Tetanus

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Author:
japanice27
ID:
307062
Filename:
Tetanus
Updated:
2015-08-30 06:39:00
Tags:
tetanus lockjaw
Folders:
cdn
Description:
a review about tetanus disease
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  1. TETANUS:
    • -infectious disease cause by Clostridium tetani.
    • -(+) neuromuscular effects such as generalized spasmodic contraction of the skeletal musculator.
    • -poor prognosis (death: 10 days of onset)
  2. IP:
    • adults: three days to three weeks
    • NB: three to thirty days (tetanus neonatorum)
  3. E.A:
    • causative organism: Cl. Tetani
    • characteristics:
    • ~anaerobic, gram (+), with a round terminal spore and a slender body (drumstick appearance)
    • ~TWO FORMS: spore-forming and vegetative
    • ~the organism releases two types of toxins:
    • 1. tetanospasmin-responsible for muscle spasm.
    • 2. tetanolysin-responsible for destruction of RBCs
  4. Sources of infection:
    • -animal and human feces (organism are found in the intestinal wall of herbivorous animals, including man)
    • -soil and dust
    • -plaster of paris, unsterile sutures, pins and scissors and rusty materials
  5. MOT:
    • -punctured wound contaminated by dust, soil or animal excreta containing Cl. tetani.
    • -rugged, traumatic wound and burns
    • -umbilical stump of a NB (esp if delivered @ home)
    • -unrecognized wounds
    • -dental extraction, circumcision and ear piercing
  6. Pathogenesis:
    1. when Cl. tetani enters the body ⇒ local infection and tissue destruction

    2. multiplication of organism occurs frequently when the wound has healed. while reproducing, Cl. tetani also releases toxins that are absorbed by the bloodstream and lymphatics and directly by the peripheral motor nerves. these eventually spread in the CNS.

    3. tetanospasmin has strong affinity in the CNS tissue and spinal motor ganglia
  7. S/SX:
    • NEONATE:
    • -(+)feeding and sucking difficulties
    • -cry excessively (short, mild and voiceless)
    • -attempt to suck results in spasm and cyanosis
    • -(+) fever (infection and dehydration)
    • -jaw bone becomes thick and the baby cannot suck or swallow
    • -tonic or rigid muscular contractions, spasms or convulsions are provoked by stimuli
    • -(+)cyanosis and pallor
    • -severe cases: flaccidity, exhaustion and death

    • OLDER CHILDREN and ADULT:
    • -localized tetanus: (+) spasm and increased muscle tone near the wound.
    • -if systemic and generalized:
    • a. hypertonicity, hyperactive deep tendon reflexes, tachycardia, profuse sweating, low-grade fever and involuntary muscle contractions.
    • b. neck and facial muscle rigidity (trismus)
    • c. grinning expression (risus sardonicus)-pathognomic sign
    • d. board-like abdomen/ abdominal rigidity
    • e. opisthotonos
    • f. convulsions lasting for several minutes which may cause death due to asphyxiation
    • g. severe: larygospasm: (+) accumulation of secretion in the lower airways resulting in resp distress
    • h. fracture of the vertebrae may occur during severe spasm; yielding to coma and death
    • -mild cases: spasm gradually decreases; trismus is the LAST to disappear
    • -fatal cases: death occurs during the first 10 days of the disease
  8. COMPLICATION:
    • ~larygospasm involvement and resp muscle:
    • -hypostatic pneumonia
    • -hypoxia (decreased O2 and laryngospasm)
    • -atelectasis and pneumothorax
    • -traumatic glossitis and microglossia

    • ~symphathetic nervous sx:
    • -transitory hallucinosis
    • -hypersalvation, diaphoresis, tachycardia, esp with the use of aerosolized bronchodilators
    • -cardiac standstill and bradycardia

    • ~due to trauma:
    • -lacertion of the tongue and buccal mucosa
    • -IM hematoma
    • -fracture of spine and ribs

    ~septicemia
  9. TX:
    • SPECIFIC:
    • -within 72 hours: give ATS, TAT, or TIG (esp if pt has no previous immunization)
    • -TT: 0.5 cc IM
    • -Pen G Na to control infection
    • -muscle relaxant

    • NON-SPECIFIC:
    • -O2
    • -NGT
    • -tracheostomy
    • -adeqaute f&e and caloric intake
    • -adequate airway
    • -cardiac monitoring
    • -IV line
    • -wound care
    • -avoid stimulation: do not upset or overstimulate pt
    • -px contractures and pressure ulcers
    • -WOF urinary retention
    • -VS and muscle tone
    • -provide comfort
  10. Prognosis:
    • high fatality rates: very young and very old
    • good prognosis: (-) convulsion, local tetanus
    • resp obstruction and oversedation: death

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