1.

Lyme Disease
a. Description: infection caused by spirochete Borrelia burgdorferi, acquired
from a tick bite(ticks live in wooded areas and survive by attaching to a
host)
b. Pathophysiology: infection stimulates inflammatory cytokines and
autoimmune mechanisms
i. Mimics MS, Mono, Meningitis
c. Risk Factors: ticks feed on mice, dogs, cats, cows, horses, deer, and
humans
i. Wild animals do not have to exhibit illness
ii. Person to person transfer DOES NOT OCCUR
1. Peak season SUMMER
a. Northeastern coast (Maryland to Massachusetts)
b. Mid western States (Wisconsin and Minnesota)
c. Northwestern coast (California and Oregon)
i. Reinfection not common
d. ASSESSMENT:
i. Early Sign: erythema migrans (EM)- skin lesion (bulls eye rash)
1. Small red pimple that grows into ring-shaped rash anywhere
on body
a. Large/small/absent
2. Occurs in 70%-80% of ppl at site of tick bite
3. Within 3-30 days after exposure
a. Accompanied with acute flu like symptoms: low-grade
fever, chills, headache, stiff neck, fatigue, swollen
lymph nodes, and migratory joint and muscle pain
i. Symptoms resolve over period of weeks/months
even if untreated
1. Carditis may occur because of spirochete
disseminating to heart/joints/CNS
a. Chronic arthritic pain and swelling
in large joints occur
b. NS problems:- svr headaches/poor
motor coordination, tertiary
neuroborreliosis (neuro condition,
forgetfulness/confusion)
b. Loss of tone in facial muscles can manifest Bells
palsy
i. Usually occur in 1 week but may be delayed for
up to 30 day
ii. Second Stage: several weeks after,
1. Joint pain occurs, neurological and cardiac complications
iii. Third Stage: large joints become involved. Arthritis progresses
e. Lab Tests: CBC, ESR normal
i. 2 step testing process is recommending
1. Enxyme Immunoassy (EIA)- have + results for most ppl with
Lyme Disease
2. If inconclusive/+Western blot test to confirm infection
3. If neuro involvement check CSF

f.

Interventions:
i. Active Lesions- treat with antibiotics (Early-stage interventions 23wks)
1. Doxycycline (Vibramycin)-prevent LD when given within 3
days after bite of deer tick
2. Cefuroxime (Ceftin)
3. Amoxicillin
ii. Pts with neurologic/cardiac complications- may req IV therapy with
1. Ceftriaxone(Rocephin)
2. Or Penicillin
g. Complication: Post-Lyme disease Syndrome: residual damage to tissues
and immune system
i. Results in lingering fatigue/joint and muscle pain
h. Teaching:
i. Avoid walking through tall grass & low brush, and sitting on logs
ii. Mow grass- remove brush around paths/buildings/campsites (for
tick free zone)
iii. Move woodpiles and bird feeders away from house. Discourage deer
(main source of food for adult ticks) from being in area
iv. Wear long pants/nylon tights of tightly woven, light colored fabric so
ticks can be easily seen
v. Tuck pants into boots or long socks, wear long-sleeved shirts tucked
into pants, and wear closed shoes when hiking
vi. Check often for ticks crawling from pants to open skin
vii. Thoroughly inspect and wash clothes. Placing clothing in dryer on
high heat effectively kills ticks*
viii. Spray insect repellent containing DEET sparingly on skin / apply
permethrin to boots, clothes (esp lower extremities) and camping
gear
ix. Have pets wear tick collars, inspect them often and do not allow
pets on furniture/beds
x. EPIDEMIC AREAS
1. Remove attached ticks with tweezers not fingers. Grasp ticks
mouth parts as close to skin as possible and gently pull
straight out . dont twist/jerk. Avoid folk solutions like painting
with nail polish/petroleum jelly
2. Save tick in bottle of alcohol(if necessary for id)
3. Wash bitten area with soap and water and apply antiseptic.
Wash hands
4. See HCP immediately if flu-like symptoms or bulls eye rash
appears within 2-30 days after removal of tick

