Tetanus

Tetanus is an infection caused by a bacterium called Clostridium tetani. 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.

Time from exposure to illness

The incubation period — time from exposure to illness — is usually between 3 and 21

days (average 8 days). However, it may range from 1 day to several months, depending on

the kind of wound. Most cases occur within 14 days.

Prognosis of Tetanus

The prognosis generally depends on incubation period and the time from first

symptom to first muscle spasm. In general, if symptoms develop and progress rapidly, the

prognosis is worse. But with treatment, patients usually survive tetanus and recover

Types of Tetanus

1. Localized tetanus - a persistent contraction of muscles at the site of injury that can

persist for weeks. This type is uncommonly fatal; however, it can progress to the

generalized form of tetanus, which is more life-threatening.

2. Generalized tetanus - most common form of tetanus, occurring in approximately

80% of cases

3. Neonatal tetanus - a form of the disease that occurs in newborns. A newborn’s

umbilical cord stump, the part that’s left after the cord is cut, can become

contaminated. Most infants who get this form of the disease die. This form occurs
 very rarely in developed countries. Neonatal tetanus is particularly common in rural

areas where most deliveries are at home without sterile procedures

4. Cerebral/Cephalic tetanus - limited to the muscles and nerves of the head. Cephalic

tetanus occurs most commonly after head trauma such as a skull fracture, head

laceration, eye injury, dental procedures, otitis media, or from another injury site.

Other cranial nerves can also be affected. These findings can lead to further

complications such as broncho-aspiration, paralysis of respiratory and laryngeal

muscles, and respiratory failure. This type can also progress to generalized tetanus.

Medical, Surgical & Nursing Management

Medical Management

1. Diagnostic test- diagnosis of tetanus is clinical with no particular laboratory test. Key

features to note when diagnosing tetanus include acute onset and muscle contractures

with generalised spasms without any other medical cause. Some patients can recall a

history of injury, but not all.

○ Spatula test- has been described before shows high specificity and sensitivity

for the clinical diagnosis of tetanus. This involves using a soft-tipped

instrument to touch the posterior pharyngeal wall. If this elicits an involuntary

jaw contraction instead of the normal gag reflex, this suggests a positive test.

2. Tetanus Vaccine- Tetanus toxoid is given as part of the combination vaccine known

as DTaP (Diphtheria, Tetanus, and Pertussis) in childhood and Tdap (Tetanus,

Diphtheria, and Pertussis) in adolescence and adulthood. Protection from the tetanus

vaccine does not last a lifetime, which is why people should get booster shots every

10 years.
- Pregnant women should receive the tetanus vaccine during the pregnancy (and any

following pregnancies). This reduces the risk of neonatal tetanus infection by 94

percent.

3. Wound care and debridement- after cleaning the wound thoroughly, debridement of

infected and dead tissue is intended to reduce the number of spores and limit the

extent of the disease.

4. Tetanus immunoglobulin (TIG)- a key component of treatment to neutralize the

tetanus toxin and prevent its further effects. TIG also shortens the course of illness

and may help in reducing the severity. A dose of 500 U, either intramuscular or

intravenous, is effective.

5. Supportive management- In moderate or severe cases, patients should be intubated.

Mechanical ventilation is essential when neuromuscular blockade is required to

control muscle spasms that impair respirations

6. Medications
 I. Antibiotics therapy:

A. Purpose: To control bacterial infection and inhibit the growth of

Clostridium tetani.

B. Commonly used antibiotics: Metronidazole or penicillin G

C. Administration: Given intravenously (IV) or intramuscularly (IM).

II. Muscle Relaxants:

A. Purpose: To alleviate muscle spasms and prevent muscle rigidity.

B. Commonly used muscle relaxants: Diazepam (Valium) or baclofen.

C. Administration: Given orally or intravenously.

III. Sedatives:

A. Purpose: To provide sedation and reduce anxiety associated with

muscle spasms.

B. Commonly used sedatives: Midazolam or lorazepam.

C. Administration: Given orally or intravenously.

IV. Analgesics:

A. Purpose: To manage pain associated with muscle spasms.

B. Commonly used analgesics: Acetaminophen or opioids (caution is

needed due to potential respiratory depression).

C. Administration: Given orally or intravenously.

Surgical Management

Surgical management is not the primary approach for treating tetanus, as the condition

is caused by a neurotoxin produced by the bacterium Clostridium tetani rather than a

localized infection requiring surgical intervention. However, in some cases, surgical

procedures may be necessary to address complications or associated issues.

 - Wound Debridement:

- While wound debridement is typically performed as part of initial wound care,

in some cases, extensive or deep wounds may require additional surgical

debridement to remove damaged or infected tissue.

- Abscess Drainage:

- If an abscess develops at the site of the wound, surgical drainage may be

necessary to remove pus and infected material.

Nursing Management

1.Assessment:

○ Perform a thorough assessment of the patient's overall health, vaccination

history, and the nature of the wound.

○ Monitor vital signs, including respiratory status, blood pressure, heart rate, and

temperature.

2. Wound Care:

○ Clean and dress wounds according to medical orders.

○ Assist with wound debridement procedures as directed by healthcare

providers.

○ Monitor for signs of infection or abscess formation.

3. Tetanus Immunoglobulin (TIG) Administration:

 ○ Administer tetanus immunoglobulin as prescribed by the healthcare provider.

○ Ensure accurate documentation of TIG administration, including site, dose,

and time.

4.Respiratory Support:

○ Monitor respiratory function closely, as tetanus can lead to respiratory muscle

spasms.

○ Collaborate with respiratory therapists to provide appropriate support,

including oxygen therapy

5. Muscle Spasm Management:

○ Administer medications to manage muscle spasms and pain.

○ Provide comfort measures such as repositioning and warm compresses

6. Safety Measures:

○ Implement safety measures to prevent injury during episodes of muscle

spasms.

○ Use appropriate restraints if necessary, ensuring they are applied safely and

with consideration for the patient's comfort.

7. Patient Education:
 ○ Educate the patient and their family about tetanus, the importance of

completing the vaccination series, and wound care at home.

○ Emphasise the need for follow-up care and monitoring.

https://www.everydayhealth.com/tetanus/guide/

https://www.ncbi.nlm.nih.gov/books/NBK459217/

https://www.uptodate.com/contents/tetanus#H1