Lyme disease, also known as Lyme borreliosis, is a vector-borne disease passed to humans by infected ticks causing a bacterial infection. The disease was originally thought to be juvenile rheumatoid arthritis and was first recognized when a cluster of cases was identified in the towns of Lyme and Old Lyme in Connecticut, giving its name Lyme disease.
It is most common in spring and early summer with an estimated 476,000 cases yearly in the United States and 200,000 yearly in Western Europe. Currently, there are no available human vaccines for Lyme disease but multiple vaccines to prevent Lyme disease are available for dogs.
Signs and Symptoms of Lyme Disease
Lyme disease can produce a wide range of symptoms if left untreated. The symptoms depend on the stage of infection, such as:
- Stage 1. This stage is called early localized disease, which happens within 3 to 30 days after a tick bite. It starts with a single-circle rash that spreads around the site with a clear center which is not painful or itchy but warm to the touch also called erythema migrans (EM). Other symptoms include fever, headache, fatigue, muscle pains, joint stiffness, nausea, upper respiratory problems, and swollen lymph nodes.
- Stage 2. This stage is called early disseminated disease, with more serious and widespread symptoms often showing within 3 to 10 weeks after a tick bite. Symptoms include rashes on different parts of the body, severe headache, neck pain or stiffness, facial muscle weakness, Bannwarth syndrome, dysrhythmias, fainting, shortness of breath, paresthesia, back pain radiating to the hips and legs, eye pain, swelling, or vision loss.
- Stage 3. This stage is called late disseminated disease and usually begins 2 to 12 months after a tick bite. Symptoms include long-lasting pain and swelling, arthritis in large joints, peripheral neuropathy, acrodermatitis chronic atrophicans, heart problems, insomnia, memory or concentration problems, and swelling/discoloration of the hands, feet, elbows, and knees.
Causes of Lyme Disease
Lyme disease is an infectious disease caused by a bite of Borrelia burgdorferi by injecting saliva with substances that disrupt the immune response in the skin.
The saliva inhibits the production of the host neutrophil function providing a protective environment to survive and spread infection throughout the body. The black-legged tick or deer tick usually bites and stays attached to the skin for 36 to 48 hours.
After days to weeks, the infection spread via the bloodstream to distant skin sites, joints, the heart, and the nervous system causing a variety of symptoms.
Ticks are tiny spider-like parasites usually found in woodland and moorland areas, which feed on the blood of humans, mammals, and birds. It is not transmissible between people by other animals nor through the consumption of food.
Risk Factors for Lyme Disease
Several factors increase the risk of acquiring and the spread of Lyme disease. These include
- Age and sex. Men between the ages of 15 to 60 are most likely to play outside and go on outdoor activities such as camping, hunting, and hiking.
- Socioeconomic factors. Those people who live and work outdoors, in construction, landscaping, near the farm, park, wildlife, or forest.
- Geographic location. Ticks that carry Lyme disease are widespread but are mostly found in the northeast, upper midwest, and mid-Atlantic states and south-central and southeast Canada.
- Weather conditions. Tick bites are common during summer when people spend more time outdoors but it is also possible during early fall and late winter with extremes of temperatures.
- Environmental factors. Spending time in moorland and woodland areas with deep or overgrown plants with animals to feed the ticks and an increase in deer population where the ticks thrive.
- Pet. Taking care of a pet, especially a dog, increase the risk for Lyme disease.
Complications of Lyme Disease
Patients with Lyme disease usually get better over time or have serious and deadly complications such as:
- Post-Treatment Lyme Disease Syndrome (PTLDS). Patients with Lyme disease continue to experience pain, fatigue, or difficulty thinking for more than 6 months even after they finish the treatment.
- Arthritis. It is the most common complication for untreated Lyme disease where there is a large joint effusion and swelling.
- Peripheral neuropathy. Describe numbness, tingling, or burning sensation at the feet or hands moving up to the limbs over time.
- Neuroborreliosis. Early neuroborreliosis is a combination of cranial neuritis, lymphocytic meningitis, radiculopathy, and mononeuritis multiplex typically appearing 4 to 6 weeks after a tick bite. After several months symptoms present as tinnitus, vertigo, dizziness, hearing loss or partial vision loss, facial paralysis, movement impairment, and permanent motor or sensory function impairment.
