Botulism is a bactera caused disease. This botulism can appear in world wide. It often attacks adults than children. Then you have to know how to do right botulism nursing care, in case you are a nurse. Let’s have a deep look of botulism.
Why Do We Should Care about Botulism?
People may think that this is not a serious disease. In fact, the mortality of botulism is about 5-10%, and death can be caused by respiratory failure for first week after the disease occurred. So, we should aware of it, and prevent it well.
Have you ever heard of Botulism? Botulism is a paralytic disease that is caused by exotoxin from positive-gram basil and anaerobe, it is Clostridium botulinum. Yes, bacteria! This disease types are as a ptomaine poisoning botulism, wound botulism, and infant botulism.
- Ptomaine poisoning: consuming contaminated food or uncooked food
- Infant Botulism: colonized C. botulinum in gastro intestine tract from many unknown sources, and exotoxin is produced in the intestine.
- Wound Botulism: open wound with C. botulinum infection that secrets toxins.
Sign and Symptoms
- The disease starts in 12 to 36 hours (about 6 hours to 8 days) after the patient consumed contaminated food. The severity is varied depend on toxin amount and immune competence degree (the attack in 24 hours is signed critical and fatal disease)
- Acute symmetric cranial nerve damage (signed by ptosis, diplopia, and dysarthria) , followed by muscle weakness or paralysis in extremities or body part, and dyspnea because of respiratory muscle paralysis. This damage influences mental or sensory status, and it has no fever.
- Dry mouth
- Sore throat
Botulism usually attacks 3-20 weeks babies; it can cause baby hypotonic syndrome (floppy) that is signed by:
- Cranial nerves deficits that involve weak face expression, ptosis, and oftalmophlegia.
- Suppressed gag reflex
- General muscle weakness
- Unable in breast-feeding
- No head control
- Respiratory deficits
Please read this for symptoms of botulism in detail
Diagnosis Examination Before The Nursing Care
- Exotoxin identification in serum, feces, or gastric content can be done, include the food sample.
- Electromyogram shows muscle weakness caused by single supraximal nerves stimulus decrease.
The diagnosis must eliminate botulism-like condition like Guillain-Barre syndrome, myasthenia gravis, stroke, staphylococcus ptomaine poisoning, tick paralysis (flea-like), chemical intoxication, fish poisoning, trichinosis and diphtheria.
- If patient with ptomaine poisoning: botulinum antitoxin
- Infant botulism needs supportive care because the antitoxin and antibiotic is not work well, and human botulism globulin was being developing.
- Antibiotic and aminoglycoside should not be administrated because it can increase neuromuscular inhibitor. Those medicines should be administrated for secondary infection only.
Botulism Nursing Care
Prevention in Botulism Nursing Care:
- Ask patient to get information about right technique in foods processing and storing.
- Remind the patient to avoid puffed canned-foods (although the taste is still nice) or smelly foods, and know how to sterilizing dishes (by boiling it) that has contacted with botulism contamination. Remember the small contamination can be fatal.
If the contaminated food has already digested:
- Get right history of food intake of patient last days. Check and assess the family member that has similar symptoms and foods.
- Assess the neurology abnormality. If the patient is ready to come home, ask the family to be aware of patient’s symptoms that can appear like weakness, blurry vision, and talking problems. Suggest the family to report it to medical health facility soon.
- If patient has consumed contaminated foods since last hours, help patient to puke it, do gastric lavage, and give a laxative to clean toxin inside the intestine.
If the sign and symptoms of botulism have appeared:
- Bring the patient to intensive care unit for monitoring cardiac and respiratory condition.
- Give botulinum antitoxin as needed to neutralize all of circulated toxin in blood stream. Before antitoxin administration, read the patient’s medical report about the allergy toward antitoxin, especially horse allergy, and do skin test.
- Take serum sample to identify toxin before antitoxin administration
- After antitoxin administration, look at anaphylactic or hypersensitivity and serum disease. Always provide epinephrine 1:1.000 (for subcutaneous) and CPR equipment.
- Assess the neurology status include bilateral motoric function (reflex and muscle movement)
- Give intravenous fluid based on patient’s need. Manage patient’s position, and suggest the patient to do deepbreath. The patient may need respiration aid.
- Patient does not need to be isolated.
- Because of botulism makes fatal condition, give the information about it to the patient and his/her family.
Inform immediately to public health workers about botulism cases.