Nursing Guide to Lice: Nursing Diagnosis, Interventions, & Care Plans

Lice (pediculosis) are parasitic insects that may infest the hair and skin of humans. There are three main types of lice that affect people: head lice (Pediculus humanus capitis), body lice (Pediculus humanus corporis), and pubic lice (Pthirus pubis).  

While lice are not dangerous and do not spread disease, they can cause intense itching, discomfort, and sometimes secondary skin infections due to scratching. Infestations are highly contagious, especially in settings where close personal contact is common, such as schools, daycare centers, and households. 

Etiology and epidemiology 

Lice infestations occur when direct contact is made with an infested person or through contact with contaminated personal items like combs, brushes, hats, bedding, or clothing. Lice do not fly or jump; they crawl from one host to another.  

The most common form of infestation, head lice, is prevalent among school-aged children, particularly between the ages of 3 and 11. Body lice are more commonly associated with poor hygiene and crowded living conditions. Pubic lice are spread primarily through sexual contact. 

• Head lice: More common in children, affecting millions globally every year. Prevalence is higher in girls than boys, likely due to hair length.
• Body lice: Typically found in people living in crowded and unsanitary conditions, such as the homeless population.
• Pubic lice: Spread primarily through sexual contact and affects both men and women. 

Lice infestations are not related to poor personal hygiene for head or pubic lice and can occur in individuals of all socioeconomic backgrounds. 

Lice ICD-10 code 

• B85.0: Pediculosis due to Pediculus humanus capitis (head lice)
• B85.1: Pediculosis due to Pediculus humanus corporis (body lice)
• B85.2: Pediculosis due to Pthirus pubis (pubic lice) 

Source: ICD10data.com (https://www.icd10data.com/ICD10CM/Codes/A00-B99/B85-B89/B85-/B85.2) 

Diagnosis 

Lice infestations are diagnosed through visual examination of the hair, scalp, or body. Key diagnostic steps include: 

• Head lice:
• Examine the scalp and hair, particularly behind the ears and at the nape of the neck, for live lice or nits (lice eggs).
• Nits are small, oval, and yellowish-white, and are attached firmly to the hair shaft.
• Use a fine-tooth comb to inspect the hair, as lice move quickly and are difficult to spot.
• Body lice:
• Check clothing, especially seams, for lice or eggs. Body lice live on clothing and only move to the skin to feed.
• Pubic lice:
• Visual examination of the pubic hair for lice or eggs. Pubic lice have a crab-like appearance and may also be found in other coarse body hair, such as the eyebrows, eyelashes, and chest hair. 

Management 

The primary goal of treatment is to eradicate lice and nits, prevent reinfestation, and relieve symptoms of itching and irritation. 

Medications 

• Over-the-counter (OTC) treatments:
• Permethrin 1% lotion is the first-line treatment for head lice.
• Pyrethrin-based shampoos are effective against lice but may not kill all nits, so a second treatment is often necessary 7-10 days after the first application.
• Prescription medications:
• Ivermectin lotion or oral tablets are used for resistant cases.
• Malathion lotion (0.5%) is another option, particularly for resistant infestations.
• Spinosad (0.9% topical suspension) is an effective prescription treatment for head lice.
• Non-pharmacological methods:
• Manual removal: Use of a fine-tooth comb to remove lice and nits after treatment. This should be done every 2-3 days for at least 2 weeks.
• Shaving the affected area: Often considered for pubic lice but not typically recommended for head lice. 

Environmental control 

Lice do not live long off the host, but careful cleaning of personal items is essential to prevent reinfestation: 

• Clothing, bedding, and towels: Should be washed in hot water (at least 130°F) and dried on a high-heat setting.
• Combs and brushes: Soak in hot water for 5-10 minutes.
• Non-washable items: Can be sealed in plastic bags for 2 weeks to kill any remaining lice. 

Lice nursing care plan 

Nursing considerations 

Nurses must provide education about lice transmission, treatment, and prevention. Reducing the stigma associated with lice infestations is essential, particularly in children. 

Assessment 

• Assess for signs of scratching, inflammation, or secondary infections from excessive itching. 
• Inspect the scalp, hair, and body for live lice and nits. 
• Evaluate the patient's hygiene practices and home environment to determine the potential for reinfestation. 

Nursing diagnosis/risk for 

• Impaired skin integrity related to itching and scratching. 
• Risk for infection due to skin excoriation from scratching. 
• Anxiety related to the stigma of lice infestation and the risk of transmission to others. 
• Knowledge deficit regarding lice treatment and prevention. 

Interventions 

• Education: Provide instructions on proper use of lice treatment medications, emphasizing the importance of following treatment guidelines and repeating treatments if necessary. 
• Infection prevention: Educate about the risk of secondary infections and how to care for irritated skin. Encourage patients not to scratch the affected area to avoid skin breakdown. 
• Environmental control: Teach patients how to disinfect personal items and household surfaces to prevent reinfestation. 
• Psychosocial support: Address any stigma associated with lice infestations and reassure the patient or family that lice are common and not a result of poor hygiene. 

Expected outcomes 

• Lice and nits will be effectively eradicated following treatment. 
• The patient will remain free from secondary skin infections. 
• The patient or caregiver will demonstrate an understanding of lice prevention and treatment methods. 
• The patient will maintain skin integrity without further irritation or excoriation. 

Individual/caregiver education 

• Treatment adherence: Emphasize the importance of completing the entire course of treatment, including follow-up applications if necessary. 
• Lice transmission: Teach about lice transmission and the importance of avoiding sharing personal items like combs, hats, and clothing. 
• Environmental cleaning: Explain the steps to clean household items and personal belongings to prevent reinfestation. 
• Preventive strategies: Advise regular hair inspection in high-risk environments, especially in children attending daycare or school.