- Lyme encephalopathy. It is associated with cognitive difficulties, subtle memory, insomnia, and personality changes. Fibromyalgia and depression are generally common in patients with Lyme disease.
- Lyme Carditis. Lyme disease adversely affects the electrical conduction system of the heart causing palpitations, dizziness, fainting, shortness of breath, chest pain, and dysrhythmias. It can also cause myocardial complications such as cardiomegaly, congestive heart failure, or left ventricular dysfunction.
- Borrelial lymphocytoma. It is a skin condition with a purplish lump that develops on the ear lobe, nipple, or scrotum.
- Acrodermatitis chronica atrophicans (ACA). It is a chronic skin condition that begins as a reddish-blue patch on the hands or feet and slowly atrophies having thin and wrinkled skin with hairless and dry skin.
Diagnosis of Lyme Disease
Diagnosis of Lyme disease is based on the combination of signs and symptoms, history of exposure, and tests such as:
- Personal history and exposure. Patients with Lyme disease may or may not have symptoms and asking for recent tick exposure, being outdoors, or going to places infested with ticks may help with the diagnosis.
- Physical exam. The presence of erythema migrans (EM) rash, arthritis, facial paralysis, or early symptoms of Lyme disease should have a total body skin examination and be asked about the duration of the EM rash.
- ELISA and Western blot test. The ELISA test is performed first due to its sensitivity, then the more specific Western blot will be run to test for antibodies in the blood. These tests are usually performed based on the presence of EM rash or up to 30 days after the onset of infection to detect the IgM or IgG antibodies.
- Lumbar puncture. This is usually done when symptoms associated with the peripheral nervous system appear such as facial paralysis. The immune system produces antibodies in the intrathecal space against Lyme disease and is interpreted by the density of lymphocytes and protein in the CSF.
- CSF pleocytosis test. Used as an objective marker to determine treatment success and the decision to retreat.
- Polymerase chain reaction (PCR) test. The culture or PCR detects the presence of Lyme disease spirochete.
- Nerve conduction studies and electromyography. Used to monitor the effectiveness of treatment for patients with the infection involving the PNS.
- MRI scan and single-photon emission computed tomography (SPECT). These tests detect abnormalities in the brain. SPECT can show numerous areas of insufficient blood flow to the cortex and subcortical white matter.
Treatment for Lyme Disease
The chance of recovery from Lyme disease increases with early detection and treatment. This includes
- Medications. Used to relieve signs and symptoms and the infection associated with Lyme disease.
- NSAIDs. This is given for persistent pain associated with Lyme disease.
- Antibiotics. Early-stage Lyme disease usually follows a course of 10 to 14 days of oral antibiotic treatment. For severe or late disseminated infections intravenous antibiotic administration is recommended. The second round of antibiotic treatment is given if the swelling persists or recurs. Prolonged antibiotic treatment is recommended only for up to 28 days. Lyme arthritis or diseases affecting the heart and nervous system also requires an IV antibiotic treatment.
- Removing ticks. Use tweezers by applying them near the head or mouth of the tick while gently pulling it, making sure that all the tick parts have been removed. Wash hands and the site of the tick bite with soap and water then clean with rubbing alcohol.
- Physical therapy. This is recommended following the resolution of Lyme arthritis in adult patients.
- Pacemaker. Heart conduction abnormalities for patients with Lyme disease usually resolve within 6 weeks but some may end up with a permanent pacemaker or persistent heart block.
- DMARDs or synovectomy. It can accelerate recovery in patients with Lyme arthritis.
Nursing Diagnosis for Lyme Disease
Lyme Disease Nursing Care Plan 1
Risk for Impaired Skin Integrity
Nursing Diagnosis: Risk for Impaired Skin Integrity related to impaired sensation secondary to Lyme disease
Desired Outcomes:
- The patient will be able to verbalize awareness of the risk of loss of sensation with Lyme disease.
- The patient will collaborate with the nurse in planning care to maintain uncompromised skin and tissue integrity.
