CHAPTERONE

I
NTRODUCTI
ON

1.
0 BACKGROUNDOFTHESTUDY

Thi
sisacar
est
udyofMrF.
O,a42y
ear
sol
dmanadmi
tt
edi
ntot
hemal
emedi
calwar
d
ofNnamdiAzi
ki
weUni
ver
sit
yTeachi
ngHopsi
tal
,Awka,Anambr
aSt
at he12th of
eont
Januar
y,2022wi
tht
hedi
agnosi
sofLy
me'
sdi
seasewhi
chhecont
ract
edduet
ohi
s
exposur
etot
icksi
nhi
sfar
m.

Ly
medi
sease,
alsoknownasLy
mebor
rel
i
osi
s,i
sav
ect
or-
bor
nedi
seasecausedbyt
he
Bor
rel
i
abact
eri
um,whi
chi
sspr
eadbyt
icksi
nthegenusI
xodes(
Wenner&Mel
i
nda
2021)
.The mostcommon si
gn ofi
nfect
ion i
san expandi
ng r
ed r
ash,known as
er
ythemami
grans,whi
chappear
satt
hesi
teoft
het
ickbi
teaboutaweekaf
ter
war
ds
(
CDC2013)
.Ther
ashi
sty
pical
l
ynei
theri
tchynorpai
nful
.Appr
oxi
mat
ely70–80% of
i
nfect
edpeopl
edev
elopar
ash.Ear
lydi
agnosi
scanbedi
ff
icul
t.Ot
herear
lysy
mpt
oms
mayi
ncl
udef
ever
,headachesandt
ir
edness(
CDC2013)
.Ifunt
reat
ed,sy
mpt
omsmay
i
ncl
udel
ossoft
heabi
l
ityt
omov
eoneorbot
hsi
desoft
hef
ace,j
ointpai
ns,sev
ere
headacheswi
thneckst
if
fnessorhear
tpal
pit
ati
ons.

1.
1 PATI
ENT’
SIDENTI
FICATI
ONDATA

Gener
alI
nfor
mat
ionoft
hepat
ient

Name:
Mr.F.
O

Addr
ess:
14,
Wil
ber
for
cest
reet
,awka,
Anambr
aSt
ate.

St
ateofOr
igi
n:Anambr
a

Local
Gov
tAr
ea:
AwkaSout
h

Age:
42y
ear
sol
d

Gender
:Mal
e
Occupat
ion:
Oil
pal
m Far
mer

Educat
ional
Qual
i
ficat
ions:
SSCEHol
der

Et
hni
cGr
oup:
Igbo

NextofKi
n:Mi
ss.F.
M.

Rel
ati
onshi
p:Si
ster

Nat
ional
i
ty:
Niger
ian

Rel
i
gion:
Chr
ist
iani
ty

Dat
eofAdmi
ssi
on:
12t
hJanuar
y2022

Medi
cal
Diagnosi
s:Ly
meDi
sease

Dat
eofDi
schar
ge:
30t
hofJanuar
y2022

St
udentNur
se:
StudentNur
seM.
A

1.
2.Est
abl
i
shi
ngRel
ati
onshi
pwi
thPat
ientandPat
ient
'sFami
l
y

I
twasv
erynecessar
yfort
heent
ir
eteam ofheal
thpr
ofessi
onali
nchar
geoft
he
managementofMr
.F.
O'smedi
calcondi
ti
onest
abl
i
shed acl
i
nicaland t
her
apeut
ic
r
elat
ionshi
pwi
thMr
.F.
Oandhi
sfami
l
y.Howev
eri
nthatr
egar
d,t
hest
udentnur
seM.
A
al
soest
abl
i
shedagoodandt
her
apeut
icr
appor
twi
tht
hepat
ientandhi
sfami
l
yinor
der
t
oachi
evet
hedel
i
ver
yofhol
i
sti
ccar
etot
hepat
ient
.

