Pediculosis capitis, commonly known as head lice infestation, is a prevalent condition that affects millions of people worldwide, particularly school-aged children. This nursing diagnosis focuses on the assessment, interventions, and care planning for patients with head lice, aiming to eradicate the infestation and prevent its spread.
Causes (Related to)
Pediculosis capitis is primarily caused by the human head louse, Pediculus humanus capitis. The following factors can contribute to the spread and persistence of head lice:
- Direct head-to-head contact with an infected person
- Sharing personal items such as hats, scarves, combs, or brushes
- Lying on infested beds, couches, pillows, or carpets
- Poor personal hygiene
- Overcrowded living conditions
- Lack of knowledge about lice prevention and treatment
- Resistance to common pediculicides
Signs and Symptoms (As evidenced by)
Pediculosis capitis can manifest with various signs and symptoms. During a physical assessment, a patient with head lice may present with one or more of the following:
Subjective: (Patient reports)
- Intense itching of the scalp
- A tickling sensation on the head
- Difficulty sleeping due to increased lice activity at night
- Irritability or restlessness
Objective: (Nurse assesses)
- Visible lice on the scalp, particularly behind the ears and near the neckline
- Presence of nits (lice eggs) attached to hair shafts
- Scratch marks or small red bumps on the scalp, neck, and shoulders
- Swollen lymph nodes in the neck
- Secondary bacterial infection of the scalp (in severe cases)
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for pediculosis capitis:
- The patient will be free of lice and nits within 7-10 days of treatment initiation
- The patient will demonstrate proper technique for applying pediculicides and removing nits
- The patient’s scalp will show no signs of secondary infection or irritation
- The patient will verbalize understanding of preventive measures to avoid reinfestation
- Family members and close contacts will be screened and treated if necessary
- The patient will report relief from itching and discomfort associated with lice infestation
Nursing Assessment
The first step in nursing care is the assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. The following section covers subjective and objective data related to pediculosis capitis.
- Perform a thorough scalp examination.
Part the hair and examine the scalp closely with a fine-toothed comb (nit comb). Look for live lice and nits behind the ears and near the neckline. - Assess for signs of secondary infection.
Check for redness, swelling, or pustules on the scalp that may indicate a secondary bacterial infection. - Evaluate the patient’s and family’s knowledge.
Assess the patient’s and family’s understanding of lice transmission, treatment, and prevention methods. - Check for infestation in family members.
Inquire about symptoms in other family members or close contacts, as lice can spread quickly within households. - Review recent activities and contacts.
Ask about recent sleepovers, shared personal items, or close contact with someone known to have lice. - Assess for treatment history.
Inquire about previous lice infestations and treatments, including over-the-counter and prescription medications. - Evaluate the impact on daily life.
Assess how the infestation affects the patient’s sleep, school attendance, and social interactions. - Check for signs of excessive scratching.
Look for excoriations or signs of trauma to the scalp due to intense itching. - Assess for allergic reactions.
Some patients may develop allergic reactions to lice saliva, resulting in more severe itching and inflammation.
Nursing Interventions
Nursing interventions and care are essential for the patient’s recovery from pediculosis capitis. In the following section, you’ll learn about possible nursing interventions for a patient with head lice.
- Educate on proper treatment application.
Teach the patient and family how to apply pediculicides correctly, following the manufacturer’s instructions or healthcare provider’s recommendations. - Demonstrate nit removal technique.
Show the patient and family how to use a fine-toothed comb to remove nits from the hair shafts, emphasizing the importance of thorough and repeated combing. - Recommend environmental cleaning
Advise washing bedding, clothing, and personal items in hot water (at least 130°F or 54°C) and drying them on high heat for at least 20 minutes. - Promote non-chemical interventions
Encourage regular combing with a nit comb and manual removal of lice and nits as a complement to pediculicide treatment. - Educate on prevention strategies.
