Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice

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Outline

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

  • 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.

Writing a Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice

A Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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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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