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Summary
Botulism is a rare condition that can be quite fatal despite a noticeable lack of public knowledge. The most vulnerable part to botulism is the nerves, where the toxins are most lethal. Notably, the Centers for Disease Control and Prevention (CDC) has listed botulism as an agent of bioterror (Scruth & Schoenlein, 2020). The specific type of bacteria is called Clostridium botulinum and is responsible for the toxin (Rasetti-Escargueil, 2019). Two primary reasons can lead to the virus; a patient can either be infected through the food they have eaten or when they succumb to an injury and get a wound. Also, the condition can occur in infants when bacterial spores grow in their intestines. Other rare reasons include medical treatment or political reasons such as bioterrorism. Natural causes mostly affect infants and people with wounds, especially wounds that are not efficiently treated. Notably, botulism infections often occur and worsen due to inaccurate diagnoses by healthcare workers or laboratory technicians.
There are several forms of botulism, the most common being foodborne botulism. This form is where the lethal bacteria grows and manifests into toxins in an environment with little to no oxygen. For example, home-canned food is a potentially viable environment. Another form is wound botulism. When the bacteria manifest itself on a cut, the infection ranges from mild to lethal which can generate a toxin. The final form is infant botulism, the most generic way that people get infections. This form begins when spores of C botulinum bacteria start to show and grow in a baby’s intestinal tract (Rasetti-Escargueil et al., 2019). The form typically occurs in babies between two and eight months.
In some rare cases, the form of intestinal botulism affects adults. In some infrequent cases, botulism can be diagnosed when excessive toxins are injected cosmetic or medically. This is infrequent and is called iatrogenic botulism, and the medical term is iatrogenic, which is used to define an illness resulting from a medical exam or treatment. Nonetheless, all forms of botulism are fatal and considered medical emergencies. Over 100 cases are reported annually in the United States concerning botulism patients. Over 25% of cases are foodborne botulism, and the mean age of affected people is 46 years, ranging from 3 to 78 years. Gender is not a factor in botulism infection. Botulism’s mortality rate can be high if not diagnosed promptly and appropriately. The disease can be fatal in5 to 10% of cases (Lonati et al., 2020). Notably, early diagnosis leads to quick and effective treatment with minimal casualties.
Determinants of Health
Botulism toxin is a category A disease that the United Nations and the United States have recognized as a dangerous element. Governments and other terrorist groups have used botulism as a lethal weapon of terrorism and as part of their weapons and military programs. Nonetheless, botulism often occurs in patients naturally. According to Lonati et al. (2019), there are several determinants of health concerning botulism, including behavior, genetic behavior, medical care, environmental and physical influences, and social factors. The disease does not manifest in genetics based on genetic characterization (Lonati et al., 2019). Behavior does not directly cause botulism unless a wound is not treated. Additionally, environment and physical influences are not vital determinants concerning the disease.
However, medical care is a strong factor, especially concerning treatment and diagnosis of the condition. A nursing practitioner will conduct some tests, including testing the patient’s muscles, testing their spinal fluid, nerve and a brain scan, and tensile tests for myasthenia gravis (Lonati et al., 2019). If these tests do not provide or help diagnose the situation, the doctor may suggest a laboratory test to determine the potential toxin or bacterium that causes botulism. Laboratory tests are the most certain method to establish if a patient’s case is botulism. In the event a patient has botulism, treatment should be administered immediately. Notably, antitoxins and intensive medical care ensure patients recovery (Jacob et al. 2021). However, some patients may succumb to respiratory failure or other infections.
Epidemiological Triad of Botulism
Epidemiological triads involve an agent, a host (the patient), and an enabling environment that connects the host and agent or connects the synchronization of the two. There are minimal external agents of botulism. However, healthcare workers who do not adhere to quality standards and effective care may lead to botulism. The most susceptible hosts are infants between two and eight months or adults with wounds. In terms of environment, botulinum produces spores that exist widely in soil, rivers, and seawater (Halpin et al., 2018). The growth of the bacteria and toxin formation mainly thrive in areas with low oxygen content and distinct combinations of preservative parameters and storage temperatures (Halpin et al. 2018). Therefore, it mostly occurs in natural environments except when it is used as an agent of bioterror.