1.
3 Appear
anceofPat
ientatFi
rstCont
act

Atf
ir
stcont
actwi
th wi
tht
hepat
ient
,thepat
ientappear
ed cal
m and hehad f
ull
knowl
edgeofhi
sdi
agnosi
s.I
twasal
readyhi
ssecondweekonadmi
ssi
on.Thenur
ses'
r
epor
tshowedt
hatt
hepat
ientwasi
nrecov
ery
,thepr
ognosi
sisgood,andhewas
compl
i
antwi
thhi
sdr
ugr
egi
men.

1.
4.Fami
l
yandSoci
alHi
stor
y

Hei
sfr
om anucl
earf
ami
l
yandi
sthet
hir
damongf
ivechi
l
dren.Hehasacor
dial
r
elat
ionshi
pwi
thhi
ssi
bli
ngs.Heaf
fi
rmedt
hathi
smot
herwast
hest
ri
ctt
ypebutt
hat
shei
sact
ual
l
ythemosti
mpor
tantper
soni
nhi
sli
feandhi
sfat
herwasabi
tleni
entbut
t
hathedi
dn’
ttakeadv
ant
ageoft
hat
.Heal
soenj
oyst
hesuppor
tofhi
smot
herandhi
s
si
bli
ngs as t
hey shar
e a st
rong f
ami
l
y bond among t
hemsel
ves.He i
s abl
eto
communi
cat
eef
fect
ivel
yandef
fi
cient
ly.Hehasgoodi
nter
per
sonalr
elat
ionshi
pwi
th
bot
hhi
sfami
l
yandco-
pat
ient
sont
hewar
d.Hei
snotmar
ri
edbutr
eveal
edt
hathei
sin
ar
elat
ionshi
pwi
tha29y
ear
sol
dLadywhoabusi
nesswomani
nAwka.

1.
5.PastMedi
cal
andSur
gical
Hist
ory

Whenasked,pat
ientr
eveal
edt
hathehadsur
ger
yduet
oint
est
inalher
niawhenhewas
21y
ear
sol
d.Asi
det
hesur
ger
y,noot
hermedi
cal
hist
ory
,noal
l
ergi
es.

1.
6 Hi
stor
yofPat
ient
'sI
ll
ness

The pat
ientwas br
oughti
n byhi
sfr
iend accompani
ed byt
he gener
alout
pat
ient
depar
tmentat
tendant
.Hewasadmi
tt
ed ont
he12t
hofJanuar
y,2022i
ntot
hemal
e
medi
calwar
d.Hepr
esent
edf
ever
,chi
l
ls,f
ati
gue,bodyaches,headache,neckst
if
fness,
gener
almal
aise,Er
ythema mi
grans.The pat
ientwas r
evi
ewed byt
he doct
orand
di
agnosedofLy
medi
seaseasar
esul
toft
hei
nvest
igat
ioncar
ri
edoutonhi
m.

Subj
ect
ive Dat
a:Pr
esent
ing compl
aint
s att
he assessmentuni
tincl
uded;Undue
i
rr
it
abi
l
ity
,reducedsl
eep,f
ever
,chi
l
ls,headaches,f
ati
gue,bodypai
ns,st
if
fedneck,r
ash
(
Ery
themami
grans)
Obj
ect
iveDat
a:Thepat
ientv
ital
signswast
akenandr
ecor
dedasseenbel
ow;

Temper
atur
e: 6OC
39.

Pul
se:
92b/
m

Respi
rat
ion:
20c/
m

Bl
oodPr
essur
e:128/
860mmHg

Wei
ght
:74kg

OnExami
nat
ion:
Hepat
ientwasf
ebr
il
e,pal
or,
jaundi
ced

Thef
oll
owi
ngi
nvest
igat
ionswer
eor
der
ed:

1.Enzy
me-
li
nkedi
mmunosor
bentassay(
ELI
SA)t
est
.

2.West
ernbl
ott
est
.