Teach patients and families about avoiding head-to-head contact, not sharing personal items, and regular head checks to prevent re-infestation. - Monitor for treatment effectiveness.
Assess the scalp regularly during and after treatment to ensure the elimination of lice and nits. - Address secondary infections
If a secondary bacterial infection is present, administer prescribed antibiotics and teach proper wound care.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for pediculosis capitis.
Nursing Care Plan 1: Impaired Skin Integrity
Nursing Diagnosis: Impaired Skin Integrity related to pruritus and scratching secondary to pediculosis capitis infestation.
Related factors/causes:
- Intense itching caused by lice saliva
- Persistent scratching of the scalp
- Potential secondary bacterial infection
Nursing Interventions and Rationales:
- Assess the scalp for signs of excoriation and infection.
Rationale: Early detection of skin breakdown or infection allows for prompt treatment. - Teach the patient to avoid scratching and to keep fingernails short and clean.
Rationale: Reducing scratching minimizes skin damage and the risk of secondary infection. - Apply cool compresses to the scalp to relieve itching.
Rationale: Cool compresses can provide symptomatic relief and reduce the urge to scratch. - Administer topical antipruritic medications as prescribed.
Rationale: These medications can help manage itching and prevent further skin damage. - Educate the patient on proper hair and scalp hygiene during and after treatment.
Rationale: Good hygiene practices promote skin healing and to avoid reinfestation.
Desired Outcomes:
- The patient will demonstrate decreased scratching behavior within 24 hours.
- The patient’s scalp will show signs of healing without new excoriations within 3 days.
- The patient will verbalize understanding of strategies to manage itching without scratching within 24 hours.
Care Plan 2: Deficient Knowledge
Nursing Diagnosis: Deficient Knowledge related to pediculosis capitis treatment and prevention as evidenced by incorrect application of pediculicides and lack of preventive measures.
Related factors/causes:
- Lack of exposure to information about head lice
- Misunderstandings about lice transmission and treatment
- Language or cultural barriers
Nursing Interventions and Rationales:
- Assess the patient’s and family’s current knowledge about head lice.
Rationale: Identifying knowledge gaps allows for targeted education. - Provide clear, concise information about lice transmission, treatment, and prevention.
Rationale: Accurate information empowers the patient and family to manage the infestation effectively. - Demonstrate proper application of pediculicides and nit removal techniques.
Rationale: Hands-on instruction ensures correct treatment application and improves outcomes. - Discuss environmental cleaning measures to prevent re-infestation.
Rationale: Understanding how to clean personal items reduces the risk of re-infestation. - Provide written materials in the patient’s preferred language.
Rationale: Written resources reinforce verbal instructions and serve as a reference at home.
Desired Outcomes:
- Patient and family will demonstrate the correct pediculicide application technique within 24 hours.
- The patient will verbalize three prevention strategies for head lice before discharge.
- The family will report implementing environmental cleaning measures within 48 hours.
Care Plan 3: Social Isolation
Nursing Diagnosis: Social Isolation related to stigma associated with pediculosis capitis as evidenced by patient’s reluctance to attend school or social gatherings.
Related factors/causes:
- Misconceptions about head lice and personal hygiene
- Fear of social rejection or ridicule
- School policies requiring temporary exclusion
Nursing Interventions and Rationales:
- Assess the patient’s feelings about the lice infestation and its impact on social interactions.
Rationale: Understanding the patient’s emotional state guides interventions to address social concerns. - Provide education to the patient, family, and school about the facts of lice transmission.
Rationale: Dispelling myths can reduce stigma and promote understanding. - Collaborate with school nurses or administrators to facilitate the patient’s return to school.
Rationale: Coordinating with the school ensures appropriate management and minimizes unnecessary exclusion. - Encourage the patient to express feelings and concerns about the infestation.
Rationale: Emotional support can help the patient cope with the psychological impact of the infestation. - Teach the patient age-appropriate responses to questions or comments about head lice.
