Nursing Guide to Lyme Disease: Nursing Diagnosis, Interventions, & Care Plans

Lyme Disease Definition

Lyme disease, named for Lyme, Connecticut, originates from the initial discovered outbreak there in 1972. Medical providers were treating individuals experiencing an unusual outbreak of a previous unknown arthritic condition.

Lyme disease is a bacterial infection spread by blacklegged ticks. If untreated, it can spread from the skin to the joints, heart, and nervous system (Centers for Disease Control and Prevention [CDC], 2024; Mayo Clinic, 2023).

Lyme Disease Etiology and Epidemiology

Lyme disease is caused by blacklegged ticks, also known as deer ticks. These ticks acquire Borrelia burgdorferi when feeding on small animals like mice. The risk of transmission increases if a tick remains attached for at least 24 hours.

Most infections occur during outdoor activities in wooded or grassy areas where ticks are common (Mayo Clinic, 2023; Cleveland Clinic, 2022). Each year, about 30,000 cases of Lyme disease are reported to the CDC in the U.S., though actual numbers are likely higher due to underreporting (CDC, 2024).

• Thrives more in the temperate climates of the northern hemisphere
• Infects individuals from, and is endemic in, North America and Europe
• Appears in almost every state but shows significant prevalence in the:
  • Northeast
  • Upper Midwest
• Uses hard bodied ticks (genus Ixodes) as carrier
• Flourishes in the environment via reservoir hosts of:
  • Small mammals
  • Rodents
  • Birds
  • Deer (during tick mating site)
• Infects annually between the months of April and September
• Shows commonality in children aged 5 to 9 and adults 55 to 69 years (DynaMed, n.d.)

The infecting organism for Lyme disease is the spirochetes of Borrelia burgdorferi. At least six species of Borrelia can bring about the disease. The Borrelia species is the primary pathogen found in the U.S. Lyme disease is transmitted through:

• Tick bites
• Sustained tick head embedment
• Saliva injection

The typical immune response provides:

• Innate and adaptive macrophage and antibody mediation
• Symptomatic inflammatory reaction
• IgM and IgG antibody response lasting many years

The disease is most common in the upper Midwest, Northeast, and mid-Atlantic regions of the U.S. (Mayo Clinic, 2023).

Diagnostic Criteria

A bull’s-eye rash (erythema migrans) confirms Lyme disease without the need for lab testing. If the rash is not present, diagnosis is based on symptoms, history of tick exposure, and laboratory testing (CDC, 2024; Mayo Clinic, 2023).

Signs and symptoms for Lyme Disease may be classified as early or late and include:

Standard Two-Tiered Testing (STTT)

• First Step: Enzyme Immunoassay (EIA) or Immunofluorescence Assay (IFA) to detect antibodies against Borrelia burgdorferi
• Second Step: Western Blot (WB) to confirm positive or equivocal results from the first step

Modified Two-Tiered Testing (MTTT)

• Uses two different Enzyme Immunoassays (EIAs) instead of the Western Blot for both steps.

PCR-Based Molecular Testing 

• Detects Borrelia burgdorferi DNA in blood, synovial fluid, or cerebrospinal fluid and can identify other tick-borne pathogens.

Key points to consider: 

• Blood tests may be negative in early Lyme disease since antibodies take time to appear.
• False positives can happen due to other infections like syphilis or Epstein-Barr virus.
• Testing is unnecessary for early Lyme disease if erythema migrans are present and tick exposure is confirmed.

Laboratory serologic testing for Lyme disease includes a two-step process (CDC, 2021):

• Enzyme immunoassay (EIA)
• Western immunoblot assay

Common Signs and Symptoms 

Symptoms progress in stages (Mayo Clinic, 2023; Quest Diagnostics, 2021):

Early Localized Stage (3 to 30 days post-bite)

• Erythema migrans
• Fever, headache
• Fatigue, muscle, and joint stiffness
• Swollen lymph nodes

Early Disseminated Stage (weeks to months post-bite) 

• Multiple erythema migrans rashes
• Neurologic symptoms (facial palsy, meningitis)
• Migratory joint pain
• Cardiac involvement (Lyme carditis with AV block)

Late Disseminated Stage (months to years post-bite) 

Chronic arthritis (especially in large joints like the knee)

• Neurological complications (encephalopathy, polyneuropathy)
• Cognitive impairment ("brain fog")
   

Lyme Disease ICD-10 Code (unspecified): A69.20

Red Flags 

• Sudden onset of facial paralysis (Bell’s palsy)
• Palpitations, dizziness, or syncope due to AV block
• Severe headache, neck stiffness, or other meningeal signs
• Persistent joint swelling despite treatment

Potential Complications

Complications can occur if Lyme disease is not treated early or if symptoms persist after treatment (Cleveland Clinic, 2022; CDC, 2024; Mayo Clinic, 2023):

• Post-treatment Lyme Disease Syndrome (PTLDS) causes persistent fatigue, joint pain, and cognitive difficulties that can last for months after completing antibiotics.
• Lyme carditis occurs when Lyme disease affects the heart, leading to inflammation that can cause heart block and require hospitalization.
• Chronic neurological symptoms may develop in late-stage Lyme disease, resulting in long-term nerve damage, encephalopathy, and cognitive impairment.