3.Pol
ymer
aseChai
nReact
ion(
PCR)

TheELI
SAandWest
ernbl
ott
est
sdonewer
eabl
etodet
ectt
heant
ibodi
est
o Bor
rel
i
a
bact
eri
a,aswel
lasi
tsgenomev
iaPCRt
estl
eadi
ngt
otheconf
ir
mat
ionoft
hedi
agnosi
s
ofLy
me'
sdi
sease.

1.
7 Di
agnosi
sonAdmi
ssi
on:
LymeDi
sease

1.
8. ReasonForChoosi
ngThi
sPat
ient

Ly
medi
seasei
sadi
seasewi
thl
owr
epor
trat
esf
rom af
fect
edhencet
her
easont
her
e's
l
ow l
evelofawar
enessamongstpeopl
e.I
not
herwor
ds,i
t'
sst
ranget
othepubl
i
cand
peopl
erar
elyt
alkabouti
t.Ly
medi
seaseaf
fect
smost
lypeopl
ewhoar
einorar
ound
f
armr
ear
ingenv
ironment
,yett
her
e'sl
ow r
epor
tofi
nci
dentorpr
eval
entf
rom t
hese
per
sons.

Ly
medi
seasei
susual
l
ymi
sdi
agnosed,andt
hepat
ient
sendupwi
tht
hel
ongt
erm
chr
oni
cly
mesdi
seasebecauseofl
ackofpr
opert
reat
menti
ntheear
lyst
ages.I
fItcan
bei
dent
if
ied,
proper
lydi
agnosedear
ly,
andpeopl
esensi
ti
zedabouti
t,t
hiswi
l
lgoal
ong
wayi
ncur
bingt
hedi
sease,
hencet
her
easonf
orchoosi
ngt
hispat
ientwi
tht
hedi
sease
condi
ti
on.

1.
9 Obj
ect
iveoft
hecar
est
udy

Theobj
ect
ivesoft
hiscar
est
udyar
easf
oll
ows;

1. To gai
n an i
n-dept
h knowl
edge on pat
ient
’s di
agnosi
s and gai
n ski
l
lsi
n
i
ndependentr
esear
chout
sidel
ect
ureenv
ironment
.

2. To cr
eat
e awar
eness t
othe publ
i
c on t
he causes,si
gns,sy
mpt
oms and
pr
event
ionandf
urt
hercompl
i
cat
iont
hatmayoccuri
fnotdi
agnosedandear
ly
t
reat
ed.

3. To be abl
etoi
dent
if
ythe cl
i
nicalf
eat
ures ofLy
me'
s di
sease and ar
range
appr
opr
iat
edi
agnost
ict
est
.

4. Toenhancesenseofsel
fest
eem

5. Todevel
opmet
hodandappr
oachest
oenhancepubl
i
cunder
standi
ngofbasi
c
sci
ent
if
icconcept
sandbi
omedi
cal
resear
ch

1.
10 Def
ini
ti
onoft
hedi
seasecondi
ti
on

Ly
me di
sease orLy
me bor
rel
i
osi
sist
he mostcommonl
ytr
ansmi
tt
ed t
ick-
bor
ne
i
nfect
ioni
ntheUni
tedSt
atesandamongt
hemostf
requent
lydi
agnosedt
ick-
bor
ne
i
nfect
ionswor
ldwi
de.Ly
medi
seasei
sdi
vi
dedi
ntot
hreest
ages(
Skar&Si
monsen2018)
:
Ear
lyl
ocal
i
zed-di
sti
ngui
shedbyt
her
edr
ing-
li
keexpandi
ngr
ashofEr
ythemami
grans
att
hesi
teofar
ecentt
ickbi
te.Ot
hersy
mpt
omsexper
iencedatt
hisst
agemaybef
lu-
l
i
kesy
mpt
oms,
mal
aise,
headache,
fev
er,
myal
gia,
andar
thr
algi
a.

