Ed4Nurses.com

Here is your answer to Friday's question. Thank you all for sending in all of your responses. We have a winner! Our winner from the drawing from our correct responses is Tracy Kaltenbacher. She will be getting an autographed copy of my 101 Tips to Improve your Nursing Care book. Here's the question.

The correct answer is B, Lyme's disease.

Lyme's disease is caused by bacteria that are carried by ticks, typically a hard body (hard tick). The patient gets a tick bite and the bacteria are introduced. So one of the things you want to ask your patient is “what activities are they doing outside where they might come in contact with ticks.” For example, playing sports after work; in the evening hours they may have come in contact with a tick when they're outside in the field, or in the woods.

Symptoms include a fever, headache, fatigue, depression and a characteristic rash – called a “bullseye” rash. The rash may take anywhere from about three days up to a month to appear, but the rash starts with a dark center and moves outward in a red circle around that dark center. In some cases there is a clearing around the red center to form the “bullseye” pattern – a dark red center, cleaning around it and then another rash around the outside of that. Even though the “bullseye” rash is a “classic” symptom, it only occurs in about 10percent of patients who have Lyme's disease. Many other patients will get a rash but it doesn't have that bullseye pattern to it, it's more like a red rash with a dark center.

Other symptoms include pain in the joints, the muscles, and the tendons, called Lyme's arthritis. Treatment will be with antibiotics, Doxycycline in adults and Amoxicillin in children.

One of the other choices was Rocky Mountain spotted fever, which is also transmitted by ticks and it also is a bacterial illness. However, the type of rash the patient gets is entirely different. The classic triad in Rocky Mountain spotted fever is fever (hence the name) rash and a history of a tick bite. The rash oftentimes will start in the extremities (the hands and the feet) and work its way up toward the trunk. The rash starts out as being small, flat, pink, non-itchy spots and can turn into kind of a petechiae rash after about a week. The rash also involves the palms of the hand and the soles of the feet in as many as 80percent of cases. Again, the treatment is antibiotics.

The black widow spider bite does not typically cause a rash. Instead, it's a neurotoxin that causes generalized muscle cramps, weakness, tremors and abdominal pain that could be associated with nausea and vomiting. Children and elderly are typically more severely affected then are adults. One of the main symptoms that occur with the black widow spider bite is severe pain and a lot of this could be due to the neurotoxin causing a component of the muscle spasms and cramps in addition to nerve-type pain. Treatment would consist of pain relief and anti venom.

Our last choice was a copperhead bite. Copperheads are a type of snake called a pit viper and their bites generally lead to localized tissue destruction with severe bruising and bleeding in that area, bruising and bleeding may continue up the arm or up the leg from where the bite is. The injuries are mostly caused by coagulopathies, leading to swelling, bruising, and bleeding.