Public Health Education
 The Role of Nurses and Lyme Disease Prevention
Whether acting in the capacity of primary care provider, advocate
or educator, nurses can take an active role in the prevention and
control of Lyme disease. To do this effectively, nurses need to
understand issues related to the diagnosis, treatment and prevention
of Lyme disease. Nurses' ability to recognize the signs and symptoms
of Lyme disease can have a significant impact on the chronic
morbidities associated with this illness. Likewise, nurses' ability
to educate patients about Lyme disease may be one of the best tools
available to prevent exposure to this illness.
The need for health care providers to quickly and accurately
detect and treat Lyme is extremely important. Their role in the
prevention of this illness is equally important. Nurses' role in
prevention strategies that reduce exposure to infected ticks can
significantly reduce the incidence of this illness.
Nurses, often the first point of contact in the health care
system, can play a significant role in patient education, as well as
in educating the larger community because they are viewed as
approachable sources of health-related information. Whether
providing this type of community education informally on an
individual basis, or formally by offering community education
programs, the nurse needs to be familiar with currently recommended
prevention strategies.
Difficult to Diagnose
Lyme disease can be difficult to diagnose
because many of its symptoms mimic those of other disorders.
Although a tick bite is an important clue in diagnosis, many
patients cannot recall a recent tick bite, since the nymphal stage
of the tick is so tiny and a tick bite is usually painless (Figure
1).
Figure 1
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When a patient does not develop the distinctive erythema migrans
rash, the health care provider must rely on a detailed
medical history and a careful physical examination
for essential clues to diagnosis, with laboratory tests playing a
supportive role.
The serological tests currently available to determine the
presence of Lyme disease lack sufficient sensitivity and specificity
to be relied upon for diagnosing Lyme disease. This makes obtaining
a medical history and conducting a physical examination crucial.
Serologic tests are not "diagnostic tests."
Nursing Assessment
Assessment — a cornerstone of nursing practice — is one of the
most critical skills nurses can apply to the early diagnosis and
treatment of Lyme disease. Some key questions to consider:
- Does the patient live, play or work in an area endemic for
tick infestation?
- Has the patient traveled to other areas where Lyme disease
ticks are endemic ?
- Does the patient remember being bitten by a tick or recall a
rash?
- What are the patients outdoor activities — gardening, mowing
or clearing brush or leaves from wooded areas of property,
hiking, camping, etc.?
- Have other household members or neighbors been diagnosed
with a tick-borne illness?
- Does the patient have pets? If so, is there a history of
tick borne diseases or tick attachments with these pets?
- Could the patient's presenting
symptoms be
attributable to Lyme disease?
With this historical and travel background and a complete
physical exam, a Lyme experienced practitioner can use disease onset
and current status of signs and symptoms to arrive at a diagnosis.
If Lyme disease is considered likely, the practitioner should
determine which antibiotic treatment
may be necessary.
Prevention Information
Prevention of Tick-borne Illness
Proper tick removal
Controlling the tick population on your property
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