2. SLE-Systemic Lupus Erythematosus

a. Description: chronic, progressive, systemic inflammatory disease that can
cause major organs and systems to fail
b. Patho: CT and fibrin deposits collect in bv on collagen fibers and on organs
i. Leads to necrosis and inflammation in bv, lymph nodes, GI tract and
pleura
ii. No cure but remissions occur with good management

c. Etiology: unknown but defect in immunological mechanisms with genetic

link
d. Risk Factors: medications, stress, genetic factors, sunlight/UV light,
pregnancy
i. Women of child bearing age***
ii. Ethnicity***- A.A. Latino, Asian, Native American
e. Assessment:
i. Assess for precipitating/risk factors
1. Drugs: phenytoin, hydralazine, procainamide, isoniazid,
penicillamine
a. Stop if pt on any of these medications
2. Infection: pleuritis/pleural effusions
ii. Erythema of the face (malar rash/butterfly rash), erythema of palms
iii. Dry, scaly, raised rash on face or upper body
iv. Fever, weakness, malaise and fatigue, anorexia, wt loss,
v. Photosensitivity, joint pain, anemia,
f. Complications:
i. Kidney involvement: Renal failure- leading cause of death
ii. Cardiac involvement:
iii. CNS: manifestations (subtle behavioral changes to profound
disturbances-stroke)
iv. Altered immune response- increased risk for infections, anemia,
leukopenia, thrombocytopenia and hemolytic anemia,
v. Oral contraceptives- increase estrogen therefore increase risk of
flare ups
g. Lab tests:
i. + ANA (anti-nuclear antibody), +LE (lupus erythematous)
preparation(+RF)
ii. ESR(erythrocyte sedimentation rate) and C reactive protein (CRP)
may increase
iii. CBC- low WBC, platelets
iv. Urinalysis, x-ray, ECG,
h. Interventions:
i. NSAIDs for mild disease- monitor for GI and renal effects
ii. Steroid sparing drugs (eg methotrexate)
iii. Antimalarial (eg hydroxycholoquine and chloroquine)-treat fatige
and moderate skin and joint problems
1. Effects may not be noted for several months, also prevents
flares
2. Funduscopic and visual field exam must be performed every
6-12 months when pt on hydroxycholoquine
a. To prevent retinopathy: but reverses when stops taking
drugs
b. If pt cant tolerate antimarial, then antieprosy drug
(dapsone)
iv. Corticosteroids for exacerbations and severe disease
1. Should be limited
2. Tapering doeses of IV methylprednisolone may help control
severe exacerbations of polyarthritis

3. Blood
a.
b.
c.
d.
e.

a. Steroid-sparing (methotrexate) can be used as

alternate with folic acid to decrease side effects of
corticosteroids
b. High dose may be necessary for cutaneous SLE
i. Monitor I&O and Daily wts to avoid FVE
v. Immunosuppressive drugs (cyclophosphamide, mycophenolate
mofetil)
1. Azathioprine/cyclophosphamide-to reduce LT corticosteroid
therapy
a. Treats severe organ-system disease (LN)
i. Monitor closely to avoid toxicity and Side Effects
vi. Anticoagulants- warfarin/heparinto prevent clots*
vii. Diet- high vitamin/high iron, high protein(if no evidence of kidney
disease)
viii. Monitor for proteinuria, and red cell casts in urine
1. Monitor: pleuritis, nephritis, pericarditis, CAD, HTN, neuritis,
anemia, peritonitis
Transfusions
Check that client has given consent for receiving blood transfusion
Verify physicians order and any meds given before
Check typing and crossmatch
Obtain pretransfusion v/s- note temp, report elevation of 100F prior to
getting blood
Get blood; maintain patency of IV line with NS while waiting for blood.
i. Dont return blood after 20 minutes
ii. Validate data on blood with another nurse, (blood type/Rh match)
iii. Note expiration date