TETANUS (Lock Jaw) • Tetanus is an infectious disease caused by Clostridium tetani which produces potent exotoxin with prominent

systemic neuromuscular efforts manifested by generalized spasmodic contractions of the skeletal musculator. Tetanus is fatal up to 60 percent of unimmunized persons, usually within ten days of onset. When symptoms develop within three days, the prognosis is poor

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Incubation period The incubation period is within three days to three weeks in adult and three days in Tetanus neonatorum. Etiologic agent The causative organism of the disease is Clostridium tetani with the following characteristics: 1. 2. 3. Anaerobic, gram (+) with round terminal spore with slender body giving a drumstick appearance. The organism comes in two forms, spore forming and the vegetative form. The organism releases two types of toxin: a. Tetanospasmin that is responsible for muscle spasm; and b. Tetanolysin that is responsible for destruction of RBC. Mode of transmission Normally, the mode of transmission is through punctured wound that is contaminated by dust, soil, or animal excreta containing Clostridium tetani. 1. Rugged traumatic wounds and burns delivered to mothers without Tetanous toxoid immunization 3. Unrecognized wounds (cleaning of the ears with sharp materials) 4. Dental extraction, circumcision, ear piercing Pathogenesis After Clostridium tetani enters the body, it causes local infection and tissue necrosis. While reproducing, they also release toxins that enter the bloodstream and the lymphatics and eventually spread into central nervous system, or absorbed by the motor nerve endings and passes up through the axon cylinder, to the anterior horn cells of the spinal cord. This stimulates contraction of the muscles supplied by the neurons which the toxin diffuses. 2. Umbilical stump in newborn especially for babies delivered at home with faulty cord dressing; babies

Older children and adult a. Hypertonicity. May end with flaccidity. spasm or convulsions provoked by stimuli g. Tonic or rigid muscular contraction. An attempt to sucks results in spasm and cyanosis d. Newborn infants have feeding and sucking difficulty b. profuse sweating. There is fever due to infection and dehydration e. after a period of weeks.Clinical Manifestation 1. The jaw becomes so stiff that the baby cannot suck or swallow f. death usually occurs during the first 10 days of the disease . low grade fever. tachycardia. laryngospasm followed by the accumulation of secretions in the lower airway resulting to respiratory distress due to involvement of respiratory muscles Fracture of the vertebrae may occur during severe spasm. Cyanosis and pallor i. most of the time voiceless crying c. indications include: • • • • • • • • c. and painful involuntary muscle contractions Neck and facial muscle rigidity (trismus) Grinning expression (risus sardonicus) – considered as pathognomonic sign of the disease Board-like abdomen/ abdominal rigidity Opisthotonus Intermittent tonic convulsions lasting for several minutes which may result in cyanosis and sudden death due to asphyxiation In severe cases. and finally death 2. In fatal cases. spasm gradually diminishes in frequency and severity with trismus being the last symptom to disappear d. The infant may cry excessively. short. If tetanus remains localized. Neonate a. voiceless cry h. signs of onset are spasm and increase muscle tone near the wound b. yielding to coma and death In mild cases. hyperactive deep tendon reflexes. Mild. exhaustion. If it becomes systemic or generalized.

Nonspecific • • • • • Oxygen inhalation Feed thru NGT Tracheostomy Adequate fluid.Complications 1. Due to trauma a. and caloric intake Good nursing care Avoidance of external stimulation . Hypostatic pneumonia b. Laceration of tongue and bucal mucosa b. the patient should receive ATS. Hypoxia due to laryngospasm and decreased oxygen c. electrolyte. Atelectasis d. Pneumothorax 2.5cc IM given in standard schedule Pen G Na to control infection Muscle relaxant to decrease muscle rigidity and spasm II. Septicemia Modalities of treatment I. TAT or TIG especially if they don’t have any previous immunizations Tetanus toxoid. Fracture of the spine and ribs 3. . Specific • • • • Within 72 hours after a punctured wound. Intramuscular hematoma c. Resulting from laryngospasm and involvement of respiratory muscle a.

- Prevention from further injury Maintain adequate airway Provide cardiac monitoring Maintain an IV line for medication and emergency care if necessary Carry out efficient wound care Avoid contractures WOF urinary retention Close monitoring on vital signs and muscle tone Provision of optimum comfort measures Provision of optimim comfort measures Prevention and control • • • Active immunization with tetanus toxoid for adult DPT for babies and children Early consultation and adequate wound care after an injury .

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