Definition and Risk factors
Pediculosis.
Infestation by lice, involves three different parasites:
- Pediculosis humanus capitis (head louse)
- Pediculosis humanus corporis (body louse)
- Phthirus pubis (pubic or crab louse)
Scabies
- Involves infestation by the itch mite, Sarcoptes scabiei.
Pathophysiology
Pediculosis
- Lice live on the host’s skin surface and depend on the host for nourishment, feeding on human blood approximately five times daily. They inject their digestive juices and excrement into the host’s skin and lay their eggs (i.e. nits) on hair shafts.
Scabies
- Adult itch mites burrow into the superficial layer of skin and lay two to three eggs daily for up to 2 months. Eggs hatch in 3 to 4 days, clinical symptoms are related to a sensitivity reaction as larvae emerge to the skin surface.
Assessment/Clinical Manifestations/Signs and Symptoms
Pediculosis
- Itching
- Excoriation from scratching
- Possibly, small, red papules in infected areas.
- Tiny, gray-white nits on hair shafts
Scabies
- Severe itching
- Excoriated lesions possibly appearing as erythematous nodules
- Possible secondary bacterial infection
Medical Management
- Pediculosis capitis: treatment involves the hair with a shampoo containing lindane (Kwell) or pyrethrin compounds with piperonyl butoxide (RID or R&C Shampoo). The patient is instructed to shampoo the scalp and hair according to the product directions.
- Pediculosis corporis and pubis: the patient is instructed to bathe with soap and water, after which lindane (Kwell) or 5% permetrhin (Elimite) is applied to affected areas of the skin and to hair areas, according to the product directions. An alternative topical therapy is an over-the-counter strength of permethrin (1% Nix)
- Scabies: A prescription scabidie such as lindane (Kwell), crotamiton (Eurax), or 5% permethrin (Elimite) is applied thinly to entire skin from the neck down, spatting only the face and scalp (which are not affected in scabies). The medication is left on for 12 to 24 hours, after which the patient is instructed to wash thoroughly. One application may be curative, but it is advisable to repeat the treatment in 1 week.
Nursing Diagnosis
- Deficient knowledge about the disease process and treatment
- Impaired skin integrity related to lesions and inflammatory response
- Disturbed body image related to embarrassment over appearance and self-perception of uncleanliness
Nursing Management
- Provide general nursing care for parasitic skin diseases, which focuses on enhancing skin integrity, providing pain relief, preventing infection and providing client and family teaching.
- Provide client and family teaching regarding measures to treat pediculosis.
- Teach the client with lice (or a parent if the client is a child) to shampoo with lindane and remove nits with a fine-tooth comb.
- Provide client and family teaching regarding measures to treat scabies.
- Teach the client how to use a scabicide, such as lindane or crotamiton.
- Explain that the scabicide is directly absorbed by the parasites.
- Instruct the client to wash scaling debris or crusts with warm, soapy water and dry the area thoroughly before applying medication.
- Leave the medication on for 12 to 24 hours and then wash thoroughly.
- Teach precautions to prevent future infestations.
- Wash all bedding and clothing in hot water and dry it using the hot cycle of the clothes dryer.
- Never share hair brushes, combs or hats.
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