NUR 350 Module 1 Short Paper example

Ticks at the Edge of the Woods: Applying the Levels of Prevention to Lyme Disease in a Rural County

[Student Name]

Southern New Hampshire University

NUR 350: Community and Population Health

Module One Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Ticks at the Edge of the Woods: Applying the Levels of Prevention to Lyme Disease in a Rural County

Roughly 38,000 people live in Pine Ridge County, a composite made for this paper that is mostly forest and farmland broken by small towns, lakes and a state park. Deer are abundant, many homes sit at the edge of woodland, and residents hike, hunt, farm and garden through the spring and summer. The county health department received 186 reports of Lyme disease last year, a rate of about 490 per 100,000 residents, many times the national reported rate. Reported cases, however, are only part of the picture. Using insurance claims data, federal researchers estimated that roughly 476,000 people in the United States are diagnosed and treated for Lyme disease each year, far more than the number reported through surveillance (Kugeler et al., 2021). The true burden in Pine Ridge County is therefore likely several times the reported count.

Lyme disease is caused by the bacterium Borrelia burgdorferi and transmitted mainly by the nymphs of the blacklegged tick, which are small and often unnoticed. Most infections in this region occur between May and August, when nymphs are active and people are outdoors (Mead, 2015). Because exposure happens in yards, fields and trails rather than in a clinic, the problem is a population problem that calls for prevention at every level, not only treatment of individuals.

Primary Prevention: Stopping the Bite

Primary prevention aims to stop infection before it happens by reducing tick bites. At the personal level, residents can use repellents registered by the Environmental Protection Agency on skin, treat clothing and boots with permethrin, wear long pants tucked into socks in tall grass, and check their bodies for ticks after being outdoors, including the scalp, behind the knees and in the groin. Showering within a few hours of coming indoors helps find and wash off unattached ticks. Because transmission usually requires a tick to be attached for more than a day, prompt tick checks are among the most effective personal measures (Lantos et al., 2021).

At the household level, keeping lawns short, placing a barrier of wood chips or gravel between lawns and woods, and moving play equipment away from the forest edge reduce contact with tick habitat. Pets can carry ticks indoors and should be protected with veterinary products. At the community level, primary prevention includes clear signs at trailheads and parks, repellent stations at the state park entrance, and seasonal messages through schools, farm organizations, hunting license outlets and churches. Teaching is most effective when it is timed to the start of the tick season and delivered where people are already gathering.

Secondary Prevention: Early Recognition and Treatment

Secondary prevention focuses on finding and treating infection early, before it spreads to joints, the heart or the nervous system. The most common early sign is erythema migrans, an expanding red rash at the site of the bite, often appearing 3 to 30 days later, sometimes with fever, fatigue and aches. Many people never saw the tick. Early Lyme disease with this rash is usually diagnosed clinically, without blood tests, and treated with a short course of oral antibiotics, which is highly effective at this stage (Lantos et al., 2021).

In highly endemic areas such as Pine Ridge County, a single dose of doxycycline may be offered within 72 hours of removing an attached blacklegged tick that is estimated to have been attached for at least 36 hours. Secondary prevention in the community therefore includes making sure residents know how to remove a tick with fine-tipped tweezers, recognize the rash and seek care promptly, and making sure primary care clinics and urgent care centers follow current guidance so that people are neither undertreated nor given unnecessary tests.

Tertiary Prevention: Reducing Complications

Tertiary prevention applies to people who already have later manifestations, such as Lyme arthritis, facial nerve palsy, meningitis or heart block. The goals are prompt treatment of these complications, restoration of function and prevention of disability. Most late manifestations respond to appropriate antibiotic courses, and people with persistent joint swelling may need referral to a specialist.

A smaller group of patients report persistent fatigue, pain or difficulty concentrating after treatment. Tertiary prevention for them includes symptom management, support and follow-up, and protection from harm. Guidelines recommend against prolonged courses of antibiotics for persistent symptoms, because trials have not shown benefit and long-term intravenous antibiotics carry serious risks (Lantos et al., 2021). Community nurses can help patients understand the evidence and find reputable care.

Summary of the Prevention Plan

The table below summarizes prevention at each level for the county.

Table 1

Levels of Prevention for Lyme Disease in Pine Ridge County

The Community Health Nurse's Role

The community health nurse works across all three levels. At the primary level, the nurse plans and delivers seasonal education, partners with the park service and agricultural extension office, and advocates for repellent stations and signage. At the secondary level, the nurse teaches tick removal and rash recognition, shares prophylaxis guidance with clinics, and analyzes surveillance reports each season to spot changes in timing or geography. At the tertiary level, the nurse connects people with late disease to care and offers accurate information to counter misleading claims. Because the county's reported cases understate the true burden, the nurse can also work with clinicians to improve reporting, which strengthens the data that guide every level of prevention.

Conclusion

Lyme disease in a wooded rural county is a population problem rooted in where people live, work and play. Primary prevention reduces tick bites through personal, household and community action; secondary prevention catches infection early, when treatment is simple and effective; and tertiary prevention treats complications while protecting patients from harm. The community health nurse links all three levels, turning surveillance data into targeted education and partnerships that fit the rhythms of rural life.

References

Kugeler, K. J., Schwartz, A. M., Delorey, M. J., Mead, P. S., & Hinckley, A. F. (2021). Estimating the frequency of Lyme disease diagnoses, United States, 2010-2018. Emerging Infectious Diseases, 27(2), 616-619. https://doi.org/10.3201/eid2702.202731

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. (2021). Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease. Clinical Infectious Diseases, 72(1), e1-e48. https://doi.org/10.1093/cid/ciaa1215

Mead, P. S. (2015). Epidemiology of Lyme disease. Infectious Disease Clinics of North America, 29(2), 187-210. https://doi.org/10.1016/j.idc.2015.02.010