Nursing Care Plan for Pediculosis Capitis / Head Lice

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Pathophysiology

Pediculosis capitis is more commonly known as “head lice” and is a common, very contagious, infestation of the human head louse in the patient’s hair. It generally infests the hair on the head and causes extreme itching. The itching is often a result of an allergic reaction to the louse saliva after it bites the skin. The louse feeds on human blood in order to survive. Head lice is most prevalent in schools, day care centers and nurseries.

Etiology

Head lice are spread from person to person through direct contact with someone who already has an infestation. The easiest contact is during play such as sports activities, playgrounds and slumber parties, but can also be transmitted by sharing combs, brushes, hats and scarves, sports uniforms or using blankets or towels that were used by an infested person. Lice can only crawl and create a tickling sensation on the skin; they are not able to fly or jump from person to person.

Desired Outcome

Patient will be free from active lice infestation; patient will verbalize ways to prevent future reinfestation

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 Interventions and Rationales

  1. 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

  2. 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.

  3. Use PPE for examining patient

  4. Lice are easily transmitted in clothing and on skin; use gloves to examine patient and change gloves between patients to prevent further transmission

  5. Use Wood’s lamp (black light) to determine presence of lice or nits

  6. This method involves less chance of transmission of lice and is done by shining the black light on the patients head. Lice and nits will look like glowing yellow or green dots.

  7. Apply pediculicide shampoo to patient’s scalp and hair

  8. Over the counter and prescription strength shampoos are available. Hair should not be washed again for 1 -2 days following treatment.

  9. Comb hair with nit comb

  10. 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.

  11. Administer oral medication as a last option (Ivermectin)

  12. 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.

  13. Assess skin for signs of infection

  14. Itching is the most worrisome symptom, but introducing bacteria into excoriated skin can lead to skin infections.

  15. Ensure patient’s nails are trimmed and clean

  16. 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.

  17. Address patient or caregivers’ emotional distress

  18. Many people feel that lice is 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.

  19. 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.


References

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