- The patient will be able to prevent the development of the condition from complications.
| Lyme Disease Nursing Interventions | Rationale |
| Assess the patient’s overall skin condition by its appearance and awareness of sensations. | Daily assessment of the patient’s overall skin condition and sensation allows the nurse to identify changes and adjust treatment as necessary. Patients with decreased sensation are not aware of pressure and pain. |
| Identify the areas in the patient’s body with the greatest risk for loss of sensation such as the face, neck, hands, feet, and limbs. | Knowing the areas that are likely to affect will help the patient have focused attention and intervention specific to that areas. |
| Encourage frequent position changes in bed or chair and frequent ambulation. | These interventions reduce pressure on tissue improving circulation in the areas with decreased blood flow. |
| Provide gentle rub or massage on the face, neck, hands, feet, and limbs. | A gentle rub or massage can improve the blood flow to those areas. |
| Educate the patient about active and passive range of motion exercises. | This promotes good blood circulation throughout the body. |
| Provide comfort measures such as an egg-crate mattress or foam cushions. | This reduces the pressure on the skin improving circulation. |
| Encourage adequate nutrition of more than 2000 kcal per day and fluid intake of more than 2000 mL per day. | Adequate nutrition and hydration maintain moisture and skin turgor preventing damage caused by pressure in the skin and tissue. |
| Instruct to avoid constrictive or tight-fitting clothing, accessories, or footwear. | These can cause pressure and decrease tissue perfusion in the area. |
| Educate the patient and significant others about hazards to remove at home and safety precautions to institute. | Patients with impaired sensation are vulnerable to injury and hazards such as heat, cold, and trauma. |
Lyme Disease Nursing Care Plan 2
Nursing Diagnosis: Hyperthermia related to infectious process secondary to Lyme disease as evidenced by a temperature of 102.4 degrees Fahrenheit, weakness, and dehydration.
Desired Outcomes:
- The patient will be able to maintain a normal body temperature between 97.8 to 98.6 degrees Fahrenheit within 24 hours.
- The patient will display an increase in energy as evidenced by active participation in activities of daily living.
- The patient will display adequate tissue perfusion as evidenced by normal skin turgor.
| Lyme Disease Nursing Interventions | Rationale |
| Assess the patient’s vital signs every 4 hours. Report if the temperature is greater than 100.4 degrees Fahrenheit. | Monitoring the patient every 4 hours helps track the patient’s response and progress with the treatment. |
| Assess and monitor for dehydration by checking the skin turgor and energy level by rating it from 1-10 with 10 being the highest. | Have baseline data to determine changes and progress after nursing interventions. |
| Encourage an increased oral fluid intake of 3 liters per day. Start an intravenous therapy as ordered. | This will help reduce the fever and hydrate the patient faster. |
| Provide a tepid sponge bath, or cool bath, or apply ice packs in the groin, neck, and axillae. Assess the area after these cooling measures. | Reduce the temperature fast based on the principles of evaporation and conduction. These measures can also cause burns to the skin from the extreme cold. |
| Provide a comfortable environment by adjusting the room temperature, a cooling blanket, and removal of constrictive clothing. | This will help the body cool itself while making sure that the patient is comfortable. Constrictive clothing can cause body temperature to rise. |
| Administer medications as ordered such as antipyretics and antibiotics. | Antipyretics normalizes body temperature faster. Patients with Lyme disease should be treated with antibiotics to control the symptoms such as hyperthermia and resolve the infection caused by the tick bite. |
| Encourage an increased caloric diet with nutritional value or as indicated by the health care provider. | To meet the increased metabolic demand of the patient’s body from fever, increase the energy level of the patient, and help with the healing process by increasing immune response. |
| Educate the patient about the cause of hyperthermia in Lyme disease, things to watch out for, and interventions to manage it in the future. | Lyme disease can be recurring and long-term. Educating the patient increases their self-esteem and reduces anxiety if symptoms occur and recur. |
Lyme Disease Nursing Care Plan 3
Nursing Diagnosis: Fatigue related to prolonged infection secondary to Lyme disease as evidenced by general body discomfort and muscle weakness.
Desired Outcomes:
- The patient will verbalize improvements in fatigue after 72 hours of nursing interventions.
