Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice
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Outline
Lesson Objective for Pediculosis Capitis (Head Lice) Nursing Care Plan
- Understanding of Pediculosis Capitis:
- Identification: Develop knowledge and skills to identify the signs and symptoms of head lice infestation, including inspection of the scalp and hair.
- Transmission Routes: Understand the various ways head lice can be transmitted to effectively educate patients and caregivers on prevention.
- Treatment Modalities:
- Topical Treatments: Gain knowledge about topical treatments for head lice, including the appropriate use of pediculicides and their application.
- Combing Techniques: Learn effective combing techniques to remove lice and nits from the hair, promoting successful treatment.
- Preventive Measures:
- Education on Prevention: Provide education on preventive measures, including personal hygiene practices, avoiding shared items, and routine head checks to reduce the risk of reinfestation.
- Community Awareness: Promote awareness within communities, schools, and families about the importance of early detection and prevention of head lice.
- Psychosocial Support:
- Addressing Stigma: Understand the psychosocial impact of head lice and develop strategies to address stigma and misconceptions associated with infestations.
- Communication Skills: Enhance communication skills to effectively educate and support individuals and families dealing with head lice.
- Monitoring and Follow-Up:
- Post-Treatment Assessment: Learn to conduct post-treatment assessments to ensure the effectiveness of interventions and address any residual concerns.
- Follow-Up Education: Provide ongoing education for patients and caregivers on maintaining a lice-free environment and recognizing potential signs of re-infestation.
Pathophysiology of Pediculosis Capitis (Head Lice)
- Life Cycle of Lice:
- Head lice (Pediculus humanus capitis) go through three developmental stages: nit (egg), nymph, and adult louse.
- Nits are laid close to the scalp and are firmly attached to the hair shaft. After hatching, nymphs mature into adult lice in about 9-12 days.
- Feeding and Reproduction:
- Adult head lice feed multiple times daily by piercing the scalp and ingesting small amounts of blood.
- Females lay eggs on hair shafts, and these nits hatch into nymphs. The nymphs molt three times before reaching adulthood.
- Duration of Infestation:
- Head lice infestations can persist for an extended period if not treated, as adult lice can survive for about 30 days on the host.
- Continuous reproduction can lead to an increase in the number of lice if not addressed promptly.
- Mode of Transmission:
- Head lice are primarily transmitted through direct head-to-head contact. They cannot jump or fly but move quickly from one host to another when in close proximity.
- Sharing personal items like combs, brushes, hats, and bedding can also contribute to transmission.
- Clinical Manifestations:
- Itching (pruritus) is a common symptom caused by an allergic reaction to louse saliva.
- Scratching may lead to secondary bacterial infections and can be associated with red papules or sores on the scalp and neck.
Etiology of Pediculosis Capitis (Head Lice)
- Pediculus humanus capitis:
- Head lice, scientifically known as Pediculus humanus capitis, are small insects that infest the human scalp and hair.
- These lice specifically target the scalp as their primary habitat for feeding, mating, and laying eggs.
- Direct Human-to-Human Transmission:
- The primary mode of transmission is direct head-to-head contact with an infested person.
- Head lice cannot fly or jump but move quickly from one person to another when there is close physical contact.
- Sharing Personal Items:
- The sharing of personal items like combs, brushes, hats, scarves, headphones, and bedding can contribute to the spread of head lice.
- Lice or their eggs (nits) can be transferred when items infested with them come into contact with another person.
- Prevalence in Close Communities:
- Head lice infestations are more common in settings where people are in close contact, such as schools, childcare centers, and households.
- Crowded living conditions and shared spaces facilitate the transmission of lice.
- Resistance to Certain Treatments:
- Over time, head lice have developed resistance to some traditional insecticides used in lice treatments.
- This resistance can complicate eradication efforts and may require alternative approaches in treatment.
Desired Outcome for Pediculosis Capitis (Head Lice)
- Eradication of Lice Infestation:
- The primary goal is to completely eliminate the presence of adult lice, nymphs, and eggs (nits) from the infested individual’s scalp and hair.
