Tetanus
Definition
Tetanus is a neurological disorder characterized by increased muscle tone and spasm, caused by tetanospasmin, a potent protein toxin produced by Clostridium tetani. (Ismanoe, 2009 ; 2911)
Etiology
Tetanus is caused by the gram-positive bacillus, Clostridium tetani. These bacteria are ubiquitous, with their natural habitat in soil, but can also be isolated from pet and human feces.
Pathophysiology
Tetanus disease occurs by Clostridium tetani entering the body through wounds on the body such as wounds pierced by nails, broken glass or cans, burns, and in infants through the umbilical cord. The organism secretes two toxins, namely tetanospasmin / neurotoxin which is a strong toxin, can cause muscle tension and affect the central nervous system and tetanolysin which is a secondary toxin. The resulting ethotoxin will reach the central nervous system by passing through the neuro axons or the vascular system. These germs become bound to a nerve or nerve tissue and can no longer be neutralized by the specific antitoxic. However, the free toxin in the blood circulation is very easily neutralized by antitoxin. (Zulkoni, 2011 ; 167
Physical Examination for Clients with Nervous System Disorders - Tetanus
According to Muttaqin in his book entitled "Teaching Book of Nursing Care for Clients with Nervous System Disorders" it includes: anamnesis, disease history, physical examination and diagnostic examination.
Physical examination should be carried out per system (B1-B6) with a focus on physical examination on B3 (Brain) examinations that are directed and associated with complaints from clients.
B1 (Breathing)
Inspection: Does the client cough, sputum production, shortness of breath, use of accessory muscles to breathe and increase in respiratory frequency.
Palpation: Tactile premise balanced right and left.
Auscultation: Additional breath sounds such as rhonkhi due to increased production of secretions.
B2 (Blood)
Assessment of the cardiovascular system revealed hypoleemic shock.
Normal blood pressure, increased heart rate, anemia due to the destruction of erythrocytes.
B3 (Brain)
a) Level of consciousness
Composmentis, in advanced conditions decreased to lethargy, stupor and semicomatous.
b) Cerebral function
Experiencing changes in speech style, facial expressions and motor activity.
c) Examination of the cranial nerves
Nerve I: no abnormalities, normal olfactory function.
Nerve II: normal visual acuity.
Nerves III, IV and VI; for unknown reasons, the client has photophobia or is excessively sensitive to light.
Nerve V: increased massester reflex. Spiral mouth like a fish's mouth (a typical symptom of tetanus)
Nerve VII: normal taste, symmetrical face
Nerve VIII: no conductive and perceptual deafness were found.
Nerves IX and X: poor swallowing ability, difficulty opening the mouth (trismus).
Nerve XI: stiff neck obtained. Jaw and neck muscle tension (sudden).
Nerve XII: symmetrical tongue, normal sense of taste.
d) Motor system
Decreased muscle strength, balance control and coordination changes.
e) Check reflex
Deep reflex, tapping on tendons, ligaments, or periosteum reflex degree in normal response.
f) Involuntary movement
No tremors, tics, and dystonia were found. However, in certain circumstances generalized seizures occur, which are associated secondary to a sensitive cortical focal area.
B4 (Bladder)
Decreased urine output volume is associated with decreased perfusion and decreased cardiac output to the kidneys.
B5 (Bowel)
Nausea, vomiting due to increased stomach acid, lack of nutrition due to anorexia and seizures (stiffness of the stomach wall / stomach board).
Difficult bowel movements due to muscle spasm.
B6 (Bone)
Impaired mobility and activities of daily living due to generalized seizures.
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