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Lyme Disease Nursing Guide

Content Creator: Edward Bartels, RN, BSN, MICN

Overview: Lyme Disease

This course is intended as a Quick Reference for Lyme disease and will cover an overview as well as nursing considerations utilizing the nursing process.

Etiology and Epidemiology

Lyme disease, named for Lyme, Connecticut, originates from the initial discovered outbreak there in 1972. Medical providers were treating individuals experiencing an unusual outbreak of a previous unknown arthritic condition.

Lyme disease is the most common vector-borne disorder in the U.S. (Centers for Disease Control and Prevention [CDC], 2021). Lyme disease:

  • Thrives more in the temperate climates of the northern hemisphere
  • Infects individuals from, and is endemic in, North America and Europe
  • Appears in almost every state but shows significant prevalence in the:
    • Northeast
    • Upper Midwest
  • Uses hard bodied ticks (genus Ixodes) as carrier
  • Flourishes in the environment via reservoir hosts of:
    • Small mammals
    • Rodents
    • Birds
    • Deer (during tick mating site)
  • Infects annually between the months of April and September
  • Shows commonality in children aged 5 to 9 and adults 55 to 69 years (DynaMed, n.d.)

The infecting organism for Lyme disease is the spirochetes of Borrelia burgdorferi. At least six species of Borrelia can bring about the disease. The Borrelia species is the primary pathogen found in the U.S. Lyme disease is transmitted through:

  • Tick bites
  • Sustained tick head embedment
  • Saliva injection

The typical immune response provides:

  • Innate and adaptive macrophage and antibody mediation
  • Symptomatic inflammatory reaction
  • IgM and IgG antibody response lasting many years

In 2018, 15 states located in the Northeast and upper Midwest regions reported significant Lyme disease incidence rates (DynaMed, n.d.). Lyme disease is not a reportable illness and thus, its underreporting may be reflected in the statistics. Of those cases reported, an estimated 476,000 individuals were diagnosed in the U.S. between 2010 and 2018. More recent estimations, with consideration for underreporting, indicate that upwards of 476,000 people a year may be infected with Lyme disease in the U.S. (CDC, 2021).

Lyme Disease Diagnosis

Signs and symptoms may be classified as early or late and include:

  • History of tick bite
  • Reported travel to endemic regions
  • Fever
  • Skin rash also known as “erythema migrans” may present as:
    • “Bulls’ eye” or irregular elliptical
    • The first symptom to appear
    • Multiple sites
  • Swollen lymph nodes
  • Fatigue
  • Migratory arthralgia
  • Neck stiffness
  • Cardiac symptoms:
    • Palpitations
    • Decreased cardiac output
  • Neurological symptoms:
    • Shooting pain
    • Numbness, or tingling in hands or feet
    • Photosensitivity
    • Memory loss
    • Headaches
    • Facial palsy
    • Paraplegia
  • Symptoms suggesting Lyme carditis:
    • Dyspnea or shortness of breath
    • Lightheadedness
    • Chest pain

Laboratory serologic testing for Lyme disease includes a two-step process (CDC, 2021):

  • Enzyme immunoassay (EIA)
  • Western immunoblot assay

Management

  • If still present, complete removal of embedded tick from skin
  • Symptom control:
    • PO NSAIDs (Motrin®, Aleve®)
    • Acetaminophen (Tylenol®)
    • Steroid injections (Depo-Medrol®)
    • Dietary supplements such as glucosamine and chondroitin (Movewell™)
  • PO or IV antibiotics therapy for prophylaxis or treatment incorporating:
    • Doxycycline (Vibramycin®)
    • Amoxicillin (Amoxil®)
    • Cefuroxime axetil (Ceftil®)
    • Azithromycin (Zithromax®)
    • Cefotaxime (Claforan®)
    • Penicillin G (Bicillin LA®)
  • Rheumatology referral

Rashes typically resolve within weeks without treatment, but arthritic changes may persist with chronicity. Early antibiotic treatment has demonstrated excellent long-term prognostics. If Lyme disease remains untreated, meningitis could develop, or the disease could spread to the:

  • Joints
  • Heart
  • Nervous system

The Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology proposed 2020 guidelines for oral antibiotic treatment or prophylaxis (DynaMed, n.d.). Most cases of Lyme disease can be successfully treated early with a typical course of antibiotic therapy.

Post-treatment Lyme disease syndrome results when the chronicity of symptoms lasts beyond 6 months duration. It is unknown why some individuals with Lyme disease experience this condition, but it is believed related to an autoimmune response triggered by the Borrelia burgdorferi bacterium (CDC, 2019).

