Botulism

Treatment-Activity

Bed rest

Overview-Causes

Clostridium botulinum bacteria

Assessment-Wound

Injury approximately 4 to 14 days prior Possible fever Heroin use

Nursing Considerations-Associated Nursing Procedures

Blood pressure assessment Health history interview and physical assessment IV bag preparation IV bolus injection IV catheter insertion Intake and output assessment Intramuscular injection Intubation with direct visualization Mechanical ventilation, positive pressure Nasogastric tube insertion Nasogastric tube monitoring Nasopharyngeal airway insertion and care Oxygen administration Pain management Parenteral nutrition administration Parenteral nutrition monitoring Pulse assessment Respiration assessment Stool specimen collection, random Venipuncture

Overview-Incidence

Botulism occurs worldwide. There's an average annual occurrence of about 154 cases in the United States. Males and females are equally affected with food-borne botulism; more men than women develop wound botulism.

Nursing Considerations-Nursing Diagnoses

Acute pain Imbalanced nutrition: Less than body requirements Impaired physical mobility Impaired swallowing Impaired verbal communication Ineffective airway clearance Ineffective breathing pattern Risk for injury

Diagnostic Test Results-Laboratory

An assay detects a toxin in the patient's serum, stool, or gastric contents and suspected food and containers.

Overview

Life-threatening paralytic illness Resulting from an exotoxin produced by the gram-positive, anaerobic bacillus Clostridium botulinum Occurring in various forms, including food-borne, infantile, wound, inadvertent, and possibly, inhalational (due to deliberate release of toxin) Mortality about 25%, with death most commonly caused by respiratory failure during the first week of illness Onset of disease within 24 hours after ingesting food signaling critical and potentially fatal illness

Assessment-Food-borne

Consumption of home-canned foods, prepared foods, or foods incubated in anaerobic conditions 12 to 36 hours (possibly as long as 14 days) before onset of symptoms Nausea and vomiting Malaise Dry mouth Constipation Urinary retention Muscle weakness Lack of fever

Treatment-Diet

Nasogastric feedings, if indicated Total parenteral nutrition, as necessary

Assessment-History

Consumption of home-canned foods, prepared foods, or foods incubated in anaerobic conditions 12 to 36 hours (possibly as long as 14 days) before onset of symptoms Nausea and vomiting Malaise Dry mouth Constipation Urinary retention Muscle weakness Lack of fever

Assessment-Physical Findings

Nausea Vomiting Dysphagia Extreme dry mouth (unrelieved by drinking fluids) Symmetric descending weakness or paralysis of motor and autonomic nerves Cranial nerve paralysis: ptosis, extraocular muscle paresis, dysphagia, and dilated pupils Postural hypotension

Overview-Complications

Aspiration pneumonia Respiratory failure Paralytic ileus Death

Nursing Considerations-Monitoring

Neurologic status, including deep tendon reflexes Cardiac and respiratory function Cough and gag reflexes Intake and output Arterial blood gas levels Appearance of wound if appropriate Nutritional status and GI function

Treatment-Surgery

Debridement of wounds to remove source of toxin-producing bacteria

Overview-Risk Factors

Eating improperly preserved foods Trauma involving soil contaminated with spores Using injectable street drugs

Diagnostic Test Results-Diagnostic Procedures

Electromyography shows diminished muscle action potential after a single supramaximal nerve stimulus, but results may be normal or nonspecific.

Treatment-Medications

Equine serum heptavalent botulism antitoxin Human botulism immune globulin for infantile botulism Penicillin G potassium or sodium or metronidazole I.V. as an adjunct in wound botulism; chloramphenicol or clindamycin phosphate as alternatives to penicillin Supplemental oxygen as appropriate

Nursing Considerations-Nursing Interventions

Obtain a history of food intake for the past several days. Obtain a family history of similar symptoms and food intake. Administer I.V. fluids as ordered to maintain fluid balance. Ensure a patent airway, and anticipate the need for insertion of an artificial airway or endotracheal intubation and ventilatory support if the patient has difficulty maintaining a patent airway. Administer oxygen based on oxygen saturation levels via pulse oximetry as needed to ensure adequate tissue perfusion. Encourage coughing and deep breathing. Assess the patient's level of consciousness and neurologic status. Perform NG suctioning as needed to remove ingested contaminated sources. Ensure patent I.V. access, and administer prescribed medications via I.V. as soon as readily available. Position the patient to maximize chest expansion; change the patient's position frequently to reduce the risk of pressure ulcers. Provide meticulous skin care, including wound care as ordered (for wound botulism). Work with physical therapy to promote range-of-motion exercises and assisted ambulation as tolerated. Provide safety measures to protect the patient from injury.

Patient Teaching-Discharge Planning

Refer the patient to support services. Refer the patient to possible physical therapy for exercise and muscle strengthening.

Treatment-General

Supportive measures Airway management; early tracheotomy and ventilatory assistance in respiratory failure Nasogastric (NG) suctioning if ileus is present

Overview-Pathophysiology

Toxins produced by the spores are absorbed from the stomach and small intestines. The toxins aren't broken down by the GI tract enzymes and spread via the blood stream, ultimately affecting the nervous, GI, endocrine, and metabolic systems. Endotoxin acts at the neuromuscular junction of skeletal muscle, preventing acetylcholine release and blocking neural transmission, eventually resulting in paralysis.

Nursing Considerations-Expected Outcomes

communicate feelings of comfort or reduced pain maintain daily calorie requirements return to his normal mobility level swallow without pain or difficulty demonstrate effective communication skills maintain a patent airway. Suction the airway as indicated. maintain tissue perfusion and cellular oxygenation remain free from signs and symptoms of injury.

Patient Teaching-General

disorder, diagnosis, causes, and treatment, including use of antitoxin therapy signs and symptoms of food-borne illness, including the need to notify a practitioner immediately proper techniques for preparing home-processed and home-preserved foods avoidance of purchasing canned foods that have bulging cans or jarred foods with popped lids need to avoid tasting or eating food from a bulging can or one with a peculiar odor proper technique for sterilizing utensils by boiling whatever utensils touched suspected contaminated food measures to care for wound, as indicated. signs and symptoms of wound infection and the need to notify a practitioner if any occur.