- Prevention of Secondary Infections:
- A successful outcome involves preventing secondary bacterial infections that can occur due to excessive scratching and open sores on the scalp.
- Restoration of Scalp Health:
- The scalp should return to a healthy state, free from irritation, inflammation, and discomfort caused by the presence of head lice and their bites.
- Education on Preventive Measures:
- Individuals and their families should be educated on effective preventive measures to reduce the risk of future head lice infestations.
- Knowledge about personal hygiene, avoiding head-to-head contact, and not sharing personal items helps in long-term prevention.
- Psychosocial Well-being:
- A positive outcome includes addressing any psychosocial impact on the affected individual, especially children who may experience embarrassment or social stigma.
- Successful treatment contributes to improved self-esteem and overall well-being.
The desired outcome for treating pediculosis capitis extends beyond the elimination of lice, encompassing prevention, education, and the well-being of the affected individual.
Pediculosis Capitis / Head Lice Nursing Care Plan
Subjective Data:
- Extreme itching on the scalp
- Irritability
- Difficulty sleeping
Objective Data:
- Small red bumps or sores on the scalp, neck or shoulders
- Swollen lymph nodes behind the ears
- Red, irritated eyes (if lice present in eyelashes)
- Small bugs noted on scalp or found on pillow or sheets
Nursing Assessment for Pediculosis Capitis (Head Lice)
- Physical Examination:
- Inspect the scalp and hair for the presence of adult lice, nymphs, and nits. Pay attention to areas behind the ears and the nape of the neck.
- Assessment of Scalp Condition:
- Evaluate the scalp for signs of inflammation, redness, and sores caused by scratching. Note any secondary bacterial infections.
- Patient History:
- Obtain information about the duration of symptoms, including itching and discomfort.
- Inquire about recent exposure to individuals with head lice and any previous attempts at treatment.
- Family Assessment:
- Perform a thorough assessment of family members, as head lice can spread easily within households.
- Identify any shared items or close contacts that may contribute to the transmission of lice.
- Psychosocial Assessment:
- Assess the emotional impact of head lice on the affected individual, especially children who may experience embarrassment or distress.
- Education Needs:
- Determine the patient’s and family’s knowledge about head lice, transmission, and preventive measures.
- Identify areas where education is needed regarding proper hygiene practices and avoiding reinfestation.
- Presence of Allergic Reactions:
- Note any signs of allergic reactions such as redness, swelling, or rash. These reactions may indicate sensitivity to lice bites or products used for treatment.
- Comprehensive Inspection:
- Check personal items such as combs, brushes, and hats for the presence of lice or nits.
- Examine the environment for potential sources of reinfestation, such as contaminated bedding or upholstered furniture.
A thorough nursing assessment is crucial for accurately diagnosing and treating pediculosis capitis. It involves not only physical examination but also consideration of psychosocial factors and education to prevent recurrence.
Implementation for Pediculosis Capitis (Head Lice)
- Topical Treatment:
- Administer prescribed or over-the-counter medicated shampoos, creams, or lotions containing pediculicides as directed.
- Instruct the patient and family on the correct application and timing of the treatment.
- Environmental Measures:
- Advise thorough cleaning and vacuuming of the home, especially areas where the affected individual spends time.
- Wash all bedding, clothing, and personal items in hot water and dry them on high heat to kill lice and nits.
- Education on Preventive Measures:
- Provide education on preventive strategies, including avoiding head-to-head contact, not sharing personal items, and using lice repellents if necessary.
- Emphasize the importance of routine head checks, especially in households with school-aged children.
- Combing and Nit Removal:
- Instruct the patient or caregiver to use a fine-toothed comb to remove dead lice and nits from the hair.
- Demonstrate proper combing techniques, ensuring thorough coverage of the scalp.
- Follow-up and Reassessment:
- Schedule follow-up appointments to assess treatment effectiveness and check for any signs of reinfestation.
- Reinforce the importance of completing the full course of treatment and addressing any remaining nits.
