Nursing Care Plan (NCP) for Lyme Disease

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Outline

Pathophysiology

Lyme disease is a tick-borne illness caused by the bacteria Borrelia burgdorferi. Following the bite of an infected tick, the disease may begin to show symptoms within 3-30 days. Lyme disease is characterized by rash and symptoms may continue for months or years following onset. Severe cases can lead to organ dysfunction such as heart and liver involvement.

Etiology

An infected tick transmits the bacteria into the host (human) through a bite on the skin. The tick, which must be attached for 36-48 hours to transmit bacteria, may be so small that the host does not realize they have been bitten. Once the bacteria enters the bloodstream, it attacks the tissues and results in pain and inflammation of the joints, neurological symptoms and cardiac dysrhythmias.

Desired Outcome

Patient will be infection free, manage and reduce pain and inflammation; regain optimal mobility, prevent complications

Lyme Disease Nursing Care Plan

Subjective Data:

Initial Symptoms

  • Headache
  • Fatigue
  • Muscle / joint pain

Advanced Symptoms:

  • Neck stiffness
  • Nerve pain
  • Short-term memory loss
  • Dizziness
  • Shortness of breath

Objective Data:

Initial Symptoms

  • Bullseye rash (erythema migrans)
  • Fever / chills
  • Swollen lymph nodes

Advanced Symptoms:

  • Facial palsy
  • Inflammation of the brain / spinal cord
  • Palpitations and irregular heartbeats

Nursing Interventions and Rationales

  • Assess skin for rash

 

Classic, hallmark symptom of Lyme Disease is the bullseye rash at the site of the tick bite that is non-painful and not itchy. Other areas may develop rash as the disease progresses if not treated.

 

  • Monitor vital signs

 

As the disease progresses, it may affect organ systems. Monitor for changes in blood pressure, heart rate and elevation of temperature.

 

  • Perform 12-lead ECG

 

Lyme carditis is a complication of Lyme disease and may cause cardiac dysrhythmias and chest pains.

 

  • Apply cool compresses to swollen and painful joints

 

Patients will commonly complain of joint swelling and pain, especially of the knees, which are warm to touch. Cool compresses help relieve pain and swelling.

 

  • Provide and promote calm, low stress environment

 

Advanced Lyme disease may cause neurological disorders such as memory loss and irritability. Provide low stress environment to help manage neurological symptoms.

 

  • Assist with ROM exercises; AROM and PROM

 

Encourage mobility and loosen painful joints

 

  • Administer medications appropriately

 

Antibiotics are given as soon as the disease is detected to treat Lyme disease. Other medications may be given to treat symptoms of disease such as analgesics, NSAIDs to reduce inflammation, and anti-emetics for gastric involvement.

 

  • Educate patients and family members on ways to reduce risk of Lyme disease

 

Prevent re-exposure and further complications

Writing a Nursing Care Plan (NCP) for Lyme Disease

A Nursing Care Plan (NCP) for Lyme Disease starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Today, we are talking about Lyme disease. Okay. I’m sure many of you have heard of Lyme disease, but Lyme disease is a tick-borne illness that is caused by the bacteria Borrelia burgdorferi, and it happens after you are bitten by an infected tick. The disease can show symptoms for 30 days after. The main characterization, the symptoms are rash and they can continue for months or a year. Following the initial onset, severe cases can lead to organ dysfunction, such as heart and liver involvement. Some of the nursing considerations that we want to do, we want to assess for a bullseye rash. I have a picture of that for you, but we want to assess for a bullseye rash. That is the hallmark sign that you have been infected with Lyme disease. We also want to assess the patient’s neurological status and heart sounds. We want to take a list of the heart sounds, and we want to monitor the heart with ECG for arrhythmias. The desired outcomes for the patient to be infection-free. 

