To detect antibodies to the organism that causes Lyme disease.
SpecimenSerum (1 mL) collected in a gold-, red-, or red/gray-top tube.
(Method: Enzyme immunoassay) Less than 0.91 index; positives are confirmed by Western blot analysis.
Borrelia burgdorferi, a deer tick–borne spirochete, is the organism that causes Lyme disease. Lyme disease affects multiple systems and is characterized by fever, arthralgia, and arthritis. The circular, red rash characterizing erythema migrans can appear 3 to 30 days after the tick bite. About one-half of patients in the early stage of Lyme disease (stage 1) and generally all of those in the advanced stage (stage 2—with cardiac, neurological, and rheumatoid manifestations) will have a positive test result. Patients in remission will also have a positive test response. The presence of immunoglobulin M (IgM) antibodies indicates acute infection. The presence of IgG antibodies indicates current or past infection. The Centers for Disease Control and Prevention (CDC) recommends a two-step testing process that begins with an immunofluorescence or enzyme-linked immunosorbent assay. (ELISA) and is confirmed by using a Western blot test.
This procedure is contraindicated for
Assist in establishing a diagnosis of Lyme disease
Positive findings in:
- High rheumatoid-factor titers as well as cross-reactivity with Epstein-Barr virus and other spirochetes (e.g., Rickettsia, Treponema) may cause false-positive results.
- Positive test results should be confirmed by the Western blot method.
Nursing Implications and Procedure
Potential nursing problems
|Problem||Signs & Symptoms||Interventions|
|Infection (Related to Borrelia burgdorferi bacteria; transmission of B. burgdorferi bacteria in utero from infected mother to baby)||Macular flush; flu-like symptoms; headache; extreme fatigue; neck pain; joint pain; joint swelling; bone pain; classic bull’s-eye rash; unexplained fever; difficulty swallowing; chest pain; shortness of breath; heart palpitations; nausea; vomiting; pain in feet; twitching; numbness; irritability; visual disturbance; mood swings; depression; paranoia||Administer prescribed antibiotics; administer prescribed medications to treat symptoms; minimize future exposure by following these recommendations: stay out of the woods in spring and summer, stay toward the center of the hiking trail, do not sit on the ground in leafy/grassy wooded areas, complete frequent self-check for ticks, wear long-sleeved shirts, tuck pants into your socks, tuck shirt into your pants, wear light-colored clothing to make attached ticks more visible, use bug repellant with DEET, strip down and do a full body check after being outdoors in endemic areas, check your pets for ticks|
|Fatigue (Related to B. burgdorferi bacteria infection)||Decreased concentration; increased physical complaints; unable to restore energy with sleep; reports being tired; unable to maintain normal routine||Assess for physical cause of fatigue; pace activities to preserve energy stores; rate fatigue on a numeric scale to trend degree of fatigue over time; identify what aggravates and decreases fatigue; assess for related emotional factors such as depression; evaluate current medications in relation to fatigue; assess for physiologic factors such as anemia|
|Anxiety (Related to physical and mental changes that may or may not be reversible secondary to bacterial infection with B. burgdorferi associated with tick bite)||Consequences of B. burgdorferi infection to lifestyle and individual functionality; insomnia; restlessness; irritability; difficulty concentrating; anorexia; focus on self; expressions of concern; apprehension||Assess coping strategies used and their effectiveness; acknowledge the presence of anxiety; keep a calm presence while interacting with the patient; administer prescribed medications to decrease anxiety; use simple, straightforward language to increase understanding and decrease anxiety; support selected coping strategies; facilitate referral for psychiatric evaluation as needed; refer to Lyme disease support group|
- Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
- Patient Teaching: Inform the patient this test can assist in diagnosing Lyme disease.
- Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex. Discuss history of exposure; ask the patient if he or she lives in or visits wooded areas, wears long pants and long-sleeved shirts when in wooded areas or when doing yard work, or has ever been bitten by a tick.
- Obtain a history of the patient’s immune and musculoskeletal systems, symptoms, a history of exposure, and results of previously performed laboratory tests and diagnostic and surgical procedures.
- Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
- Review the procedure with the patient. Inform the patient that several tests may be necessary to confirm diagnosis. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
- Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
- Note that there are no food, fluid, or medication restrictions unless by medical direction.
- Potential complications: N/A
- Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
- Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
- Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
- Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
- Promptly transport the specimen to the laboratory for processing and analysis.
- Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
- Recognize anxiety related to test results, and be supportive of impaired activity related to perceived loss of independence and fear of shortened life expectancy. Lyme disease can be debilitating and can result in significant changes in lifestyle. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services.
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP.
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Warn the patient that false-positive test results can occur and that false-negative test results frequently occur. Answer any questions or address any concerns voiced by the patient or family.
- Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
- Advise the patient to wear light-colored clothing that covers extremities when in areas infested by deer ticks and to check body for ticks after returning from infested areas.
- Emphasize the importance of reporting continued signs and symptoms of the infection.
- Answer any questions or address any concerns voiced by the patient or family.
Expected Patient Outcomes
- States understanding that tick bite risk increases in specific designated geographical areas
- States understanding of the importance of taking prescribed antibiotic to treat infection, including that repeated antibiotic treatments may be necessary
- Describes clothing that would be appropriate to use in prevention of tick bites
- Demonstrates proficiency in the self-administering of the prescribed antibiotic
- Follows recommendation to take measures to prevent future tick bites
- Complies with recommendation to attend support group to decreased anxiety and increase understanding of disease process
- Related tests include ANA, CBC, ESR, rheumatoid factor, and synovial fluid analysis.
- Refer to the Immune and Musculoskeletal systems tables at the end of the book for related tests by body system.