Nursing Care and Pathophysiology for Lyme Disease

Okay guys, we’re going to talk about Lyme Disease and how it affects our patients. This isn’t something that you will see very often, but there are a couple of important points you may be tested on, so that’s what we’re going to hit here.

Lyme disease is a vector-borne illness - that means it’s carried by another creature and transmitted to humans. In this case, it is transmitted by a tick bite. Ticks live out in the woods and if you brush up against one it will just latch onto you. They could even be super tiny and between your toes so make sure you’re checking for ticks after hiking in the woods. The good news here is that the tick usually has to stay attached for 36-48 hours for you to contract Lyme Disease, so if you find it right away and remove it, there shouldn’t be any problems. Now, Lyme disease has three stages depending on the progression. First is early localized, this is just a localized inflammatory response where the bite was. Then Stage 2 is early disseminated. That means it has started spreading regionally and might be causing some symptoms in other areas of the skin or into muscles. Stage 3 is late disseminated, this means it has spread systemically and is affecting multiple body systems. Now - it is VERY rare for patients to reach stage 3 because it is usually caught and treated before then. But, as I’ll explain in a second, stage 3 can actually be fatal if we don’t begin treatment.

One thing you may see on a test or the NCLEX is this bullseye rash. This is the classic sign of a tick bite causing Lyme disease. You can see these concentric red circles around the bite. This is the reason most people don’t progress to stage 3, they see this rash, know something’s up, get seen by a doctor and get treated quickly. This is the early localized phase - just this local bullseye rash skin reaction. As they progress to the early disseminated phase, we will see flu-like symptoms - fever, muscle aches, fatigue, as well as joint pain as it reaches the muscles and joints. If they do progress to stage 3, we can see neurological deficits because it can cause encephalopathies. So we’ll see decreased LOC, confusion, and even seizures. This is the point where this can become fatal if we don’t treat it. But again, most people are getting checked out and treated much sooner.

So what do we need to do for them? Well first and foremost - if the tick is still attached, we need to get it off RIGHT AWAY. You want to use tweezers and pull gently and carefully outward. You want to make sure you remove the head AND the body, not just the body - that head can get burrowed under the skin and stay attached. We also don’t want to use any chemicals because that will cause the tick to essentially spew out the toxins before it lets go, so you’re more likely to have issues. As far as treatment, we’ll give the patient antibiotics and usually it clears up pretty quickly. We CAN do a blood test to confirm the diagnosis, but typically once they see a tick bite, a bullseye rash and get a good history - we can easily diagnose that it’s Lyme Disease. The other important thing is Patient Education. First of all, we want to make sure they take the entire course of antibiotics or the infection can return. Or they could develop drug resistant superbugs, which is never a good thing. The other thing is that we should educate all patients to use bug spray any time they go outside, especially if they’ll be walking through the woods. I know I love to go camping and I always wear long pants and long sleeves when I hike through the woods, especially in high brush. And I’m always checking everywhere for ticks afterwards.

Priority nursing concepts are immunity and comfort - we want to remove the source of the infection and treat it with antibiotics, and we want to support the patient’s symptoms and keep them comfortable.

So Lyme disease is pretty straight forward, but let’s recap. It’s a vector-borne illness transmitted by a tick-bite. It’s highly treatable if caught early enough, so we look for that bullseye rash and get antibiotics started ASAP. It’s pretty rare for patients to reach the later stages, but if they do, it can be fatal because of the effects on the nervous system. We want to teach patients to wear bug spray any time they go outside, especially into the woods, remove the entire tick, including the head with a pair of tweezers, and to take their full course of antibiotics to make sure the infection is fully eradicated.

So those are the highlights of Lyme disease. We love you guys, let us know if you have any questions. Now, go out and be your best selves today. And, as always, happy nursing!