Treatments 

Pharmacological 

Antibiotics are the only proven treatment for Lyme disease. The choice of medication and duration depends on the stage of the disease and the severity of symptoms (Mayo Clinic, 2023).

Oral Antibiotics

• Standard treatment is a 10- to 14-day course of oral antibiotics.

IV Antibiotics

• These are used for severe cases involving the joints, nervous system, or heart.

Preventive Antibiotics

• A single prophylactic antibiotic dose may be considered if the tick is a blacklegged tick, the individual was in a high-risk area, and the attachment lasted 36 hours or more.

Non-Pharmacological 

Supportive care can help manage symptoms and improve recovery. This may include pain management, physical therapy for joint stiffness, and lifestyle modifications such as rest and hydration.

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Management

Assessment and Interventions

Neurological Symptoms

• Assess for facial paralysis, confusion, headaches, and neck stiffness.
• Monitor for signs of meningitis or encephalopathy and report worsening symptoms.
• Ensure fall precautions for individuals with dizziness or weakness.

Cardiac Symptoms

• Monitor for irregular heart rhythms, palpitations, dizziness, and syncope.
• Check ECG for heart block in individuals with Lyme carditis.
• Report worsening symptoms and prepare for IV antibiotic therapy if needed.

Joint and Musculoskeletal Symptoms

• Assess for joint pain, swelling, and stiffness, especially in large joints like the knees.
• Encourage range-of-motion exercises and use heat or cold therapy for pain relief.
• Monitor response to antibiotics and refer to specialists if joint symptoms persist.

Psychosocial and Cultural Considerations

Psychosocial Support

• Assess for anxiety, depression, or frustration due to chronic symptoms, especially in individuals with PTLDS.
• Provide education on realistic recovery expectations to help manage uncertainty and reduce stress.
• Encourage participation in support groups or counseling for individuals struggling with the long-term effects of Lyme disease.

Cultural Considerations

• Be aware of traditional or alternative medicine practices individuals may use and provide evidence-based education on proven treatments.
• Educate individuals in a culturally appropriate way, using translated materials or interpreters as needed.
• Respect beliefs and health practices that may influence medication adherence or follow-up care.

Lyme Disease Nursing Care Plan

Home Management 

Self-Care

• Teach individuals to monitor for recurring symptoms, such as fatigue, joint pain, or neurological changes, and report them to their healthcare provider.
• Emphasize the importance of completing the full course of antibiotics, even if symptoms improve.
• Encourage regular rest and hydration to support recovery, especially in those experiencing PTLDS.

Safety Measures

• Educate individuals on tick prevention by advising them to wear long sleeves, apply insect repellent, and perform daily tick checks after spending time outdoors.
• Instruct on proper tick removal by using fine-tipped tweezers to grasp the tick close to the skin, pulling it straight out without twisting, and cleaning the area with soap and water.
• Recommend environmental precautions such as keeping grass short, removing leaf litter, and using tick-control methods in areas where ticks are common.

Content Release Date 

4/1/2022

Content Expiration

12/31/2028

Content Contributor

The content for this course was written by Sherry D. Haszto, M.S.N., R.N.
Sherry is a nursing professional with over 22 years of experience. She has earned an Associate Degree in Nursing from Randolph Community College, a Bachelor of Science in Nursing from the University of North Carolina at Greensboro, and a Master of Science in Nursing from Walden University. Her background includes work in oncology and hematology, home healthcare, hospice and palliative care, healthcare education, nursing consultation, performance improvement, and quality assurance. Sherry is committed to supporting patient care and healthcare education, focusing on enhancing patient outcomes and maintaining quality standards in all aspects of her work.

References 

Centers for Disease Control and Prevention. (2024). About lyme disease. https://www.cdc.gov/lyme/about/index.html

Cleveland Clinic. (2022). Lyme disease. https://my.clevelandclinic.org/health/diseases/11586-lyme-disease

Mayo Clinic. (2023). Lyme disease. https://www.mayoclinic.org/diseases-conditions/lyme-disease/symptoms-causes/syc-20374651

Quest Diagnostics. (2021). Lyme disease: Laboratory testing for diagnosis. https://www.questdiagnostics.com/healthcare-professionals/diagnostic-insights/articles/2021/lyme-disease-laboratory-testing