Cherron Boswell, Denise Colton, and La Nita Hood
Bowie State University
Lyme disease is the most common tick-borne disease in North America and Europe. Lyme disease is steadily increasing in the United States and the majorities of health care providers are unfamiliar with the disease; primarily because of its complexity and as a result lack the clinical skills necessary to provide comprehensive care to infected patients. The purpose of this paper is to give an overview of the health problem of the disease, epidemiology, incidence and prevalence, pathophysiology, application of the nursing theory, and present the case study with an appropriate plan of care. Overview of Health Problem
Lyme disease is the leading cause of vector-borne infections in the U.S. with about 15,000 cases reported annually (Bacon, Kugeler, & Mead, 2008). In order to provide comprehensive care the healthcare provider must recognize the progression of the disease as well as the associated symptoms. According to Ignatavicius &Workman (2010) Lyme disease progresses through three stages: * Localized stage 1 (early stage)- symptoms begin in three to thirty days of the tick bite and the patient presents with flu-like symptoms, muscle and joint pain and stiffness, and “erythema migrans”, an oval or round, flat or slightly raised rash resembling a “bull’s eye”. * Stage 2 (early disseminated stage)-symptoms occur two to twelve weeks after the tick bite. During this phase the patient may develop cardiac symptoms such as carditis, palpitations, dizziness, or dyspnea, as well as central nervous system anomalies such as meningitis, facial paralysis, or peripheral neuritis. * Stage 3 (chronic persistent stage)-this is the late stage where symptoms may develop months to years after the tick bite. During this stage arthritis, chronic fatigue, and memory problems may develop.
As with any infectious disease, if left untreated or poorly managed, Lyme disease can become a chronic and debilitating illness. Complete recovery is likely when the disease is treated with appropriate antibiotics in the early stages. In later stages, response to treatment is slower, and mortality rates are increased. Incidence and Prevalence
The incidence of Lyme disease in the United States is approximately “one in 2,719 out of 100,000 cases reported annually” (Bacon, Kugeler, & Mead, 2008). During the past ten years “93% of the cases have occurred in the Northeastern region of the United States, which includes Connecticut, Rhode Island, New York, New Jersey, Delaware, Pennsylvania, and Maryland, as well as Wisconsin” (Kruger, 2010). In 1996, the Centers for Disease Control and Prevention “reported a record high number of 16,461 cases of Lyme disease in 45 states which is an increase of 41% from the 11,700 cases reported in 1995” (Bacon, Kugeler, & Mead, 2008). “Voluntary surveillance statistics from the CDC shows an estimated increase of 101% in the annual incidence of Lyme disease from 1992 to 2006 (Kruger, 2010). Population groups most at risk for Lyme disease are children five to sixteen years old and adults 35 to 50 years old; the lowest incidence in among those 20-24 years of age” (Kruger, 2010). The increase in the number of reported cases is directly correlated to the increase in deer populations throughout the Northeastern region and the lack of education on ways to reduce the risk of tick-borne diseases. Pathophysiology
Lyme disease is a multisystem infection caused by the spirochete Borrelia burgdorferi
(B. burgdorferi); this spirochete is found to exist in “reservoir hosts”, such as deer’s, mice, squirrels, cats and dogs (Kruger, 2010). Spirochetes are motile, gram-negative, corkscrew shaped organisms that tend to have an affinity for collagen and connective tissues. The interplay between the invading spirochetes and the subsequent host immune response plays an important part in...