NSG202 Pediatric Assignment – Lyme Disease

NSG202 Pediatric Assignment – Lyme Disease

NSG202 Pediatric Assignment – Lyme Disease

INTEGUMENTARY
NRSG 202 PEDIATRICS
ASSIGNMENT: LYME DISEASE
SUMMARIZE/OUTLINE:

1. Description/pathphysiology
a. It’s the most common tick-borne disorder in the United States. Its caused by the spirochete (a type of bacteria), Borrelia burgdorferi entering the skin and loodstream through the saliva and feces of ticks, especially the deer tick.
Lyme Disease occurs most commonly in children 5 years old and adults 55
through 59 years old.

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2. Clinical manifestations
a. Stage one: Early localized disease consisting of the tick bite at the time of inoculation, followed in 3 to 30 days by the development of erythema migrans at the site of the bite. In the beginning the lesion is a small erythematous papule that enlarges radially up to 30 cm (12 inches) over a period of days to weeks. Resulting in a large circumferential ring with raised, edematous doughnut- like border, thus looking like a bull’s eye. Common sites are the thigh, the groin and the axilla. The lesion usually feels warm to
the touch and may be described as “burning”. In some cases, it may be pruritic (itchy). The single ring- shaped rash may be associated with fever, myalgia, headache or malaise.

b. Stage two: Early disseminated disease, occurs 3 to 10 weeks after inoculation. Many patients develop multiple smaller, secondary annular lesions without the indurated center. These may appear anywhere, except for the palms of hands and soles of feet. In an untreated patient, these will disappear in 3 to 4 weeks. Often observed are the following constitutional symptoms: fever, headache, malaise, fatigue, anorexia, stiff neck, generalized lymphadenopathy, splenomegaly, conjunctivitis, sore throat, abdominal pain, and cough. A centered neurological finding of cranial nerve palsy (seventh nerve palsy) occurs in 3-5% of cases. In this stage, lymphocytic meningitis
may also develop, however the symptoms are said to be less acute than viral
meningitis. Other manifestations may include ophthalmic conditions such as
optic neuritis, uveitis, conjunctivitis and keratitis.

c. Stage three: This is the most serious stage of Lyme Disease, having systemic involvement of neurological, cardiac, and musculoskeletal systems that appears 2 to 12 months after inoculation. Lyme arthritis is the most common manifestation in this stage, with pain, swelling and effusion. In children, the arthritis is characterized by intermittently painful swollen joints (mainly in the child’s knees), with spontaneous remissions and exacerbations. A few rare neurological characteristics of Lyme Disease in pediatrics may include chronic demyelinating encephalitis, polyneuritis and possible problems with memory. Cardiac complications, which may occur in a small percentage of patients 4 to 5 weeks after arythema chronicum migrans, are commonly carditis and acute atrioventricular condition abnormalities that could possible result in a severe heart blockage. Although patients may be asymptotic, they may develop syncope, palpations, dyspnea, chest pain, and severe bradycardia.

NSG202 Pediatric Assignment – Lyme Disease

3. Diagnostic evaluation
a. Based primarily on history, observation of the lesion, and clinical manifestations. Serologic testing for Lyme disease at the time of the recognized tick bite is not recommended because antibiotic are not detectable in most people. Lab diagnosis can be established in later stages with a 2-step approach which includes the screening test enzyme immunoassay or immunofluorescent immunoassay.

4. Therapeutic management
a. When the rash appears or not too long after, children over the age of 8 are
treated with oral doxycycline. Children under the age of 8 are given
amoxicillin or cefuroxime. If patients are allergic to penicillin, …

5. Nursing care management
a. The main emphasis of nursing care should be focused on teaching the
parents to protect their children from exposure to ticks. Children should
avoid any places that may be tick infested. …

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NSG202 Pediatric Assignment – Lyme Disease.