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HESI Peds Topics version 1
Lyme Disease
Lyme disease is the most common tickborne disorder in the United States. It is caused
by the spirochete Borrelia burgdorferi, which enters the skin and bloodstream through
the saliva and feces of ticks, especially the deer tick. Most cases of Lyme disease are
reported in the Northeast from southern Maine to northern Virginia. The disease may
initially appear in any of three stages:
ERUPTIONS CAUSED BY RICKETTSIAE
DISORDER,
ORGANISM, MANIFESTATIONS MANAGEMENT COMMENTS
AND HOST
Usually self-
limiting in
children
Gradual onset—Fever, malaise,
Onset in children
Rocky Mountain anorexia, myalgia Control—Protection
may resemble
spotted fever—
Abrupt onset—Rapid from tick bite by
any infectious
Rickettsia
temperature elevation, chills, wearing proper
disease
rickettsii
vomiting, myalgia, severe apparel, tick
Severe disease
Arthropod—Tick headache repellent
rare in children
Transmission— Maculopapular or petechial Tetracycline or
Inspect children
Tick rash primarily on extremities chloramphenicol
and dogs
Mammal source (ankles and wrists) but may Vigorous supportive
regularly if they
—Wild rodents, spread to other areas, therapy
play in wooded
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dogs characteristically on palms and areas
soles
See management
of ticks
• Stage 1 consists of the tick bite at the time of inoculation, followed in 3 to 31 days
by the development of erythema migrans at the site of the bite.
• Stage 2, the most serious stage of the disease, is characterized by systemic
involvement of neurologic, cardiac, and musculoskeletal systems that appears
several weeks after the cutaneous phase is completed.
• Stage 3, or the late stage, includes musculoskeletal pain that involves the
tendons, bursae, muscles, and synovia. Arthritis may occur, and late neurologic
problems include deafness and chronic encephalopathy. Nelcex purple book page
1003
Diagnostic Evaluation
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Diagnosis is best made clinically during the early stages by recognizing the characteristic
rash, erythema migrans. Serologic testing may be used to establish the diagnosis in later
stages of the disease.
Therapeutic Management
Early and appropriate treatment is essential to prevent complications. Children older
than 8 years of age are treated with oral doxycycline; amoxicillin is recommended for
children younger than 8 years of age. For patients who are allergic to penicillin,
alternative drugs include cefuroxime or erythromycin. Most experts treat individuals with
early Lyme disease for 14 to 21 days. Persons who have removed ticks from themselves
should be monitored closely for signs and symptoms of tickborne diseases for 30 days; in
particular, they should be monitored for erythema migrans, a red expanding skin lesion
at the site of the tick bite that may suggest Lyme disease. People who develop a skin
lesion or viral infection–like illness within 1 month of an attached tick should seek prompt
medical attention (Wormser, Dattwyler, Shapiro, and others, 2006). Treatment of
erythema migrans most often prevents development of later stages of Lyme disease.
Nursing Care Management
The major thrust of nursing care should be educating parents to protect their children
from exposure to ticks. Children should avoid tick-infested areas or wear light-colored
clothing so that ticks can be spotted easily, tuck pant legs into socks, and wear a long-
sleeved shirt tucked into pants when in wooded areas. Parents and children need to
perform regular tick checks when they are in infested areas (with special attention to the
scalp, neck, armpits, and groin areas). Parents should also be alert for signs of the skin
lesion, especially if their children have been in tick-infested areas. Insect repellents
containing diethyltoluamide (DEET) and permethrin can protect against ticks, but parents
should use these chemicals cautiously. Although there have been reports of serious
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neurologic complications in children resulting from frequent and excessive application of
DEET repellants, the risk is low when they are used properly. Products with DEET should
be applied sparingly according to label instructions and not applied to a child's face,
hands, or any areas of irritated skin. After the child returns indoors, treated skin should
be washed with soap and water.
Celiac Disease (Gluten-Sensitive Enteropathy)
Celiac disease, also known as gluten-induced enteropathy, gluten-sensitive enteropathy,
and celiac sprue, is a permanent intestinal intolerance to dietary wheat gliadin and
related proteins that produces mucosal lesions in genetically susceptible individuals. It is
second only to cystic fibrosis as a cause of malabsorption in children.
The incidence is variable and has been reported in 1 in 3000 to 1 in 4000 people. The
disease is seen more frequently in Europe than in the United States. It is more prevalent
in women than men and is rarely reported in Asians or African Americans. Although the
exact cause is unknown, it is now generally accepted that celiac disease is an
immunologically mediated small intestine enteropathy. The mucosal lesions contain
features that suggest both humoral and cell-mediated immunologic overstimulation.