Rationale: Preparing the patient with factual responses can boost confidence in social situations.
Desired Outcomes:
- Patient will express decreased anxiety about social interactions within 48 hours.
- The patient will return to normal school attendance within one week of treatment initiation.
- Patient will report positive social interactions with peers within two weeks.
Care Plan 4: Disturbed Sleep Pattern
Nursing Diagnosis: Disturbed Sleep Pattern related to nocturnal itching and discomfort associated with pediculosis capitis infestation.
Related factors/causes:
- Increased lice activity at night
- Persistent itching and irritation of the scalp
- Anxiety about the infestation
Nursing Interventions and Rationales:
- Assess the patient’s sleep patterns and factors contributing to sleep disturbance.
Rationale: Identifying specific sleep disruptors allows for targeted interventions. - Recommend applying pediculicides in the evening, following package instructions.
Rationale: Evening application may reduce nighttime lice activity and associated discomfort. - Teach relaxation techniques to promote sleep.
Rationale: Relaxation can help reduce anxiety and promote better sleep quality. - Suggest the use of cool compresses or over-the-counter antihistamines before bedtime as appropriate.
Rationale: These measures can help reduce itching and promote more restful sleep. - Educate about sleep hygiene practices.
Rationale: Good sleep hygiene can improve sleep quality during and after treatment.
Desired Outcomes:
- Patient will report improved sleep quality within three days of intervention implementation.
- The patient will demonstrate the use of at least one relaxation technique before bedtime within 24 hours.
- Patient will report decreased nocturnal itching within 48 hours of treatment initiation.
Care Plan 5: Risk for Spread of Infestation
Nursing Diagnosis: Risk for Spread of Infestation related to close personal contact and sharing of personal items.
Related factors/causes:
- Lack of knowledge about lice transmission
- Close living quarters or shared bedding
- Sharing of personal items such as hats, combs, or brushes
Nursing Interventions and Rationales:
- Educate the patient and family about modes of lice transmission.
Rationale: Understanding how lice spread promotes adherence to preventive measures. - Teach the importance of avoiding head-to-head contact during an active infestation.
Rationale: Direct head contact is the primary mode of lice transmission. - Instruct on the proper cleaning and storage of personal items.
Rationale: Proper cleaning and storage reduce the risk of reinfestation from contaminated items. - Recommend simultaneous treatment of all infested household members.
Rationale: Treating all infested individuals at the same time prevents cycles of reinfestation. - Discuss strategies for preventing lice spread in schools or daycare settings.
Rationale: Implementing preventive measures in group settings reduces the risk of widespread infestation.
Desired Outcomes:
- Patient and family will demonstrate proper cleaning techniques for personal items within 24 hours.
- All infested household members will begin treatment within 48 hours.
- The patient will verbalize understanding of lice transmission prevention in school settings before returning to school.
References
- Burgess, I. F. (2016). Head lice: Diagnosis and treatment. American Family Physician, 93(2), 159-164.
- Centers for Disease Control and Prevention. (2020). Head lice: Treatment. Retrieved from https://www.cdc.gov/parasites/lice/head/treatment.html
- Devore, C. D., & Schutze, G. E. (2015). Head lice. Pediatrics, 135(5), e1355-e1365.
- Feldmeier, H. (2012). Pediculosis capitis: New insights into epidemiology, diagnosis and treatment. European Journal of Clinical Microbiology & Infectious Diseases, 31(9), 2105-2110.
- Koch, E., Clark, J. M., Cohen, B., Meinking, T. L., Ryan, W. G., Stevenson, A., & Yoon, K. S. (2016). Management of head louse infestations in the United States—A literature review. Pediatric Dermatology, 33(5), 466-472.
- Mumcuoglu, K. Y., Meinking, T. A., Burkhart, C. N., & Burkhart, C. G. (2006). Head louse infestations: The “no nit” policy and its consequences. International Journal of Dermatology, 45(8), 891-896.
