LYME DISEASE 7
Chief Complain (CC): Fatigue x 2 weeks, rash, flu-likesymptoms, joint pains and neurological problems
History of the present illness (HPP): Jane is a 32-year-oldHispanic who comes to the clinic complaining of knees pain of fivehours. Jane was living her normal life until four weeks ago when shestarted suffering from fatigue and generalized malaise that precludedher from carrying her regular walking routine. When she woke up, herleft knee was swollen, tender and stiff with a mild level of rednessnoted.
White vaginal discharge began two weeks ago with some pain observedduring intercourse. The malaise and fatigue started around the sameperiod. She argues that discomfort and fatigue over the past fourweeks have been accompanied by stiff neck and mild headache.
She denies that she has chills, fever, night sweats, sweats or weightloss. Also, she denies swollen gland, eye irritation, syncope, heartpalpitations, abdominal pain or dysuria
The Past Medical History: She denies HTN, CVA, CAD and DM.report general good health. She also denies any previous injuries,illness, hospitalization and blood transfusion
Family History: Her sister suffered from Lyme arthritis
Social History: Jane lives with her mother in the localcommunity. She is active in her place of work. She is unclear whenasked about her sexual history but states that she has been in amonogamous companionship over the past seven years. She is acigarette smoker taking 1-2 packets per week and periodic ETOH wherehe takes 4 to 6 beers on weekends
Respiratory: Not reported
Musculoskeletal: The left knee with erythema as notedpreviously, full extension, Flexion limited to 100 degrees, warm tothe touch. No crepitus. All the other lower and upper extremityjoints were found without erythematic, effusions or decreased therange of motion.
Objective Assessment (0)
VS Temp 98.6F Pulse 62, BP 120/82, Hgt: 5’10”, Resp 14, WGT: 165
General- an alert, oriented Hispanic female in no acute distressnoticed to favor the left leg while going to the clinic.
Skin- no rashes noted. Erythema noticed on the left knee extendingfour centimeters below or above the patella
Chest: lung clear
Neck: No carotid bruit, thyromegaly, cervical lymphadenopathy
HEENT- Normocephalic a traumatic void of deformities. EOMI/PERRLA, noscleral icterus or conjunctival injection noted.
Lungs- AP/Lat chest ratio 3:1 where there is no accessory muscle useor deformities. No wheezes or rhonchi.
Cardiac-S3>S1 Base, PMI localized at 5th ICS MCL.Regular rate rhythm, No murmurs or S3, S4 noted
Lymphatics -Axillary, supraclavicular and inguinal regions reviewedwithout substantial lymphadenopathy
Abdomen- Scaphoid without visible scars, masses or rashes noted. Atall the four quadrants, Normoactive Bowel sounds. Tympanicpercussions were observed throughout. The liver span was 6cm at theright MCL.
Differential Diagnosis: From the complaints and symptomsexpressed the patient, she is suffering from Lyme disease. Lymedisease is characterized by flu-like illness, fatigue, muscle aches,joint pains, nausea, and chills. Some patients may express facialdropping or Bell`s palsy.
The differential diagnosis is inclusive of crystalline arthropathy,Molar pregnancy, viral arthritis and septic arthritis. Molarpregnancy is when the tissue that becomes a fetus rather becomes anaboriginal growth in the uterus. Crystal arthropathies are set ofdisorders that arise from crystals deposition around the joints.Viral arthritis is the irritation (inflammation or swelling of thejoint caused by a viral infection. Septic arthritis is caused byfungus or bacteria which results in inflammation of joints. Septicarthritis affects a large joint such as hip or knee.
Assessment: The probable disease is Lyme. Knowledge deficitincludes bacterial infection. Jane might have experienced a bite ofinfected ticks with Borrelia Burgdorferi bacterium.
Testing is made by swabbing the infected areas and bacteria that isliable for infection. The signs of Lyme are nonspecific since theticks that pass on the disease can pass on other diseases. Lab testsinclude ELISA that detects antibodies and western blot test.
After confirming Lyme infection, the patient is given a combinationof prenatal multivitamins, Doxycycline 100mg PO BID*21 days. Thepatient needs to take one hour or two hours before meals. Patientsshould inform GI or other difficulties that would preface completingRX. Patients should be apprised of any possible photosensitivity(Daly, 2015).
Possible Education: Most of the patients suffer from Lyme diseasesince they have insufficient information about the methods ofpreventing it. It will be appropriate if Jane is educated on Lymedisease
Rationale: Lyme disease can be diagnosed clinically based on themedical history which makes Doxycycline most suitable to use in thiscase. Treating Jane is the only strategy available to ensure that sheis completely healed
Reflection notes: Lyme is a clinical diagnosis, and since the typicaltests are so insensitive, a negative test result does not imply thatone does not have Lyme. There are distinct reasons why a person maydisplay negative results. The best moments when treating Jane waswhen she said that her sister had suffered from Lyme arthritis sincethis assured me that the disease was Lyme.I would recommend that shetakes probiotics to counterbalance the gut bacteria since antibioticsmay lead to additional problems (Daly,2015).
Schuiling, K. D., & Likis, F.E. (2013). Women`sGynecologic health (2nd ed.).Burlington, MA: Jones and Bartlett Publishers. Chapter7, “Diagnosis of Pregnancy at the Gynecologic Visit” (pp.143–156)
Tharpe, N. L., Farley, C., &Jordan, R. G. (2013). ClinicalPractice Guidelines for Midwifery & Women`s health (4th ed.).Burlington, MA: Jones & Bartlett Publishers.
Daly,E. R. (2015, June). Lyme Disease Diagnosis, Treatment, and ReportingPractices Among Healthcare Providers in New Hampshire, 2014. In 2015CSTE Annual Conference.Cste.
National Institutes of Health.(2012). Office ofResearch on Women’s Health (ORWH).Retrieved from http://orwh.od.nih.gov/