
 Tetanus bacilli form durable spores that occur in soil and animal
feces and remain viable for years. Spores of tetanus bacteria
are everywhere in the environment, including soil, dust, and
manure. The spores develop into bacteria when they enter the
body.
 Unlike other vaccine-preventable diseases, tetanus is not
spread from person to person.
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Transmission
 Tetanus bacteria are more likely to infect certain breaks in the
skin which include:
 Wounds contaminated with dirt, feces (poop), or saliva (spit)
 Puncture wounds (wounds caused by an object, like a nail or
needle, breaking the skin)
 Burns
 Crush injuries (injury to a body part due to pressure from another
object or being squeezed between two heavy objects)
 Injuries with dead tissue
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Transmission
 Tetanus bacteria can also infect someone’s body through breaks
in the skin caused by:
 Clean superficial wounds (when only the topmost layer of skin is
scraped off)
 Surgical procedures
 Insect bites
 Dental infections
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Transmission
 Compound fractures (an exposed broken bone)
 Chronic sores and infections
 Intravenous (IV) drug use
 Intramuscular injections (shots given in a muscle)
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Clinical Presentation
 The incubation period ranges from 2 to 50 days (average, 5 to
10 days)
 Most cases occur within 14 days. In general, shorter incubation
periods occur with more heavily contaminated wounds and more
serious disease.
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Clinical Presentation
 Tetanus infection can lead to serious health problems, including
being unable to open the mouth and having trouble swallowing
and breathing.
 People often call tetanus “lockjaw” because one of the most
common signs of this infection is tightening of the jaw muscles.
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Clinical Presentation
 Restlessness
 Irritability
 Stiff neck, arms, or legs
 Arching of the back (opisthotonos)
 Headache
 Sore throat / Trouble swallowing
 Tonic spasms
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Clinical Presentation
 Jaw cramping
 Sudden, involuntary muscle spasms — often in the stomach
 Painful muscle stiffness all over the body
 Seizures (jerking or staring)
 Fever and sweating
 Changes in blood pressure and heart rate
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Diagnosis
 By clinical evaluation
 Culture positive in 30% of cases(rarely done )
 Should be suspected in any patient with sudden unexplained
muscle stiffness or spasms, particular if he/she a history of a
recent wound or risk factors for tetanus.
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Diagnosis
 Distinguished from meningoencephalitis (bacterial and viral) by:
 Intact sensorium
 Normal cerebrospinal fluid
 Muscle spasms
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Diagnosis
 Localized tetanus:
 In localized tetanus, there is spasticity of muscles near the entry
wound but no trismus; spasticity may persist for weeks.
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Diagnosis
 Cephalic tetanus:
 Cephalic tetanus is a form of localized tetanus that affects the
cranial nerves. All cranial nerves can be involved, especially the
7th.
 It is more common among children; in them, it may occur with
chronic otitis media or may follow a head wound.
 Cephalic tetanus may become generalized.
 Incidence is highest in Africa and India.
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Diagnosis
 Tetanus Neonatorum:
 Tetanus in neonates is usually generalized and frequently fatal.
 It often begins in an inadequately cleansed umbilical stump in
children born of inadequately immunized mothers.
 Onset during the first 2 weeks of life is characterized by rigidity,
spasms, and poor feeding.
 Bilateral deafness may occur in surviving children.
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Diagnosis
 Cause of mortality
 Respiratory failure is the most common cause of death. Laryngeal
spasm and rigidity and spasms of the abdominal wall, diaphragm,
and chest wall muscles cause asphyxiation.
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Diagnosis
 Cause of mortality
 Hypoxemia can also induce cardiac arrest, and pharyngeal spasm
leads to aspiration of oral secretions with subsequent pneumonia,
contributing to a hypoxemic death.
 Pulmonary embolism is also possible. However, the immediate
cause of death may not be apparent.
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Treatment
 Wound debridement
 Respiratory support
 Spasms management
 Tetanus immunoglobulin / vaccine
 Antibiotics
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Wound debridement
 Aggressive
 Done immediately
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Respiratory support
 Mechanical ventilation may be required
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Muscle spasms
 Controlled with diazepam
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Antitoxin and toxoid
 Tetanus human Immunoglobulin 500 units IM
 50,000 units IM if animal origin
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Antibiotics
 Metronidazole is the recommended option
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Autonomic dysfunction
 Morphine
 Beta blockers
 Magnesium sulfate
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NURSING MANAGEMENT
 Assessment and Monitoring
 Monitoring for signs of muscle stiffness, spasms, and
rigidity, as well as any respiratory distress.
 Wound Care :will prevent further production of toxin
 Environmental factors that trigger spasm
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PREVENTION
 Immunization: Infants should receive diphtheria-pertussis-
tetanus(DPT), ATS for adults, TD for pregnant women.
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THANK YOU FOR LISTENING
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