Page 455 neclex
Pathophysiology
Page 4 of 220 HESI Peds Topics version 1.pdf HESI Peds Topics version 1.pdf
HESI Peds Topics version 1
Lyme Disease
Lyme disease is the most common tickborne disorder in the United States. It is caused
by the spirochete Borrelia burgdorferi, which enters the skin and bloodstream through
the saliva and feces of ticks, especially the deer tick. Most cases of Lyme disease are
reported in the Northeast from southern Maine to northern Virginia. The disease may
initially appear in any of three stages:
ERUPTIONS CAUSED BY RICKETTSIAE
DISORDER,
ORGANISM, MANIFESTATIONS MANAGEMENT COMMENTS
AND HOST
Usually self-
limiting in
children
Gradual onset—Fever, malaise,
Onset in children
Rocky Mountain anorexia, myalgia Control—Protection
may resemble
spotted fever—
Abrupt onset—Rapid from tick bite by
any infectious
Rickettsia
temperature elevation, chills, wearing proper
disease
rickettsii
vomiting, myalgia, severe apparel, tick
Severe disease
Arthropod—Tick headache repellent
rare in children
Transmission— Maculopapular or petechial Tetracycline or
Inspect children
Tick rash primarily on extremities chloramphenicol
and dogs
Mammal source (ankles and wrists) but may Vigorous supportive
regularly if they
—Wild rodents, spread to other areas, therapy
play in wooded
Page 1 of 220 HESI Peds Topics version 1.pdf HESI Peds Topics version 1.pdf
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dogs characteristically on palms and areas
soles
See management
of ticks
• Stage 1 consists of the tick bite at the time of inoculation, followed in 3 to 31 days
by the development of erythema migrans at the site of the bite.
• Stage 2, the most serious stage of the disease, is characterized by systemic
involvement of neurologic, cardiac, and musculoskeletal systems that appears
several weeks after the cutaneous phase is completed.
• Stage 3, or the late stage, includes musculoskeletal pain that involves the
tendons, bursae, muscles, and synovia. Arthritis may occur, and late neurologic
problems include deafness and chronic encephalopathy. Nelcex purple book page
1003
Diagnostic Evaluation
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Diagnosis is best made clinically during the early stages by recognizing the characteristic
rash, erythema migrans. Serologic testing may be used to establish the diagnosis in later
stages of the disease.
Therapeutic Management
Early and appropriate treatment is essential to prevent complications. Children older
than 8 years of age are treated with oral doxycycline; amoxicillin is recommended for
children younger than 8 years of age. For patients who are allergic to penicillin,
alternative drugs include cefuroxime or erythromycin. Most experts treat individuals with
early Lyme disease for 14 to 21 days. Persons who have removed ticks from themselves
should be monitored closely for signs and symptoms of tickborne diseases for 30 days; in
particular, they should be monitored for erythema migrans, a red expanding skin lesion
at the site of the tick bite that may suggest Lyme disease. People who develop a skin
lesion or viral infection–like illness within 1 month of an attached tick should seek prompt
medical attention (Wormser, Dattwyler, Shapiro, and others, 2006). Treatment of
erythema migrans most often prevents development of later stages of Lyme disease.
Nursing Care Management
The major thrust of nursing care should be educating parents to protect their children
from exposure to ticks. Children should avoid tick-infested areas or wear light-colored
clothing so that ticks can be spotted easily, tuck pant legs into socks, and wear a long-
sleeved shirt tucked into pants when in wooded areas. Parents and children need to
perform regular tick checks when they are in infested areas (with special attention to the
scalp, neck, armpits, and groin areas). Parents should also be alert for signs of the skin
lesion, especially if their children have been in tick-infested areas. Insect repellents
containing diethyltoluamide (DEET) and permethrin can protect against ticks, but parents
should use these chemicals cautiously. Although there have been reports of serious
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neurologic complications in children resulting from frequent and excessive application of
DEET repellants, the risk is low when they are used properly. Products with DEET should
be applied sparingly according to label instructions and not applied to a child's face,
hands, or any areas of irritated skin. After the child returns indoors, treated skin should
be washed with soap and water.
Celiac Disease (Gluten-Sensitive Enteropathy)
Celiac disease, also known as gluten-induced enteropathy, gluten-sensitive enteropathy,
and celiac sprue, is a permanent intestinal intolerance to dietary wheat gliadin and
related proteins that produces mucosal lesions in genetically susceptible individuals. It is
second only to cystic fibrosis as a cause of malabsorption in children.
The incidence is variable and has been reported in 1 in 3000 to 1 in 4000 people. The
disease is seen more frequently in Europe than in the United States. It is more prevalent
in women than men and is rarely reported in Asians or African Americans. Although the
exact cause is unknown, it is now generally accepted that celiac disease is an
immunologically mediated small intestine enteropathy. The mucosal lesions contain
features that suggest both humoral and cell-mediated immunologic overstimulation.
Page 455 neclex
Pathophysiology
Page 4 of 220 HESI Peds Topics version 1.pdf HESI Peds Topics version 1.pdf
