Nursing Diagnoses for Leptospirosis: Priority Problems and Interventions

Leptospirosis is a zoonotic spirochetal infection causing a spectrum from mild flu-like illness to Weil's syndrome (jaundice, renal failure, hemorrhage, pulmonary hemorrhage). Nursing diagnoses address the multisystem impact.

Priority Nursing Diagnoses (NANDA-I Framework)

1. Risk for Deficient Fluid Volume related to capillary endothelial damage, vasculitis, vomiting, diarrhea, polyuria (renal tubular dysfunction), fever.
   • Interventions: Strict I&O, daily weights, IV crystalloids (RL/NS), electrolyte replacement, monitor urine output (>0.5 mL/kg/h), CVP if critical.
2. Impaired Gas Exchange related to alveolar hemorrhage, pulmonary edema, ARDS (severe pulmonary leptospirosis).
   • Interventions: Continuous SpO₂ monitoring, supplemental O₂, high-Fowler's, prepare for intubation/ventilation, ABG monitoring.
3. Acute Pain related to myalgia (calf, lumbar), headache, conjunctival suffusion, abdominal pain.
   • Interventions: Scheduled analgesics (avoid NSAIDs if renal impairment/bleeding risk; acetaminophen preferred), non-pharmacologic measures, reassessment.
4. Risk for Bleeding related to thrombocytopenia, coagulopathy (DIC), hepatic dysfunction, vasculitis.
   • Interventions: Monitor CBC, PT/INR, aPTT, fibrinogen, D-dimer q6–12h; fall precautions; avoid IM injections; platelet/FFP transfusion per protocol.
5. Acute Kidney Injury related to direct tubular toxicity, hypovolemia, rhabdomyolysis, immune complex deposition.
   • Interventions: Monitor creatinine, BUN, K⁺, PO₄, urine output; nephrology consult; RRT preparation; adjust drug dosing.
6. Hyperthermia related to systemic inflammatory response, cytokine release.
   • Interventions: Antipyretics, cooling measures, hydration, monitor for sepsis.
7. Deficient Knowledge regarding disease transmission (rodent urine, contaminated water/soil), treatment adherence (doxycycline/penicillin), prevention.
   • Interventions: Teach-back method; written materials; occupational/environmental risk reduction.
8. Anxiety related to acute illness severity, isolation, uncertainty, potential long-term sequelae.
   • Interventions: Therapeutic communication, family involvement, explain procedures, anxiolytics if indicated.
9. Impaired Physical Mobility related to severe myalgia, muscle tenderness, weakness.
   • Interventions: Progressive mobilization, assistive devices, PT referral, fall prevention.

Collaborative Problems

• Potential for: Sepsis, DIC, ARDS, Acute Hepatic Failure, Myocarditis, Uveitis, Reactive Arthritis.

Early recognition of severe manifestations (pulmonary hemorrhage, oliguric AKI, altered mental status) and aggressive supportive care reduce mortality from 5–15% (Weil's) to <1% (mild).