Nursing Interventions and Rationales
- Assess the scalp for nits or active lice, common behind the ears, at the base of the neck and on the crown of the head
Nits will be small and firmly attached to the hair shaft. Shells of nits will still be present after they hatch but will appear more yellow. Adult lice may be more difficult to see as they are darker and crawl quickly.
- Use PPE for examining patient
Lice are easily transmitted in clothing and on skin; use gloves to examine patient and change gloves between patients to prevent further transmission
- Use Wood’s lamp (black light) to determine presence of lice or nits
This method involves less chance of transmission of lice and is done by shining the black light on the patient’s head. Lice and nits will look like glowing yellow or green dots.
- Apply pediculicide shampoo to patient’s scalp and hair
Over the counter and prescription strength shampoos are available. Hair should not be washed again for 1 -2 days following treatment.
- Comb hair with nit comb
This is a long and tedious process, but it required to remove lice and nits from the hair and prevent reinfestation. Some shampoos only kill adult lice and nymphs, so nits (eggs) must be manually removed.
- Administer oral medication as a last option (Ivermectin)
This medication is given orally when all other treatments have failed.
There may be significant side effects to this medication, so monitor for signs of liver damage, joint or muscle pain, weakness, vision changes or rash.
- Assess skin for signs of infection
Itching is the most worrisome symptom but introducing bacteria into excoriated skin can lead to skin infections.
- Ensure patient’s nails are trimmed and clean
Scratching to relieve itching is a normal response, and often is done during sleep. Make sure nails are trimmed and clean to reduce likelihood of infection.
- Address patient or caregivers’ emotional distress
Many people feel that lice are a reflection of poor hygiene. Reassure families that anyone can have lice and provide guidance on how to cope. Try to help them view the situation as a medical condition and avoid scolding or punishing the child.
- Provide education for patient and caregivers on ways to prevent further infestation
- Treatment must be reapplied within 7-10 days to ensure that all newly hatched lice and nymphs have been removed.
- Wash all bed linens, towels and clothes belonging to the patient separately in hot water.
- Vacuum carpets, rugs, furniture and mattresses to remove lice that may be hiding there
- For items that cannot be washed, such as toys or stuffed animals, seal them in a plastic bag for 4-5 weeks to kill any remaining lice or nymphs.
Evaluation for Pediculosis Capitis (Head Lice)
- Resolution of Active Infestation:
- Assess the effectiveness of the implemented treatment measures by determining whether the patient is free from live head lice. This evaluation may involve direct examination of the scalp and hair for the presence of live lice.
- Absence of Nits (Lice Eggs):
- Examine the hair shafts closely to ensure the absence of nits (lice eggs). Successful treatment should not only eliminate live lice but also prevent the hatching of any remaining eggs.
- Improvement in Symptoms:
- Evaluate whether the patient has experienced a reduction or resolution of symptoms associated with head lice infestation, such as itching, redness, or irritation of the scalp.
- Education and Prevention Understanding:
- Assess the patient’s understanding of pediculosis capitis, including its transmission, prevention strategies, and the importance of proper hygiene practices. This evaluation helps determine the effectiveness of educational interventions.
- Adherence to Treatment Plan:
- Evaluate the patient’s adherence to the prescribed treatment plan, including the application of medicated shampoos or lotions, as well as any recommended environmental cleaning measures. Adherence is crucial for the success of the treatment and prevention efforts.
References
- https://www.skinsight.com/skin-conditions/child/pediculosis-capitis-head-lice
- https://www.cdc.gov/dpdx/pediculosis/index.html
- https://www.webmd.com/drugs/2/drug-1122/ivermectin-oral/details
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Transcript
All right. Let’s dive into the nursing care plan for pediculosis capitis, better known as head lice. So head lice is a common, very contagious infestation of the human head lice in the patient’s hair. It is pretty much an infestation of the hair on the head and causes extreme itching. The itching often results from an allergic reaction to the loss of saliva. After it bites the skin, the lice feeds on human blood in order to survive. Head lice is ]most prevalent in schools, daycare centers, and nurseries. The nursing considerations that we want to keep in mind are we want to assess the scalp and eyebrows. We want to apply shampoo and treat as ordered, and we want to make sure that we educate the parents on prevention and screening methods. The desired outcome for this patient is that the patient is going to be free from active lice infestation. The patient will verbalize ways to prevent future reinfestation. So you have head lice in your head. What do you think the patient’s going to complain about? Well, I hope that you are saying extreme itchiness; it’s described as an extreme itchy scalp.
