A 38-year-old male had a 3-week history of fatigue and lethargy with intermittent complaints of headache, fever, chills, myalgia, and arthralgia. According to the history, the patient’s symptoms began shortly after a camping vacation. He recalled a bug bite and rash on his thigh immediately after the trip. The following studies were ordered: 

Studies Results Lyme disease test, Elevated IgM antibody titers against Borrelia burgdorferi (normal: low) Erythrocyte sedimentation rate (ESR), 30 mm/hour (normal: ≤15 mm/hour) Aspartate aminotransferase (AST), 32 units/L (normal: 8-20 units/L) Hemoglobin (Hgb), 12 g/dL (normal: 14-18 g/dL) Hematocrit (Hct), 36% (normal: 42%-52%) Rheumatoid factor (RF), Negative (normal: negative) Antinuclear antibodies (ANA), Negative (normal: negative) 

Diagnostic Analysis Based on the patient’s history of camping in the woods and an insect bite and rash on the thigh, Lyme disease was suspected. Early in the course of this disease, testing for specific immunoglobulin (Ig) M antibodies against B. burgdorferi is the most helpful in diagnosing Lyme disease. An elevated ESR, increased AST levels, and mild anemia are frequently seen early in this disease. RF and ANA abnormalities are usually absent. 

Critical Thinking Questions 1. What is the cardinal sign of Lyme disease? (always on the boards) 

2. At what stages of Lyme disease are the IgG and IgM antibodies elevated? 

 3. Why was the ESR elevated? 

4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatment. 

(in APA format, two bibliographical references less than 5 years,  please)

 

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Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.   Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)   Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

 

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References:

Fouka, G. & Mantzorou, M. (2011). What are the Major Ethical Issues in Conducting Research? 

Is there a Conflict between the Research Ethics and the Nature of Nursing? Health Science Journal, 5(1), 3-14. 

Furuya, Y., Dick, A., Perencevich, E., Pogorzelska, M., Goldman, D., & Stone, P. (2011). Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS ONE, 6(1), 1-6. 

 Graling, P., & Vasaly, F. (2013). The effectiveness of 2% CHG Cloth Bathing for Reducing Surgical Site Infections. AORN Journal, 97(5): 547-551.

Jeanes, A., & Bitmead, J. (2015) Reducing bloodstream infection with a chlorhexidine gel IV dressing. British Journal of Nursing, 24, S14-S19.

Kim, J., Holtom, P., & Vigen, C. (2011). Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: Epidemiologic and economic consequences. American Journal of Infection Control, 39(8), 640-646.

Klinworth, G., Stafford, J., O’Connor, M., Leong, T., Hamley, L., Watson, K., Kennon, J., Bass, P., Cheng, A. C., & Worth, L. (2014). Implementation of a successful hospital-wide initiative to reduce central line–associated bloodstream infections. American Journal of Infection Control, 42(6), 685-687.

Kramer, N. (2016). Monitoring Central Line-Associated Bloodstream Infections [CLABSI] in Home Infusion. Infusion, 22(4), 35-44.

McAlearney, A., Hefner, J., Robbins, J., Harrison, M., & Garman, A. (2013). Preventing central line-associated bloodstream infections: A Qualitative Study of Management Practices. Infection Control & Hospital Epidemiology, 36(5), 557-563. 

Mermel, L. (2014). MRSA and CLABSI Compendium updates offer additional focus on implementation. Patient Safety Monitor Journal, 15(9), 1-4. 

Power, J., Peed, J., Burns, L., & Davis, M. (2012). Chlorhexidine bathing and microbial contamination in patients’ basin. American Journal of Critical Care, 21(5), 338-342.

Pyrek, K. (2015). Experts Address the Promise and Challenges of CHG Bathing Interventions. Infection Control Today, 19(1), 32-36.

Quach, C., Milstone, A, Perpe, C., Bonenfant, M., Moore, D., & Perreault, T. (2014). Chlorhexidine Bathing in a tertiary care neonatal intensive care unit: Impact on central line–associated bloodstream infections. Infection Control & Hospital Epidemiology, 35(2), 158-163.

Richardson, J., & Tjoelker, R. (2012). Beyond the central line-associated bloodstream infection bundle: the value of the clinical nurse specialist in continuing evidence-based practice changes. The Journal of Advanced Nursing Practice, 26(4), 205-211. 

Sandoval, C. (2015). Three practice bundles to reduce CLABSIs. American Nurse Today, 10(11), 37-38. 

