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Nursing 3 Exam 4
Lyme Diseas, Tetanus and Poliomyletis
| Question | Answer |
|---|---|
| Lyme Disease | first identified in 1975 in Lyme, CT, with unusual cluster of children w/arthrits |
| most common vector(from animal)borne disease in the US | lyme disease |
| ticks feed on | mice,dogs,cats,cows,horses,deer and humans |
| clinical lyme disease does occur in.. | domestic animals |
| pathophysiology of lymes disease | caused by bacterium borrelia burgdorferi-a spirochete, transmitted by bite of an infected deer tick |
| peak season of lyme's disease is.. | summer months but can occur year round, 80% of cases are in the northeast,midwest, and northwest coast |
| clinical manifestations of lyme's disease | early-localized skin infection, early disseminated-heart and nervous system, including palsies and meningitis, late disseminated-motor & sensory nerve damage, brain inflammation adn arthritis |
| more manifestations of lymes disease | erythema migrans(early localized disease)2-30 days after exposure. may be painless, painful, itchy or hot to touch. acute flu-like symptoms, symptoms usually occur in 1 week but may be delayed to 30 days |
| erythema migrams | bulls eye |
| late onset complications of lymes disease | meningitis(stiff neck,h/a,vomitting,fever), bell's palsy, heart block and irregular heartbeats, painful joints,muscles,and bones, chronic fatigue and fibromyalgia, miscarriages |
| diagnositic testing for lymes disease | confirmed by a blood test which detects the presence of antibodies, cant take 6-8 wks for the antibodies to show up, w/early symptoms, immediate tx is usually advised, the blood test will be positive for life |
| diagnostic testing for lymes disease | symptom-based/history of exposure, reliable testing-after waiting, cerebrospinal fluid for neurological involvement |
| lab testing for lymes disease | CBC & erythrocyte sed rate(ESR) are usually normal, serology antibodies-later testing more reliable, cerebral spinal fluid |
| tick removal | wash hands, removed w/tweezers, frasp as close to skin as possible, gently pull out-no twisting or jerking, save in alcohol for later identification, wash area w/soap & water, apply antiseptic, wash hands |
| drug therapy for lymes disease | lyme vaccine not available since 2002. early-oral antibiotic therapy usually 2-3 wks, late-neurological or cardiac:IV rocephin |
| prevention of lymes disease | pt and family teaching:avoid tall grass,mow gras & clear paths, wear long, light colored clothing, DEET on skin or permethrin clothes, check skin often, inspect pets, restrict from bed, furniture |
| Tetanus(lockjaw) | anerobic bacillus clostridium tetani, grows better in low O2 levels, result of effects of potent neurotoxin, spores found in soil, garden,mold manure and mulch, enters body through wounds |
| pathophysiology of tetanus | enters the CNS to nervous tissue, binds to the membranes of nerve synapses, blocks release of inhibitory transmitters from nerve terminals, causes tonic spasticity with intermittent tonic seizures |
| clinical manifestations of tetanus | initial:trismus(stiffnes in jaw) and neck, fever, and other symptoms of infection. generalized tonic spasms. with progression, rigidity includes neck,back,abd,and extremities |
| opisthotonos | in sever forms, continuous tonic convulsions w/extreme arching and head retraction, resp spasms can cause apnea and anoxia |
| other clinical manifestations | profuse diaphoresis, labile hypertension(sudden fluctuations), tachycardia, hyperthermia, dysrythmias, painful seizures triggered by slightes stimuli, nearly 100% mortality |
| collaborative care | ABC's, tracheostomy and mechanical vent, general lab testing, monitor cardiac function(EKG), avoid stimulation,nutrition, wound care,foley cath, support & educate pt and family |
| drug therapy | tetanus and diptheria tosoid booster and tetanus immune globulin in different sites before the onset of symptoms |
| drug therapy | deep sedation and muscle relaxation induced w/valium, barbituates, and neuromuscular blocking agents, pain control(morphine & fentanyl), antibiotics for 1-2 wks |
| prevention | immunization(review records,admin immunizations,immune globulin), surgical debridement of wounds decreases the chance of infection, educate pt's to clean wounds w/soap & water |
| poliomyelitis | infectious enteroviral disease, oral ingestion of contaminated food or water or by unwashed hands, virus shed in feces of infected for as long as 6 wks, eradicated in US...Salk vaccine(1955) and Sabin oral vaccine(1961) |
| communicability of poliomyelitis | highly infectious, incubation-3 to 21 days, usually 7 days, diagnosis made by stool/throat culture |
| pathophysiology of poliomyelitis | polio virus enters the body by oral ingestion, replicates in the lymphoid tissue of the pharynx and ileum, acute polio causes inflammation of meninges and anterior horn cells w/loss of spinal and bulbar motor neurons |
| pathophysiology of poliomyelitis continued | neuro and functional loss occur as anterior horn cells are lost and the muscle fibers innervated by them are "orphaned" |
| abortive poliomyelitis | may be flu-like symptoms. nonparalytic resolves in 24-36 hrs |
| paralytic poliomyelitis | attacks motor neurons of spinal cord and/or brainstem |
| post-polio syndrome | enlarged distal motor neurons degenerate and fail |
| common post polio syndrome clinical manifestations | joint and muscle weakness, fatigue, and generalized pain |
| uncommon post polio syndrome clinical manifestations | difficulties w/speech, swallowing, respirations |
| collaborative care for postpolio syndrome | management of symptoms:weakness,pain,fatigue, protect airway(aspiration), conserve energy, maintain ideal body wt, support activities of daily living, psychosocial needs of pt/family |
| drug therapy for postpolio syndrome | no meds to kill the polio virus, treatment is supportive |
Created by:
jbittner
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