What are nursing implications of tetanus vaccinations?

Answer 1

Tetanus is not contagious between persons, so -- while normal medical prophylacsis should be maintained, no special procedures are required. Tetanus is a bacterium, Clostridium tetani, often found out of doors in soil or excrement, tending to prosper is damp, warm places. The epidemiology of tetanus is that it is easily preventable with vaccines, so it is far less common in financially advanced countries, and for more prevalent in countries that can't afford a widespread program of vaccination. Once contractred, C. tetani is frequently fatal, with 11% M&M in reported cases (which is actually misleading in that Europe and North American cases are rare and not as often fatal).

Tetanus attacks the skeletal and later the cardiac muscles (hence the name lockjaw). This makes is difficult to treat. Moderate cases can be treated with a 10-day course of Flagyl IV, using diazapam (push, PRN) to help, and of course, tetanus immune globulin adminsitered IV or IM.

Severe cases are handled in the ICU. The patient may not be able to breath for themselves, so intubation is a consideration, as is a continuous IV of diazapam as well as magnesium. Note also, lytes will almost certainly be abnormal as the disease runs its course. As this is a muscular effective, be prepared to handle rapidly changing hyper and hypotensive episodes.

Specific Nursing COnsiderations include:

• While a very dangerous disease, it's not (easily) communicable1.
• Lots of IV's in a convulsive patient spell trouble with sharps; be Very alert. Restraints are problematic in that the patient is not in control of the spasms, and so you cannot assume that pain will act to slow the patient down; be prepared for potental damage from restriants, if used.
• Cardiac and respiratory problems abound, so constant observation in severe cases is called for, even more than is usual in ICU's. Personally, I'd go with actual visual observation and not rely solely in telemetry.
• In addition to the anitbiotic, supportive, and diazepam lines, be aware ahead of time that this will present a confusing case in a logistic sense.
• As tetanus is far more prevalent in countries with rural populations and comparitively depressed economies, be prepared for the overall medical situation one encounters in such countries, e.g. supply issues, rarer diseases, nutritional issues, prophylacsis, language difficulties, different epidemiology, etc. To the extent that you can be, be prepared for supply shortages and do what you can to offset.
• Note that neonatal tetanus does in fact exist and should be a consideration in administering childbirths.

1 While all my text books tell me this disease is hard to contract in general, and cannot be contracted directly from the patient, I have to confess that I would be personally inclined to treat it as I would a blood-born pathogen in the way I'd handle the scene. I realize this is not in keeping with current views of this (in the West) rare disease. And I've never had direct experience with this disease.

Answer 2

Tetanus is not contagious between persons, so -- while normal medical prophylacsis should be maintained, no special procedures are required. Tetanus is a bacterium, Clostridium tetani, often found out of doors in soil or excrement, tending to prosper is damp, warm places. The epidemiology of tetanus is that it is easily preventable with vaccines, so it is far less common in financially advanced countries, and for more prevalent in countries that can't afford a widespread program of vaccination. Once contractred, C. tetani is frequently fatal, with 11% M&M in reported cases (which is actually misleading in that Europe and North American cases are rare and not as often fatal). Tetanus attacks the skeletal and later the cardiac muscles (hence the name lockjaw). This makes is difficult to treat. Moderate cases can be treated with a 10-day course of Flagyl IV, using diazapam (push, PRN) to help, and of course, tetanus immune globulin adminsitered IV or IM. Severe cases are handled in the ICU. The patient may not be able to breath for themselves, so intubation is a consideration, as is a continuous IV of diazapam as well as magnesium. Note also, lytes will almost certainly be abnormal as the disease runs its course. As this is a muscular effective, be prepared to handle rapidly changing hyper and hypotensive episodes. Specific Nursing COnsiderations include: * While a very dangerous disease, it's not (easily) communicable1. * Lots of IV's in a convulsive patient spell trouble with sharps; be Very alert. Restraints are problematic in that the patient is not in control of the spasms, and so you cannot assume that pain will act to slow the patient down; be prepared for potental damage from restriants, if used. * Cardiac and respiratory problems abound, so constant observation in severe cases is called for, even more than is usual in ICU's. Personally, I'd go with actual visual observation and not rely solely in telemetry. * In addition to the anitbiotic, supportive, and diazepam lines, be aware ahead of time that this will present a confusing case in a logistic sense. * As tetanus is far more prevalent in countries with rural populations and comparitively depressed economies, be prepared for the overall medical situation one encounters in such countries, e.g. supply issues, rarer diseases, nutritional issues, prophylacsis, language difficulties, different epidemiology, etc. To the extent that you can be, be prepared for supply shortages and do what you can to offset. * Note that neonatal tetanus does in fact exist and should be a consideration in administering childbirths. 1 While all my text books tell me this disease is hard to contract in general, and cannot be contracted directly from the patient, I have to confess that I would be personally inclined to treat it as I would a blood-born pathogen in the way I'd handle the scene. I realize this is not in keeping with current views of this (in the West) rare disease. And I've never had direct experience with this disease.

Answer 3

Prevention of diphtheria has four aspects: immunization, isolation of infected persons, identification and treatment of contacts, and reporting cases to health authorities.