They’re going to be very irritable, very irritable. I’d be irritable as well if I were having to scratch all the time. And finally, this is an interesting one: difficulty sleeping. But if you think about it, there’s a couple of things that work here. The patient is going to have difficulty sleeping because these pests are active at night. So the itching is going to get worse at night. That’s when they start laying their eggs and they start feeding at night. Also think about the anxiety of knowing that something is there. Would you have a hard time sleeping? Some of the objective things that we’re going to observe when we’re taking care of these patients is we may see small lumps or bumps on the neck, the scalp, or the shoulders for small bops. Um, we may also have six swollen lymph nodes behind the ears.
Also, we are going to see red, irritated eyes, and that’s really, if the lce are present in the eyelashes and we’re going to see small bugs noted on the scalp or found on a pillow or pillow sheets. So what are we going to do as our nursing intervention? I hope the first thing that you said is we’re going to assess the scalp. And what we’re looking for is we’re looking for signs of infestation. We may see behind the ears at the base of the neck, the crown of the head knits, which are very small and they’re firmly attached to the hair shaft. The shells of the neck are going to be present after they hatch. Remember they appear more yellow. Adult lights are difficult to see because they’re very dark and they crawl very fast.
So we’re going to assess the next thing we’re going to do is we’re going to want to make sure we protect ourselves. So we are going to use PPE when we are caring for this patient when examining this patient. Remember, this is very contagious, so they can cross over really quickly. So using PPE will keep them from doing that. We’re going to use a pair of gloves, maybe a gown, and we want to make sure we change it in between patients to prevent spreading it to the next patient. Next, we’re going to make sure we use a shampoo that kills these pests. We’re going to make sure we use it on the scalp. Over the counter or prescription strength are available. Hair is very important. Hair should not be washed again for one to two days. And we are going to make sure that we do a follow-up treatment as indicated, we’re going to comb over the hair.
Nit combs are very specialized cones because they have small grooves in between the teeth and they pull the nets or the eggs off of the scalp. So we want to use a nit comb. This is going to make sure that we remove it and we want to make sure we prevent reinfestation. Finally, we’re going to provide education. Education is key. So we’re going to provide education on prevention of re-infestation. Remember to watch all bed linens; it’s very important. They wash their bed linens, towels, clothing, and very hot water. Also, there must be a second treatment. Let’s make sure we educate them on that second treatment within seven to 10 days after the initial treatment. Okay, here’s the completed care plan. And here are some key points. The pathophysiology behind head lice, it’s just that infestation of lice in the patient’s head, they are going to complain of an itchy scalp difficulty sleeping.
This is one of the hallmark signs, small red bumps. You’ll see bites on the crown of the head. The base of the neck also could be present in the eyebrows, the eyelashes and the telltale sign and the most definitive sign that it is actually a head lice is we’re going to see small bugs. And those small bugs may be on the pillow case. The small bugs may be in the scalp, in the sheets, and on clothing. So transmission education, very important because we want to prevent reinfestation and passing it on. So we want to do transmission education. We want to educate parents that it is a no, no don’t share combs or hats. Don’t share towels. Don’t go to slumber parties during the active infection and also avoid sports events to prevent reinfestation. We want to educate on how to do it. We want to wash the limit. We want to wash it in hot water. We want to make sure we wash the bed sheets, the towels, like I said, any hats or caps that were thrown out, anything that can be thrown out to prevent reinfestation. We love you guys; go out and be your best self today. And, as always, happy nursing.
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Nursing Care Plans
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