Ear
lydi
ssemi
nat
ed-About20%ofpat
ient
sdev
elopt
heear
lydi
ssemi
nat
eddi
sease,
wit
h
t
he mostcommon sy
mpt
oms bei
ng mul
ti
ple er
ythema mi
grans l
esi
ons.Ot
her
sy
mpt
oms of t
he di
ssemi
nat
ed st
age ar
efl
u-l
i
ke sy
mpt
oms,l
ymphadenopat
hy,
ar
thr
algi
a,my
algi
a,pal
siesoft
hecr
ani
alner
ves(
especi
all
yCN-
VIIwhi
chr
esul
tsi
n
Faci
alPal
sy)
,opht
hal
miccondi
ti
ons,andl
ymphocy
ticmeni
ngi
ti
s.Addi
ti
onal
l
y,car
diac
mani
fest
ati
ons such as conduct
ion abnor
mal
i
ties,my
ocar
dit
is,orper
icar
dit
is may
occur
.

Lat
e-Themostcommonmani
fest
ati
onoft
hel
atedi
seasei
sar
thr
it
ist
hati
susual
l
y
pauci
art
icul
arandaf
fect
slar
gej
oint
s,especi
all
ytheknees

1.
11.Def
ini
ti
onoft
ermsusedi
nthecar
est
udy

Asy
mpt
omat
ic:Thi
siswhenapat
ientt
est
sascar
ri
erf
oradi
seaseori
nfect
ionbut
exper
iencesnosy
mpt
oms.

Car
diomegal
y:Thi
sref
erst
oamedi
cal
condi
ti
oni
nwhi
cht
hehear
tisenl
arged.

DEET:N,
N-Di
ethy
l-
met
a-t
oluami
de ordi
ethy
ltol
uami
de,i
sthe mostcommon act
ive
i
ngr
edi
enti
ninsectr
epel
l
ent
s.

Er
ythemaMi
grans:
isanexpandi
ngr
ashof
tenseeni
ntheear
lyst
ageofLy
medi
sease.

I
ncubat
ionper
iod:
Thi
sist
het
imeel
apsedbet
weenexposur
etoapat
hogeni
cor
gani
sm,
achemi
cal
,orr
adi
ati
on,
andwhensy
mpt
omsandsi
gnsar
efi
rstappar
ent
.

I
xodes:
Ixodesi
sagenusofhar
d-bodi
edt
ickst
hatbel
ongst
othef
ami
l
yofI
xodi
dae.

Neur
it
is:
Thi
sist
hei
nfl
ammat
ionoft
hener
ves.

Radi
cul
opat
hy:Thi
sisani
nfl
ammat
ionofspi
nalner
ver
oot
sthatof
tencausespai
nand
l
essof
tenweakness,
numbness,
oral
ter
edsensat
ioni
nthear
easoft
hebodyser
vedby
ner
vesconnect
edt
otheaf
fect
edr
oot
s.

Ti
cks:Thesear
epar
asi
ti
car
achni
dst
hatar
epar
toft
hemi
tesuper
orderPar
asi
ti
for
mes.
Adul
tti
cksar
eappr
oxi
mat
ely3t
o5mm i
nlengt
hdependi
ngonage,sex,speci
es,and
"
ful
l
ness"
.

Tweezer
s:Thesear
esmal
lhandt
ool
susedf
orgr
aspi
ngobj
ect
stoosmal
ltobeeasi
l
y
handl
edwi
tht
hehumanf
inger
s.

Vect
orbor
nedi
seases:Thesear
edi
seasest
hatar
etr
ansmi
tt
edbyl
i
vingagentor
or
gani
smsknownasv
ect
ors.Thesev
ect
orscar
ryandt
ransmi
tinf
ect
iouspat
hogenst
o
anot
herl
i
vingor
gani
sm.

Zoonosi
s:A zoonosi
sisani
nfect
iousdi
seasecausedbyapat
hogen(
ani
nfect
ious
agent
,suchasabact
eri
um,
vir
us,
par
asi
teorpr
ion)t
hathasj
umpedf
rom anani
mal
toa
human.