NR 603 Week 3 Collaboration Cafe - Lyme Disease and MS

Lyme disease: The treatment of Lyme disease is typically treatment with antibiotics, with one of the options being oral doxycycline. However, this patient has a reported allergy to minocycline and therefore is contraindicated for receiving doxycycline. A known alternative in this case would be oral amoxicillin or IV antibiotics such as ceftriaxone or penicillin. Referral to a neurologist may be necessary if neurological symptoms worsen or do not improve. Close follow-up is necessary to monitor for clinical improvement and to address any arising complications. Multiple Sclerosis: If this client were to have a primary diagnosis of MS, a referral to a neurologist would be warranted as a diagnosis of MS is very complex. Steroids may be needed for acute flares, as well as the initiation of disease- modifying therapies (Jakimovski et al., 2024). Regular neuro exams and imaging are typically required to assess for new lesions and monitor disease activity. d. Consider how this week’s care setting (a rural setting with limited resources) impacts the FNP’s assessment, diagnosis, and management of these diagnoses. Explain your rationale. Treating this patient with a diagnosis of Lyme disease in a rural setting with limited resources may be challenging. The clinic only has access to basic lab tests and therefore may not have the capability to order the necessary testing for Lyme disease. The FNP may need to order specialized testing from an outside lab to make a definitive diagnosis. The FNP may also need to decide to empirically treat this patient without lab confirmation if the suspicion for Lyme disease is high. The absence of erythema migrans may complicate this decision. There also is not an immediate option to treat with IV antibiotics, as the nearest hospital is over an hour away. This leaves oral antibiotics to be the only treatment of choice without referring to a higher level of care. It will be very important for the FNP to provide adequate education on worsening symptoms, and reasons for the patient to present back to the clinic or present to the nearest hospital. These symptoms may include worsening neurological functioning, worsening headache, or confusion. References Jakimovski, D., Bittner, S., Zivadinov, R., Morrow, S. A., Benedict, R. H., Zipp, F., & Weinstock-Guttman, B. (2024). Multiple sclerosis. Lancet (London, England), 403(10422), 183–202. https://doi.org/10.1016/S0140-6736(23)01473-3 Lantos, P. M., Rumbaugh, J., Bockenstedt, L. K., Falck-Ytter, Y. T., Aguero-Rosenfeld, M. E., Auwaerter, P. G., Baldwin, K., Bannuru, R. R., Belani, K. K., Bowie, W. R., Branda, J. A., Clifford, D. B., DiMario, F. J., Halperin, J. J., Krause, P. J., Lavergne, V., Liang, M. H., Meissner, H. C., Nigrovic, L. E., … Zemel, L. S. (2020). Clinical practice guidelines by the