An 8-year-old pediatric client arrives complaining of swelling and pain in the bilateral knees. The child's parent informs the nurse, "The swelling came out of nowhere, and it just keeps getting worse." The initial impression is Lyme disease. Which additional question should be included during the assessment and history?
An 8-year-old pediatric client arrives complaining of swelling and pain in the bilateral knees. The child's parent informs the nurse, "The swelling came out of nowhere, and it just keeps getting worse." The initial impression is Lyme disease. Which additional question should be included during the assessment and history?
A. "Have you noted any flank pain and a decrease in the urine volume?"
[7%]
B. "Has there been a fever of over 103 degrees over the last two to three weeks?"
[27%]
C. "Have you noticed any rashes on the palms or soles?"
[28%]
D. "Do you have headaches, malaise, or sore throat?"
[37%]
Statistics
Subject/Lesson
Subject
Child Health
Lesson
Musculoskeletal
Client Need
Test Plan
Physiological Adaptation
Related Topic
Alterations in Body Systems
Item Type
Item Type
Analysis
Explanation
Choice D is correct. Clients with Lyme disease often develop a musculoskeletal, flu-like syndrome consisting of malaise, fatigue, chills, fever, headache, stiff neck, myalgias, and arthralgias that may last for weeks. Symptoms are often nonspecific, resulting in the diagnosis being frequently missed if erythema migrans is absent.
Choice A is incorrect. Urinary tract infections and/or a decrease in urine production are not symptoms commonly associated with Lyme disease.
Choice B is incorrect. Any fever associated with Lyme disease is typically a low-grade fever.
Choice C is incorrect. Erythema migrans, the hallmark and best clinical indicator of Lyme disease, is the first sign of the disease. It occurs in at least 75% of clients, beginning as a red macule or papule at the site of the tick bite, usually on the proximal portion of an extremity or the trunk (especially the thigh, buttock, or axilla), between 3 days and 32 days after a tick bite. The area expands, often with a clearing between the center and periphery resembling a bull's eye. Erythema migrans does not present as rashes on the client's palms and soles.
Learning Objective
Recognize that acute early Lyme disease is associated with erythema migrans (bull's eye rash) and constitutional symptoms such as fever, arthralgias, headaches, malaise, or sore throat.
Additional Info
- Lyme disease has three stages: early localized, early disseminated, and late.
- Most clients are infected after venturing outdoors into wooded areas where Lyme disease is common and being bitten by ticks infected with the bacteria Borrelia species.
- In untreated late-stage Lyme disease, arthritis develops in about 60% of clients within several months, occasionally up to two years, of disease onset (as defined by erythema migrans) and will often present as intermittent swelling and pain in a few large joints, especially the knees.
- Treatment consists of oral or parenteral antibiotics depending on disease manifestations.