- The patient will be actively engaged with the daily activities independently.
| Lyme Disease Nursing Interventions | Rationale |
| Assess the patient’s current condition and areas of discomfort or weakness. | This will help the nurse establish baseline data for comparison of progress and response with nursing interventions. |
| Assess and monitor the patient’s vital signs before starting any activity. | Patients with abnormal vital signs may cause them to fatigue with any level of activity. |
| Encourage the patient to express feelings about fatigue and ask to keep a log of their daily activities along with their energy level at that time. | The patient’s view about fatigue will help the nurse in motivating the patient. Keeping track of activities and energy levels will help them in planning daily activities. |
| Encourage the patient to be involved in the treatment plan. Schedule activities during the most energetic hours of the day and give periods of rest in between. | This will help the patient gain a sense of control over their condition and ensure that the activities are based on their tolerance. Providing rest in between will prevent exhaustion and burnout. |
| Assess the patient’s need for assistive devices. Provide an appropriate assistive device for the activity. | This may help the patient tolerate more activities and be engaged. This will also reduce discomfort and support areas of weakness. |
| Educate the patient about passive range of motion exercises during inactive days and active range of motion during the most energetic hours of the day. | Passive and active range of motion exercises will strengthen the muscle and help reduce muscle weakness even during inactive days. |
| Encourage an increase in caloric intake with nutritional value and provide adequate hydration. | This will help the patient gain additional fuel for energy and prevent dehydration which could also be the cause of muscle weakness. |
| 8. Educate the patient about energy-conserving techniques such as delegation and time management. | This may help the patient accomplish a task and conserve energy at the same time. |
| 9. Administer antibiotics as ordered. | Explain the importance of adhering to antibiotic therapy to prevent the long-term administration of antibiotics and the long-term effects and complications of Lyme disease. |
Lyme Disease Nursing Care Plan 4
Nursing Diagnosis: Acute Pain related to peripheral neuropathy secondary to Lyme disease as evidenced by verbalization of tingling sensations and numbness.
Desired Outcomes:
- The patient will be able to adapt skills to manage the sensory disturbances with the long-term treatment of Lyme disease.
- The patient will be able to resume activities of daily living with minimal supervision and assistance.
| Lyme Disease Nursing Interventions | Rationale |
| Assess the patient’s sensory and motor functions daily. Note any discomfort, pain, and sleep alterations. | This will help the nurse monitor progress or continuous impairment in the patient’s condition. |
| Assess the patient’s need for assistive devices. Educate and provide appropriate assistive devices based on sensory and motor impairments. | This may help the patient tolerate activities of daily living, reduce discomfort, support areas of weakness or impairment, and reduce the risk of injury or falls. |
| Educate the patient about a passive range of motion exercises then gradually increase to active range of motion exercises. | A gradual increase from passive to active range of motion exercise will enhance muscle function, strengthen the muscle and reduce muscle weakness. |
| Encourage the patient to be involved in the treatment planning. Schedule activities of daily living with periods of rest in between. | This will help the patient gain a sense of control over their condition and ensure that the activities are based on their tolerance. Providing rest in between will prevent exhaustion and burnout. |
| Encourage frequent position changes in bed or chair and frequent ambulation. Provide gentle rub or massage on the face, neck, hands, feet, and limbs | These interventions reduce pressure around the tissues improving circulation in the areas with decreased blood flow. |
| Provide a safe environment for the patient by keeping the side rails up, lowering the bed, and placing things within their reach, Encourage the patient to wear protective clothing such as closed shoes or non-skid slippers. | Patients with impaired sensory functions have an increased risk of falls and injury. Footwear can also affect the balance and increase the risk of trips, slips, or falls. |
| 7. Educate the patient and significant others about Lyme disease, management of symptoms, things to watch out for, and complications associated. | Lyme disease can be a long-term debilitating disease. Giving adequate information will equip them in managing conditions associated and reduce anxiety during acute exacerbations of neuropathy. |
| 8. Refer the patient to an occupational or physical therapist upon consent. | Trained professionals can properly guide the patient to adopt new skills and improve daily functioning. |
Lyme Disease Nursing Care Plan 5
Nursing Diagnosis: Self-care Deficit related to musculoskeletal impairment secondary to Lyme disease as evidenced by poor personal hygiene.
Desired Outcomes:
- The patient will be able to perform personal hygiene measures within their level of ability.
- The patient will be able to demonstrate independence in completing personal needs through the appropriate use of adaptive equipment.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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