1. TETANUS
FELIX K. NYANDE

2. TETANUS
An acute toxin mediated infectious disease of wounds characterised by muscular spasms and rigidity.
A very dangerous disease.
Caused by a bacterium called Clostridium tetani.

3. Sources of entry Dental infection Chronic otitis media
Intravenous drug use
Human and animal bites
Burns
Frostbite
Open fractures
Gunshot wounds
Unsafe abortions
Cord sepsis

4. PATHOPHYSIOLOGY
When the organism enters the body, it produces a necrosis and an exotoxin called tetanospamin. Toxin has a high affinity for nerve endings. TOXIN stimulates the nerve endings of the motor nerves causing spasms and convulsions. Also causes the blood cells to break down.

5. CLINICAL MANIFESTATIONS
Sudden onset with severe headache,
fever
malaise
Trismus [lock jaw]
Photophobia
Insomnia
Muscular rigidity
Convulsions
Risus sardonicus [sardonic grin]

6. Clinical manifestations cont’d
Opisthotonos [arching of the back]
Difficulty in swallowing
Respiratory distress
Spasms of the larynx
Cyanosis
Profuse sweating
Positive Babinski’s sign
Positive Kernig’s sign

7. INVESTIGATIONS
Wound swab for C/S
FBC
Blood culture

8. Management Medications Wound care: exercise rehabilitation
Anti-tetanus serum [ATS]
Tetanus toxoid [T.T.]
Antibiotics e.g. penicillins
Sedatives e.g. diazepam
Anticonvulsants e.g. phenobarbitone
Wound care:
dress wound with H2O2
wound debridement
exercise
rehabilitation

9. Nursing Management Isolation of patient
Nurse patient in a darkened room to prevent photophobia, over stimulation and spasms.
Ensure a quiet environment to prevent spasms
Mount side rails to prevent falling
Employ barrier nursing techniques
Suction p.r.n. to clear the airway

10. Rest: ensure adequate rest and sleep by
grouping nursing activities
limiting visitors
provision of comfortable bed
adequate ventilation
Quiet environment
Sedation
Manipulation of patient should done gently, usually with a warning before the procedure

11. Management cont’d Administer oxygen Administer prescribed I.V. fluids
An NG should be passed for feeding
Observation: v/s, fits, mental state, i/o etc.
Patient should be catheterised if incontinent
Change bed linen if soiled
Administer prescribed sedatives and anticonvulsants to control spasms

12. PREVENTION Education on the existence of tetanus and prevention
Farmers and people who work in the soil and sun should put on protective clothing
Mothers should be immunised against tetanus
Proper treatment of cuts and wounds to prevent them from getting infected
Deliveries should be done under aseptic conditions
Proper cord care to prevent infection
Adequate antibiotic cover after abortion
Health facilities should adopt proper infection prevention and control measures