Tetanus

Question 1

What is tetanus?

Answer 1

It is an acute, often fatal neurologic disease caused by the toxins produced by Clostridium tetani

Rare in the US

Question 2

What are the s/s?

Answer 2

• increase muscle tone and spasm
• headache
• crankiness
• cramping of the jaw (lockjaw) followed by difficulty swallowing and a stiff neck
• seizures may result
• fever along with an elevated BP and HR
• opisthotonos (spasm of the muscles causing backward arching of the head, neck, and spine, as in severe tetanus, some kinds of meningitis, and strychnine poisoning.)
• fractures d/t spasms or muscle contractions

Question 3

How is tetanus transmitted?

Answer 3

• C. tetani spores can live anywhere but are found most commonly in soil, dust, and feces from humans or animals, such as sheep, cattle, chickens, dogs, cats, and rats. The spores can enter the body through a wound that is contaminated, through a burn, or by injecting contaminated street drugs. Once it enters the body, an anaerobic environment allows it to multiply and a poisonous toxin is released.
• not contagious so standard precautions are okay

Question 4

What are the 4 forms of tetanus?

Answer 4

1. Neonatal Tetanus: most common, d/t infected umbilical stump or unsterile surgical technique during circumcision in infants who’s mothers were poorly immunized
2. Local Tetanus: This rare form is characterized by local muscle spasms within the area of the wound
3. Cephalic Tetanus: associated with recurrent otitis media or head trauma. It is also rare and affects the cranial nerves, especially facial nerves.
4. Generalized Tetanus: is the most common and severe form and in half of patients will present with trismus (masseter muscle spasm or lockjaw) (CDC, 2015). Symptoms then progress in a descending fashion with tonic contraction of the skeletal muscles and intermittent intense, painful muscular spasms. The most profoundly affected muscles are those of the neck and back.

Question 5

What are the complications for tetanus if not treated?

Answer 5

breathing problems, fractures, elevated blood pressure, dysrhythmias, clotting in the blood vessels of the lung, pneumonia, and coma

Question 6

What are the diagnostic tests performed?

Answer 6

The diagnosis of tetanus is based on the clinical findings of the history and physical examination. There is no laboratory test to confirm tetanus.

Question 7

Nursing Management and Treatments

Answer 7

Interventions:
- observe for signs of respiratory distress
- Provide a quiet environment with reduced external stimuli to decrease the incidence of spasms.
- Appropriately manage pain.
- Encourage adequate nutrition and hydration.
- Instructing parents on proper wound care can also help prevent tetanus. All wounds should be cleaned thoroughly and a proper antiseptic used. If a wound is deep and contamination is suspected, the child should be seen by a physician or nurse practitioner

Tx:
- Administer sedatives and muscle relaxants as ordered to reduce the pain associated with the muscle spasms and to prevent seizures.
- booster every 10 yrs
- If it has been more than 5 years since the last tetanus dose, a booster may be needed. This can help to neutralize the poison and prevent it from entering the nervous system.