The nurse in the emergency department (ED) is caring for a 10-year-old client.
Item 2 of 5
- Nurses' Notes
1322: 10-year-old client and his parents report an 8-day history of a brownish-raised lesion over the back of his left leg. The parents report that the size of the rash has increased. The parents report returning from a one-week camping trip three weeks ago. The parents deny efficacy with over-the-counter antihistamine creams. The client's parents deny that the child has had a fever but has felt 'warm' occasionally and endorsed an intermittent headache. They report an area of firmness in the child's groin. On assessment, there was an erythematous, raised, nonpainful, oval patch on the back of his left leg. This was an enlargement of an inguinal lymph node. The child is alert and fully oriented and denies any pain. Peripheral pulses palpable 2+. No cyanosis or edema in the extremities. Lung sounds clear bilaterally. The parents report that the child did not receive the seasonal influenza vaccine. He currently takes a multivitamin for iron deficiency anemia and was hospitalized one year ago for an appendectomy. The parents state that the child’s sibling had influenza one month ago. Vital signs: T 98.8°F (37.1°C); HR 78 beats/min; RR 16 breaths/min; BP 110/76 mm Hg. SpO2 97% on room air.
The nurse considers if the client may have an infection caused by a tick.
Click to specify if the features are consistent with the disease process of Rocky Mountain spotted fever (RMSF) or Lyme Disease.
Each finding may support more than one (1) disease process.
The nurse considers if the client may have an infection caused by a tick.
Click to specify if the features are consistent with the disease process of Rocky Mountain spotted fever (RMSF) or Lyme Disease.
Each finding may support more than one (1) disease process.
| Feature | Rocky Mountain spotted fever | Lyme Disease |
|---|---|---|
Fever | ||
Petechial rash that becomes diffuse | ||
Erythema migrans (bullseye rash) | ||
Myalgia | ||
Causative agent Rickettsia rickettsii | ||
Causative agent Borrelia burgdorferi |
Statistics
Subject/Lesson
Subject
Child Health
Lesson
Infectious Disease
Client Need
Test Plan
Physiological Adaptation
Related Topic
Pathophysiology
Item Type
Item Type
AnalyzeCues
Explanation
- Fever
Fever is a common symptom of both RMSF and Lyme disease, as both conditions are caused by bacterial infections that trigger an immune response.
- Petechial rash that becomes diffuse
A petechial rash is a hallmark sign of RMSF and typically starts on the wrists and ankles, spreading centrally to the trunk. It often becomes more widespread and severe over time. This type of rash does not occur in Lyme disease.
- Erythema migrans (bullseye rash)
The bullseye rash (erythema migrans) is a classic sign of Lyme disease, appearing in approximately 70-80% of cases. It is an early manifestation caused by the local spread of Borrelia burgdorferi at the tick bite site. This rash is not seen in RMSF.
- Myalgias
Muscle pain (myalgia) is a common symptom of both RMSF and Lyme disease due to the inflammatory response triggered by bacterial infections.
- Causative agent Borrelia burgdorferi
Lyme disease is caused by the spirochete bacterium Borrelia burgdorferi, which is transmitted to humans through an infected deer tick bite.
- Causative agent Rickettsia rickettsii
RMSF is caused by the intracellular bacterium Rickettsia rickettsii, which is transmitted via the dog tick (Dermacentor variabilis) and the wood tick (Dermacentor andersoni).
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2 Key Topics
Transmission based precautions- Immune System
