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Rocky Mountain Spotted Fever Nursing Guide

This course is intended as a Quick Reference for Rocky Mountain Spotted Fever and will cover an overview as well as nursing considerations utilizing the nursing process.

Content reviewed by Ann Dietrich, MD, FAAP, FACEP.  

Rocky Mountain Spotted Fever Etiology and Epidemiology 

Vectors for Transmission 

  • American Dog Tick (Dermacentor variabilis) 
    • Eastern U.S., Central U.S., and limited areas on the Pacific Coast 
  • Rocky Mountain Wood Tick (Dermacentor andersoni) 
    • Western U.S. 
  • Brown Dog Tick (Rhipicephalus sanguineus) 
    • Southwestern U.S., U.S.-Mexico border 

Over 60% of RMSF cases are reported in Arkansas, Missouri, Oklahoma, Tennessee, and North Carolina. 

Risk Factors 

  • Recent hiking or outdoor activities 
  • Exposure to tick-infested areas like leaf litter, wooded areas, and high grasses 
  • Higher prevalence in individuals > 40 years of age and in men 
  • Increased incidence during summer months 

Rocky Mountain Spotted Fever ICD-10 Code

  • A77.0 - Spotted fever due to Rickettsia rickettsii

Signs and Symptoms 

Symptoms typically appear two to 14 days after a tick bite. A characteristic rash appears two to four days after fever onset, beginning on the wrists, ankles, and forearms before spreading. 

Common Signs and Symptoms 

  • Nausea and vomiting 
  • Stomach and muscle pain 
  • Lack of appetite 
  • Fever, rash, and headache (classic triad) 

Severe Illness Risk Factors 

  • Delayed treatment 
  • Age under 10 years 
  • Glucose-6-phosphate dehydrogenase (G6PD) deficiency 

Complications can include hepatic injury, renal failure, lobar pneumonia, meningoencephalitis, cardiac or respiratory failure, and disseminated intravascular coagulation. Mortality rates range from <1% to 10% with treatment, and 20% to 30% without prompt antibiotic therapy. 

Diagnosis 

Early diagnosis is critical to reduce mortality. A thorough history of tick bites and recent time in high-risk areas is essential. Treatment should not be delayed for confirmatory lab results. 

Laboratory Tests 

  • Serology: Indirect immunofluorescence antibody (IFA) assay, performed on paired serum samples 
  • PCR, Culture, and Immunohistochemistry (IHC) assays 

Additional tests may show hyponatremia, thrombocytopenia, cerebrospinal fluid pleocytosis, and elevated hepatic transaminases. A head CT scan may be necessary for patients with concerns for neurological involvement. 

Management 

The CDC recommends presumptive treatment with doxycycline for individuals of all ages, including children under 8 years old. Improved outcomes are associated with starting antibiotics within the first 5 days of illness. 

Doxycycline Treatment 

  • Adults: 100 mg every 12 hours (oral or IV) 
  • Children under 45 kg (100 lbs.): 2.2 mg/kg body weight twice a day (oral or IV) 
  • Course Duration: Minimum of 5 to 7 days, continuing at least 3 days after fever subsides 

Alternative treatments include chloramphenicol or rapid desensitization procedures for doxycycline allergies. Supportive care may involve oxygen, hemodialysis, fluids, mechanical ventilation, and treatment of hemorrhage and thrombocytopenia. 

Rocky Mountain Spotted Fever Nursing Care Plan

Assessment 

  • Thorough history, including recent tick bites, symptoms, and exposure to high-risk areas 
  • Physical assessment for seizures, dark urine, hepatomegaly, splenomegaly, bronchial cough, retinal abnormalities, abdominal tenderness, and other systemic signs 

Nursing Diagnosis/Risk For 

  • Activity intolerance related to fever 
  • Impaired skin integrity related to rash 
  • Alteration in comfort related to edema and pain 
  • Decreased cardiac output related to vascular injury 

Interventions 

  • Administer prescribed medications 
  • Encourage incentive spirometry and deep breathing 
  • Plan for adequate rest periods 
  • Refer to an infectious disease specialist if needed 
  • Provide supportive care, including oxygen and assisted ventilation 

Expected Outcomes 

  • Full recovery from disease 
  • Improved or healed lesions 
  • Maintenance of adequate fluid volume 
  • Resumption of normal activity levels 
  • Absence of skin breakdown 
  • Maintenance of adequate cardiac function 

Patient/Caregiver Education 

  • Explanation of condition, diagnosis, and treatment 
  • Medication instructions and potential side effects 
  • Reporting recurrent symptoms immediately 
  • Preventive strategies, including correct tick removal techniques 

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Additional Information

Content Release Date 

3/31/2022

Content Expiration

12/31/2025

References 

View All Clinical Guides