Case study - Leptospirosis: Nursing

Nurse Zoey works in an emergency care setting and is caring for Angelo, a 36 year old patient. Angelo presents with a one-week history of fever, muscle aches, headache, and severe fatigue.

Angelo reports his symptoms have worsened during the past 24 hours. Over the counter medications are no longer effective, and he's experiencing increasing shortness of breath.

Angelo also reports recent participation in outdoor clean-up efforts following local flooding, during which he spent several hours wading through standing water.

Given the combination of systemic symptoms and environmental exposure, the healthcare provider suspects leptospirosis, and orders an enzyme-linked immunosorbent assay, or Eliza, to support the diagnosis.

While awaiting results, nurse Zoey begins planning and implementing care for Angelo. First, nurse Zoey considers the pathology of leptospirosis by connecting Angelo's symptoms with his exposure history.

She recalls that leptospirosis is a bacterial zoonotic infection caused by the Leptospira species. These bacteria are commonly shed in the urine of infected animals, especially rodents, and can contaminate water and soil.

Infection occurs when the bacteria enter the body through cuts or abrasions in the skin, or through mucous membranes such as the conjunctiva of the eyes.

Angelo's recent exposure to floodwater significantly increases his risk, as leptospirosis outbreaks often follow heavy rainfall and flooding.

Once leptospira enters the bloodstream, it can disseminate throughout the body, leading to widespread inflammation and organ involvement.

Potential complications include acute kidney injury, liver dysfunction, pulmonary involvement, meningitis, and in severe cases, multi-organ failure.

Next, nurse Zoey obtains Angelo's vital signs, which reveal a temperature of 102.2 °F or 39 °C, BP of 98/62 millimeters of mercury, a heart rate of 112 BPM, respirations of 26 breaths per minute, and an oxygen saturation of 92% on room air.

Nurse Zoey notes that Angelo appears uncomfortable, and his eyes are noticeably reddened, but without drainage, which is known as conjunctival suffusion.

She also notes that Angelo's skin and sclera have mild yellow discoloration or jaundice. How are you feeling, Angelo?

I'm so tired, and my legs and back are very achy. How would you rate your pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine?

About a 7. I could handle it if it was closer to a 4.

Angelo also reports decreased urine output and describes his urine as dark yellow. When these findings are grouped together, nurse Zoe recognizes a pattern consistent with a systemic infectious disease like leptospirosis.

Using the information she's gathered, nurse Zoey identifies Angelo's priority problems to begin managing his care. She notes the priority problems include impaired gas exchange, impaired renal function, and increased body temperature.

With these problems in mind, nurse Zoey notes individualized measurable goals, including maintaining an oxygen saturation of 95% or higher, maintaining adequate urine output, and reducing Angelo's temperature.

Next, nurse Zoey reviews the healthcare provider's orders and applies supplemental oxygen, and administers the prescribed IV fluids, as well as antipyretics and antibiotic, following safe medication administration principles.

Angelo, I know this seems like a lot. The oxygen will help your breathing, and the IV fluids will help your kidneys start making more urine.

The other medications are to decrease your fever and get rid of the infection. Thanks, I hope all this helps.

Throughout her shift, nurse Zoey closely monitors Angelo's respiratory status and titrates the oxygen as ordered. She monitors his vital signs, tracks his urine output, and checks for changes in mental status.

While monitoring Angelo, nurse Zoey keeps in mind that she'll report any signs of his condition worsening to the healthcare provider right away.

Near the end of her shift, nurse Zoey evaluates Angelo's response to interventions. His current vital signs are a temperature of 100.3 °F, or 37.9 °C, BP of 112/70 millimeters of mercury, heart rate of 95 BPM, respirations of 18 breaths per minute.

And an oxygen saturation of 96% on 4 L nasal cannula. His urine output has increased and is light yellow.

Angela reports feeling less fatigued and rates his pain as 3 on a 10 point scale. Nurse Zoey notes that jaundice of the skin and sclera persists without progression.

Based on these findings, she determines that interventions have been effective and continues close monitoring. Before the end of her shift, nurse Zoey provides and reinforces education for Angelo and his family.

She explains that leptospirosis is transmitted through water contaminated with animal urine, and advises Angelo to avoid infection when coming in contact with floodwaters by covering any cuts or abrasions, and protecting his eyes and face from the contaminated water.

She reviews prevention strategies such as wearing protective clothing, practicing proper hand hygiene, promptly cleaning and covering open wounds, and using safe water for drinking and bathing.

Nurse Zoe also explains that preventing leptospirosis at the community level involves efforts such as rodent control and environmental sanitation, which are addressed through collaboration with the healthcare team and public health agencies.

Finally, she reinforces the importance of seeking medical care promptly if symptoms recur or worsen when he's discharged.

All right, as a quick recap. Nurse Zoey observed clinical manifestations related to Angelo's suspected leptospirosis, including fever, red eyes without drainage, jaundice, respiratory changes, and decreased urine output.

She connected these findings to environmental exposure to leptospirosis, identified and prioritized key problems, implemented care, and monitored Angelo's response to treatment.

She provided patient and family education focused on prevention strategies to reduce future risk.