Question

Read the following scenario:

J.T. has injured his hand at work and is accompanied to the emergency department (ED) by a co-worker. You examine his left hand and find a piece of a drill bit sticking out of the skin between the third and fourth knuckles. There is another puncture site about an inch below and toward the center of the hand. Bleeding is minimal. J.T. is 41 years old and has no significant medical history. He states the accident occurred when a mill at work malfunctioned and knocked his hand onto a rack of drill bits. His last tetanus booster was 12 years ago. It is your job to provide the initial care for J.T.'s injury.

The surgeon tells J.T. that he had to repair tendons in his third and fourth fingers and instructs J.T. that he is not to work until approval is given after he has been reevaluated. He gives J.T. prescriptions for ceftazidime (Ceptaz) and naproxen (Naprosyn). He instructs J.T. to make an appointment to see him in the surgery clinic in 2 days. The nurse provides patient teaching about the purpose of these medications, as well as how to take them and possible side effects.

Think through the following related to J.T.'s condition:

Etiology and pathophysiology

Risk factors

Signs and symptoms

Diagnostic procedures

Medication and treatment

Nursing interventions, including patient education

Potential complications

Answer 1

In the above case, injury with the drill piece can lead to infections like teranus and other infections due to bacterias present in the drill piece. Clostridium tetani which is a causative agent for tetanus lives in soil, dust and rusty materials. The bacteria may be present in the drill piece which increases chances for tetanus infection.

Clostridium tetani releases toxin that is transported from the site of infection to spinal cord. It affects the central inhibitory neurons. This leads to loss of motor inhibition causing uncontrolled autonomic hyperactivity. This leads to uncontrolled muscle contraction called muscle spam.

J.T. have not received tetanus vaccine dose on regular time intervals as well as the wound with infected drill piece increases the risk of tetanus and other skin infections.

Signs and symptoms include fever, headache, restlessness, irritability, swallowing difficulty, breathing difficulty. Tetanus causes strong muscle contractions known as tetany.

There are no specific diagnostic tests. Blood tests can be conducted for detection of toxins and bacteria. Spatula test is done to stimulate jaw muscle contraction.

Treatment includes wound care and antibiotic regime.

Nursing interventions include teaching the patient about importance of vaccination and immunization. Proper wound care and first aid needs to be taught to patient. Teach patient to look out for potential complications like muscle spasm, fever, CNS involvement like irritability, confusion.