16.18 Pediculosis Capitis (Lice)

Pediculosis capitis, commonly known as head lice, is caused by a small parasite called Pediculosis humanus capitis. Head lice is highly contagious and can affect clients of any socioeconomic status. Girls are affected more frequently, especially in the age group of 3 to 12 years old. Sharing hats or other inanimate objects like hairbrushes and combs increases the risk of pediculosis capitis, as well as living in areas with increased humidity, especially in the summer months.^[1]

Pathophysiology

Lice cannot jump or fly and are transmitted by direct contact with an infected individual. Once the parasite is in the human hair, it feeds on the blood of its host, causing an immune response similar to an allergic reaction. Symptoms appear two to six weeks after initial transmission or faster for reexposures.^[2]

Assessment (Recognizing Cues)

Physical Exam

The primary symptom of pediculosis capitis is itching. The head can be examined with the aid of a bright light, a magnifying glass, or a lice comb. Upon examination, the examiner may visualize adult head lice or their tiny eggs, known as nits. Nits are typically attached to the hair shaft. See Figure 16.24^[3] for an image of an adult head louse and a nit wrapped around a hair follicle. However, the presence of nits alone does not confirm active infection. Intense scratching can lead to the development of secondary bacterial infections. Other potential complications are school absences during to treatment, as well as potential for embarrassment due to head lice infestation.^[4]

Common Laboratory and Diagnostic Tests

Head lice is a clinical diagnosis, but adult lice can be examined under a microscope for confirmation. A Wood lamp can also help in diagnosis, as nits will fluoresce a green or yellow color under the light.^[5]

Nursing Diagnosis (Analyzing Cues)

Nursing priorities for clients with pediculosis capitis include symptom management and prevention of complications. Nursing diagnoses for clients with pediculosis capitis are created based on the specific needs of the client, their signs and symptoms, and the etiology of the disorder. These nursing diagnoses guide the creation of client-specific care plans that encompass client outcomes and nursing interventions, as well the evaluation of those outcomes. These individualized care plans then serve as a guide for client treatment. Possible nursing diagnoses for clients with pediculosis capitis are as follows^[6]:

• Risk for impaired skin integrity r/t severe itching.
• Risk for infection r/t risk for secondary bacterial infection
• Disturbed body image r/t presence of head lice

Outcome Identification (Generate Solutions)

Outcome identification encompasses the creation of short- and long-term goals for the client. These goals are used to create expected outcome statements that are based on the specific needs of the client. Expected outcomes should be specific, measurable, achievable, relevant, and timebound (SMART) within a set time frame based on the application of appropriate nursing interventions. Sample expected outcomes for clients with head lice include the following:

• The client will exhibit intact skin following treatment for head lice.
• Secondary infection of the skin such as redness, edema, or purulent discharge will not occur during the course of the illness.
• The client and/or parents/caregivers will verbalize their questions and feelings about having head lice after the teaching session.

Interventions (Generate Solutions & Take Action)

Medical Interventions

Medical treatment for pediculosis capitis includes the use of topical pediculicides (i.e., lice-killing medications). However, pediculicides do not kill nits, so treatment must be repeated in seven to ten days. Shaving the hair or wet combing is used, along with pediculicides, to remove the presence of lice and nits. Wet combing involves wetting the hair and repeatedly combing the hair from top to bottom with a fine-toothed comb. Any inanimate objects that may have come into contact with lice must also be washed in hot water and dried on high heat, such as clothing, bedding, or towels. Anything that cannot be washed should be sealed in a plastic bag for a minimum of two weeks. Combs and brushes should be soaked in hot water with soap for at least ten minutes or replaced.^[7],[8]

Nursing Interventions

Registered nurses develop interventions based on the expected outcomes of the client. Prior to implementation, the nurse must determine if all previously planned interventions are still suitable based on the current situation of the client. When caring for a client with pediculosis capitis, nursing interventions can be divided into nursing assessments, nursing actions, and client teaching.^[9],[10]

Nursing Assessments

• Assess the scalp to determine the severity of the lice infection, as well as assess for areas of secondary bacterial infection.
• Assess the mental status of the client, as having head lice can lead to embarrassment, social isolation, or bullying.

Nursing Actions

• Apply topical pediculicide medications per provider order.
• Encourage the client to keep fingernails short to prevent scratching the skin.

Client Teaching

• Educate the family of the client that all family members should also be screened for pediculosis capitis.
• Teach the client and their caregivers that topical pediculicides must be reapplied in seven to ten days to ensure treatment is complete.
• Educate clients and their caregivers that personal items such as hats, hair ties, combs, and brushes should not be shared to prevent the transmission of head lice.
• Teach the client and their family to not itch the scalp, as this can increase inflammation, as well as lead to secondary bacterial infections.

Evaluation (Evaluate Outcomes)

Evaluation of client outcomes refers to the process of determining whether or not client outcomes were met by the indicated time frame. This is done by reevaluating the client as a whole and determining if their outcomes have been met, partially met, or not met. If the client outcomes were not met in their entirety, the care plan should be revised and reimplemented. Evaluation of outcomes should occur each time the nurse assesses the client, examines new laboratory or diagnostic data or interacts with another member of the client’s interdisciplinary team.