Lyme Disease Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for Lyme disease are listed below.

Assessment

With Lyme disease, delay of treatment with antibiotics could lead to chronicity of symptoms and organ system involvement. Individuals may seek care well after a tick bite due to delayed symptom presentation.

Nursing assessment for a person with Lyme disease centers around the history of the onset of symptoms as correlated to the timing of the tick bite. Assessment standards include:

  • Measuring vital signs with oxygenation levels
  • Evaluating respiratory effort and bilateral breath sounds
  • Obtaining pain level
  • Examining for neurological deficits
  • Observing for early signs of decreased cardiac output
  • Observing for skin rashes and secondary infection
  • Examining tick bite site(s)
  • Observing anxiety level
  • Determining individual’s knowledge and understanding of the disease process

Lyme Disease Nursing Diagnosis/Risk For

  • Impaired comfort and pain related to joint swelling, urticaria as evidenced by:
    • Individual reports
    • Observed facial grimacing
    • Inability to get conformable
    • Elevated vital signs
    • Scratching
    • Difficulty with joint mobility and ambulation
  • Deficit in knowledge of symptom prevention and condition management as evidenced by:
    • Request for information
    • Verbalization of problems
    • Presence of preventable complications
  • Decreased cardiac output related to dysrhythmias as evidenced by:
    • Abnormal vital signs
    • Shortness of breath
    • Easily fatigued
    • Other respiratory symptoms
  • Anxiety related to stress as evidenced by:
    • Increased tension
    • Apprehension
    • Expression of concern regarding injury and loss of normal function
  • Activity intolerance related to pain as evidenced by:
    • Exertional discomfort
    • Fatigue
    • Elevated heart rate
  • Impaired physical mobility, related to pain during mobility, as evidenced by:
    • The inability to move purposefully within the physical environment
    • Difficulty with bed mobility, transfers, and ambulation

Interventions

  • Create individualized teaching plan
  • Promote use of cool compresses for comfort
  • Support a relaxing atmosphere
  • Encourage stress reducing relaxation techniques
  • Assist with physical therapy and exercise regimen
  • Share information on support groups
  • Administer medications as ordered

Expected Outcomes

  • Demonstrates reduced anxiety levels
  • Reports decreased pain
  • Maintains nutritional requirements
  • Verbalizes understanding of:
    • Condition
    • Prevention
    • Management
  • Demonstrates absence of complications
  • Understands tick exposure prevention efforts

Individual/Caregiver Education

  • Diagnosis and treatments
  • Preventing or limiting tick exposure
  • Methods for scanning skin and clothing for ticks
  • Nutrition, diet, and weight control to support immune function
  • Physical therapy and exercise programs
  • Joint orthotics and assistive devices
  • Arthritis education and support
  • Lifestyle changes
  • Signs of potential complications
  • Support resources available
  • Call the provider if pain or symptoms worsen
  • Medications they are prescribed
  • Encourage the individual to follow-up with healthcare provider as recommended

Lyme Disease: A Review CE Course

1.0 Contact Hour

Additional Information

Content Contributor

The content was created by Edward Bartels, RN, BSN, MICN Ed has over 30 years of clinical and teaching experience, and his areas of expertise are emergency and critical care, skilled nursing, behavioral health, occupational health, and safety, and home care. Ed served in several senior nursing leadership roles including: Emergency Services Director, Physician Practices Director, and Administrative Director of Nursing at the executive level. Ed is certified in LEAN efficiency fundamentals and tactics, which he has successfully deployed over the years in multiple settings resulting in cost savings, improved quality, and patient safety. Ed is a certified clinical nursing instructor in North Carolina. He earned his Diploma in Nursing from St. Vincent's School of Nursing in Staten Island, New York, in 1990 and Bachelor of Science in Nursing from the University of North Carolina, Greensboro in 2006. Ed is retired from the U.S. Coast Guard with 34 years.

Resources

Infectious Diseases Society of America. Lyme Disease.

https://www.idsociety.org/public-health/lyme-disease/lyme-disease/

References

Centers for Disease Control and Prevention. (2019). Post-treatment Lyme disease syndrome. https://www.cdc.gov/lyme/postlds/index.html

Centers for Disease Control and Prevention. (2021). Lyme disease. https://www.cdc.gov/lyme/index.html

DynaMed. (n.d.). Lyme Disease. Retrieved October 27, 2021. https://www.dynamed.com/condition/lyme-disease#GUID-31161AF2-EECE-4F9C-A596-9E56923B1A68

 

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