The Role of NP
The AANP (American Association of Nurse Practitioners) regulates and ensures that nurses offer advanced, accessible, person-centered, equitable, and high-quality health care for different groups of people. As a result, the typical role of nursing practitioners is to provide urgent, primary, and special care to a specific population of people. (Rasetti-Escargueil et al. 2019) Their first role is early diagnosis of botulism. Nursing practitioners identify a patient with botulism based on the initial signs of a diagnosis. Lonati et al. (2019) assert that the most important factor in diagnosing botulism is early diagnosis. Another vital crucial role that they play is assuring patients of accurate diagnosis. This is because fatal cases of botulism occur when patients are wrongly diagnosed. Botulism is often misdiagnosed for another condition known as polyradiculoneuropathy.
Additionally, there are different forms of botulism, and a nursing practitioner is supposed to identify the specific form to ensure effective treatment. Nursing practitioners oversee the conduction of clinical diagnosis through specialized laboratory testing, which may require days to complete, and thus, their attention is the most vital part of botulism treatment. Therefore, nursing practitioners can drastically change a patient’s situation or condition. Effectively, nurses are healthcare’s first line of defense concerning botulism. Botulism patients require supportive care whereby nurses are supposed to execute functions such as feeding them by enteral tube or parenteral nutrition, intensive care, treatment of secondary infections, and mechanical ventilation (Lonati et al. 2020). All these functions ensure the patient recovers as quickly as medically possible.
Also, nursing practitioners should carefully monitor patients for impending respiratory failure, as respiratory failure is the leading cause of death for patients with botulism. Additionally, nursing practitioners play a crucial role in formulating the medical plan for a patient with botulism in the intensive care unit (ICU). Nurses conduct holistic evaluations during the first 24 hours with prioritization of the systems, which rapidly deteriorate (Jacob et al., 2021). Thus, nursing practitioners are in charge of monitoring the neurological and respiratory functions of the patient. The nurse determines several diagnoses, which include impaired oral mucous membrane, physical mobility, the risk for disuse syndrome, impaired urinary elimination, and risk for acute confusion (Scruth & Schoenlein, 2020). A vital role is based on the premise that their caregiving role plays a big part. This role involves considering and prioritizing physical, emotional, cultural, and social needs. Therefore, nursing practitioners offer immense physical and emotional support to patients.
References
Halpin, A. L., Khouri, J. M., Payne, J. R., Nakao, J. H., Cronquist, A., Kalas, N., Mohr, M., Osborne, M., O’Dell, S., Luquez, C., Klontz, K. C., Sobel, J., & Rao, A. K. (2017). Type F infant botulism: Investigation of recent clusters and overview of this exceedingly rare disease. Clinical Infectious Diseases, 66(suppl_1), S92-S94. Web.
Jacob, J., Bocking, N., Hummelen, R., Poirier, J., Kelly, L., Madden, S., & Schreiber, Y. (2021). The development of a community-based public health response to an outbreak of post-streptococcal glomerulonephritis in a First Nations community. Canada Communicable Disease Report, 47(7/8), 339-346. Web.
Lonati, D., Schicchi, A., Crevani, M., Buscaglia, E., Scaravaggi, G., Maida, F., Cirronis, M., Petrolini, V. M., & Locatelli, C. A. (2020). Foodborne botulism: Clinical diagnosis and medical treatment. Toxins, 12(8), 509. Web.
Rasetti-Escargueil, C., Lemichez, E., & Popoff, M. R. (2019). Public health risk associated with botulism as foodborne zoonoses. Toxins, 12(1), 17. Web.
Scruth, E., & Schoenlein, M. (2020). The medical treatment of botulism. AJN, American Journal of Nursing, 120(3), 23-23. Web.
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