We want to manage and reduce the pain and inflammation. We want to make sure the patient regains optimal mobility, and we want to prevent complications. So this right here is a photo of a bullseye rash. So you see it has the, the red ring around, and then it has a little bullseye. It looks just like a bullseye, but just remember bullseye Lyme disease. Okay. Because that is going to be on your NCLEX. Trust me. Some of the subjective data; there are typically two phases. When you think of Lyme disease, there is going to be the initial set of symptoms and there as the condition progresses. And then that’s what we get into the advanced symptoms. So some initial symptoms for Lyme disease include headache. We are going to have some fatigue. We are going to have some muscle and joint pain, and we’re going to also  advance to some of the advanced symptoms. 

So these are all subjective things. So we’re going to have some nerve pain; once we get nerve involvement, we’re pretty far along. So we’re going to have some nerve pain. We’re going to have some short term memory loss, dizziness, shortness of breath. Some of the things that we’re going to observe, some of the objective data. Initially, we are going to see the bullseye rash. So that is that red ring that looks like a bullseye. The patient is also going to have a fever and chills and swollen lymph nodes. Once we get advanced, there’s going to be some facial palsy. 

So, you know, that’s the drooping of the face. There’s also going to be some inflammation of the brain or spinal cord as well as palpitations or irregular heartbeat. So as nurses, we are going to assess the skin; we’re going to assess the skin for a rash. The classic hallmark symptom of Lyme disease is that bullseye rash. So,we want to assess for that. Other areas may develop a rash as disease progresses, if not treated. So that could also be a part of the advanced symptoms as well. We’re gonna perform a 12 lead EKG or ECG for myocarditis, which is the arrhythmias that occur. It’s just a complication of Lyme disease. So we do not want those dysrhythmias because those can be fatal if untreated. Okay, we’re going to apply cool compresses. You know, everything does not have to be pharmacological. 

We don’t always have to use medicine. We can apply warm compresses because those joints are going to be red and inflamed and tender. So we want to apply some whole compresses just to help relieve some of that pain and some of that swelling. Okay, we’re going to administer the medications appropriately. So antibiotics are to be given as soon as the disease is detected, because the quicker we can start on treating it the quicker we can add those symptoms. And hopefully we can get over that hump of Lyme disease. Also, we want to think about the pain. So we want to use things like analgesics. We want to use NSAIDs to reduce the inflammation at times, medications for any gastric involvement, because these patients also tend to have some nausea and vomiting. 

We’re going to educate the family and the patient; we’re going to educate them on how to reduce the risk of Lyme disease, because it is a tick borne illness. We want to make sure that we can prevent re-exposure so that we can avoid those further complications. So, you know, things like wearing long pants and long socks when you’re in the woods, tucking your pants into your socks, long sleeve shirts, and just covering your body, and also assessing your body, checking your body for ticks as well. Okay. And the final thing is something that we should do if we want to assess the patient with range of motion. Okay, we want to assist with range of motion, because again, those joints are stiff. Those joints are inflamed. So the patient is not going to want to move, but we go, we’re going to need to get those joints moving to kind of get that blood flow working as we work on that inflammation. 

We’ll encourage mobility and loosen those painful joints. Some key points, Lyme disease is caused by ticks. They are caused specifically by the deer tick. Some subjective and objective data that we want to just keep in mind are headache, nerve pain, dizziness, and fatigue. Those are some of the most common things that patients are going to present with. We’re going to look for that bullseye rash. That’s the hallmark sign. We’re going to look with the EKG for irregular heartbeats. We’re going to look for some facial palsy. Remember the facial palsy is going to be something that is further down the bullseye rash. That is our hallmark sign. That is the number one thing we’re going to look for. And remember that bullseye rash is not itchy. So we’re going to want to do a good visual assessment of the skin. We’re also going to do some cardiac monitoring, the 12 lead for dysrhythmias. We’re going to do frequent vital signs. Okay. Endocarditis is a complication that can cause that fatal arrhythmia. Okay. We love you guys. Go out and be your best self today. And, as always, happy nursing.

 

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