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
DISORDE
R, MANIFESTATIONS MANAGEMENT COMMENTS
ORGANIS
M, AND
HOST
Usually
self-
limiting in
Gradual onset—Fever,
children
Rocky malaise, anorexia, myalgia Control—
Onset in
Mountain
Abrupt onset—Rapid Protection from
children may
spotted fever—
temperature elevation, tick bite by
resemble any
Rickettsia
chills, vomiting, myalgia, wearing proper
infectious
rickettsii
severe headache apparel, tick
disease
Arthropod— repellent
Maculopapular or petechial
Severe
Tick
rash primarily on Tetracycline or
disease rare
Transmission— extremities (ankles and chloramphenicol
,Tick wrists) but may spread to Vigorous in children
other areas, supportive
Mammal Inspect
characteristically on palms therapy
source children and
and soles
—Wild rodents, dogs regularly
dogs if they play in
wooded areas
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
,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 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
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
DISORDE
R, MANIFESTATIONS MANAGEMENT COMMENTS
ORGANIS
M, AND
HOST
Usually
self-
limiting in
Gradual onset—Fever,
children
Rocky malaise, anorexia, myalgia Control—
Onset in
Mountain
Abrupt onset—Rapid Protection from
children may
spotted fever—
temperature elevation, tick bite by
resemble any
Rickettsia
chills, vomiting, myalgia, wearing proper
infectious
rickettsii
severe headache apparel, tick
disease
Arthropod— repellent
Maculopapular or petechial
Severe
Tick
rash primarily on Tetracycline or
disease rare
Transmission— extremities (ankles and chloramphenicol
,Tick wrists) but may spread to Vigorous in children
other areas, supportive
Mammal Inspect
characteristically on palms therapy
source children and
and soles
—Wild rodents, dogs regularly
dogs if they play in
wooded areas
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
,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 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