Scheithauer, S., Lewalter, K., Schroder, J., Koch, A., Hafner, H., Krizanovic, V., Nowicki, K., Hilgers, R.-D., & Lemmen, S. (2014). Reduction of central venous line-associated bloodstream infection rates by using a chlorhexidine-containing dressing. Infection, 42(1), 155-159. 

Wilder, K. A., Wall, B. Haggard, D. & Epperson, T. (2016). CLABSI Reduction Strategy: A Systematic Central Line Quality Improvement Initiative Integrating Line-Rounding Principles and a Team Approach. Advances in Neonatal Care, 16(3), 170-177. 

U.S. Department of Health and Human Services. (2011). Health-care-associated infection (HAI). Retrieved 10/21/2016 from http://www.hhs.gov/ash/initiatives/hai/index.html

References:

Fouka, G. & Mantzorou, M. (2011). What are the Major Ethical Issues in Conducting Research? 

Is there a Conflict between the Research Ethics and the Nature of Nursing? Health Science Journal, 5(1), 3-14. 

Furuya, Y., Dick, A., Perencevich, E., Pogorzelska, M., Goldman, D., & Stone, P. (2011). Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS ONE, 6(1), 1-6. 

 Graling, P., & Vasaly, F. (2013). The effectiveness of 2% CHG Cloth Bathing for Reducing Surgical Site Infections. AORN Journal, 97(5): 547-551.

Jeanes, A., & Bitmead, J. (2015) Reducing bloodstream infection with a chlorhexidine gel IV dressing. British Journal of Nursing, 24, S14-S19.

Kim, J., Holtom, P., & Vigen, C. (2011). Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: Epidemiologic and economic consequences. American Journal of Infection Control, 39(8), 640-646.

Klinworth, G., Stafford, J., O’Connor, M., Leong, T., Hamley, L., Watson, K., Kennon, J., Bass, P., Cheng, A. C., & Worth, L. (2014). Implementation of a successful hospital-wide initiative to reduce central line–associated bloodstream infections. American Journal of Infection Control, 42(6), 685-687.

Kramer, N. (2016). Monitoring Central Line-Associated Bloodstream Infections [CLABSI] in Home Infusion. Infusion, 22(4), 35-44.

McAlearney, A., Hefner, J., Robbins, J., Harrison, M., & Garman, A. (2013). Preventing central line-associated bloodstream infections: A Qualitative Study of Management Practices. Infection Control & Hospital Epidemiology, 36(5), 557-563.

Mermel, L. (2014). MRSA and CLABSI Compendium updates offer additional focus on implementation. Patient Safety Monitor Journal, 15(9), 1-4. 

Power, J., Peed, J., Burns, L., & Davis, M. (2012). Chlorhexidine bathing and microbial contamination in patients’ basin. American Journal of Critical Care, 21(5), 338-342.

Pyrek, K. (2015). Experts Address the Promise and Challenges of CHG Bathing Interventions. Infection Control Today, 19(1), 32-36.

Quach, C., Milstone, A, Perpe, C., Bonenfant, M., Moore, D., & Perreault, T. (2014). Chlorhexidine Bathing in a tertiary care neonatal intensive care unit: Impact on central line–associated bloodstream infections. Infection Control & Hospital Epidemiology, 35(2), 158-163.

Richardson, J., & Tjoelker, R. (2012). Beyond the central line-associated bloodstream infection bundle: the value of the clinical nurse specialist in continuing evidence-based practice changes. The Journal of Advanced Nursing Practice, 26(4), 205-211.

 

Sandoval, C. (2015). Three practice bundles to reduce CLABSIs. American Nurse Today, 10(11), 37-38. 

Scheithauer, S., Lewalter, K., Schroder, J., Koch, A., Hafner, H., Krizanovic, V., Nowicki, K., Hilgers, R.-D., & Lemmen, S. (2014). Reduction of central venous line-associated bloodstream infection rates by using a chlorhexidine-containing dressing. Infection, 42(1), 155-159. 

Wilder, K. A., Wall, B. Haggard, D. & Epperson, T. (2016). CLABSI Reduction Strategy: A Systematic Central Line Quality Improvement Initiative Integrating Line-Rounding Principles and a Team Approach. Advances in Neonatal Care, 16(3), 170-177. 

U.S. Department of Health and Human Services. (2011). Health-care-associated infection (HAI). Retrieved 10/21/2016 from http://www.hhs.gov/ash/initiatives/hai/index.html

 
 
 
 
 

 

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