12.5 Lyme's Disease, Rocky Mountain Spotted Fever, Dermatitis

Question 1

Lyme Disease

Answer 1

• Enters the bloodstream through saliva/feces of deer ticks

1st Stage
- Develops bulls-eye rash up to 12 inches
- Can be itchy, warm.

2nd Stage
- Occurs 3-10 weeks after the bite
- Secondary annular lesions without the center (NOT ON SOLES OR PALMS)
- Systemic Symptoms (stiff neck, lymphadenopathy, splenomegaly, conjunctivitis, sore throat, cranial nerve palsy)

3rd Stage
- 2-12 months after initial bite
- SYSTEMIC INVOLVEMENT OF NEUROLOGIC, CARDIAC, MUSCULOSKELETAL SYSTEM

• Lyme’s Arthritis - Most common (pain, swollen joints - especially knees)
• Remission/exacerbation of arthritis

Rare Complications
- Encephalitis
- Polyneuritis
- Memory issues

Treatment
- Doxycycline > 8 y/o
- Amoxicillin < 8 y/o

Nursing Interventions
- EARLY TREATMENT BECAUSE IT CAN HALT PROGRESSION BETWEEN STAGES
- PREVENTION IS KEY (EDUCATION ON AVOIDING TICK BITES THROUGH SPRAY, LONG SLEEVED CLOTHING, LOOKING FOR TICKS, HOW TO REMOVE TICKS)

How To Remove Ticks
- Use tweezers
- Pull straight up with steady even pressure
- Use sterile needle to remove remaining tick parts
- Cleanse site with soap and water
- Wash hands and tweezer
- Observe site in 30 days

Question 2

Rocky Mountain Spotted Fever (Rickettsia Rickettsii)

Answer 2

• Caused by tick bites
• Starts off as fever and malaise then turns into rash on extremities and HEAVY RASH ON PALMS AND SOLES OF FEET

Treatment
- Tetracycline

Question 3

Dermatitis

Answer 3

• Inflammation of skin that occurs in response to direct contact with an allergen/irritant.

Common Irritants
- Soap, detergent, bleach, lotion

Photodermatitis
- Contact with a chemical found in plants/vegetables/citrus/celery/ragweed that causes sensitivity to ultraviolet light.
- Sun exposure can cause erythema

Question 4

Diaper Dermatitis

Answer 4

• Caused by prolonged and repetitive contact with an irritant

Contact Diaper Dermatitis (Urine/Feces)
Candidiasis Diaper Dermatitis (Fungal Infection)

• Candidiasis Diaper Dermatitis (small bright red papules with satellite lesions - see other lesions in perineum, lower thigh, abdomen. Lesions spread).
• Baby wipes are not a good alternative for skin cleansing during diaper dermatitis
• Contact Diaper Dermatitis (well demarcated redness in diaper areas and redness stays within diaper area. Treatment is altering the wetness of their diaper and how long they are exposed to the irritation. TEACH PARENTS TO CHANGE DIAPERS QUICKLY AND ALLOW BUTT TO DRY. PROTECTIVE OINTMENTS CAN HELP)
• ZINC OXIDE BARRIER CREAM CAN HELP PROTECT SKIN

Question 5

Seborrhea (Cradle Cap)

Answer 5

• Crusty, oily, scaly patches on babies scalp
• Not painful or itchy but can cause scales on scalp
• Usually clears on its own in few weeks/months

Treatment
- Washing scalp with anti-seborrheic shampoo daily.

Question 6

Candidiasis Manifestations

Answer 6

• Pruritis
• Intertrigo (inflammation in skin folds)
• Beefy Erythema