CASE SIMULATION IN PEDIATRIC NURSING

Case Study 2
Name: Marquez, C. Class/Group: Group 6
INSTRUCTIONS:

All questions apply to this case study. Your responses should be brief and to the point. When asked to
provide several answers, list them in order of priority or significance. Do not assume information that
is not provided.

Scenario

An 8-year-old girl J.C. was sent to the Out-Patient Department of your hospital because she has had
several-day history of scratching her head so badly that she complains that her “head hurts”. You
complete a general examination of J.C.’s head and notice that she has red, irritated areas with several
scratch marks; a few open sores; and sesame seed-sized, silvery white and yellow nodules (bugs) that
are adhered to many of her hair shafts. You determine that J.C. has Pediculosis Capitis.

1. What is pediculosis capitis?

Head lice (pediculosis capitis) is a very infectious illness that is commonly seen in nurseries, day care
facilities, and schools. It is caused by Pediculus humanus capitis, a type of human head lice, and is
generally very itchy.

2. What will be your next steps in J.C.'s care?

Pediculicides should be used, and nit instances should be manually removed. Permethrin 1% cream rinse
(Nix), which kills adult lice and nits, is the drug of choice for infants and children. Following lice
treatment, daily removal of nits from the child's hair with a metal nit comb at least every two or three
days is a control measure. Permethrin therapy is repeated 7-10 days after the initial treatment to
guarantee cure.

3. What should be included in the educational plans for J.C. and her parents?

Have parent apply Permethrin 1% lotion or shampoo on damp hair, and then wash with non-conditioner
shampoo. Read the directions carefully before beginning treatment. Make child as comfortable as
possible during the application process. Pediculicide must remain on the scalp and hair for several
minutes. Avoid open flames while pediculicide is on due to flammability. Use an extra-fine-tooth comb
that is included in many commercial pediculicides or is available at community pharmacies to facilitate
manual removal. Inform guardian, and have them screen all household members. Measures must be
taken to prevent further infestation such as machine-wash all clothing, towels, linens and hot dry for 20
min. Vacuum and clean the house as well to prevent further infestation. Spraying with insecticide is not
recommended because of its danger to children and animals.
4. The parents take J.C. home to treat her. Which statement by J.C.'s mother would help make A.P.
the most comfortable during this treatment period? Explain.

a. “Here is the shampoo. Be sure to scrub your head for several minutes.”

b. “We can pretend you are at the beauty parlor! Lean back while I wash your hair.”

c. “I sure hope this works. I never thought this would happen!”

d. “It might be best to go ahead and cut your hair. It will grow back quickly.”

The child rests supine with his or her head over a sink or basin and covers his or her eyes with a dry
towel or washcloth while pretending that they are at a beauty parlor. This keeps medication from
spilling into the eyes, which can cause chemical conjunctivitis. If eye discomfort arises, rinse the eyes
well with lukewarm water. In addition, the child is neither embarrassed or uneasy throughout the
procedure.

5. Why would head lice occur in school-aged children?

Head lice are transferred mostly through direct contact with an infected person's hair. Because of their
close proximity to one another and the numerous interactions that serve as contact sites, head lice are
most frequent among school-aged children. Playing on playgrounds and participating in sports activities
can increase the probability of head-to-head contact.

6. What possible complications can occur as a result of failing to treat head lice? Local scalp
(secondary) infection is common when the child scratches the itchy head and might cause abrasions.

 Scratching can cause sores on the head. Bacteria that typically live on a person's skin can infect
these lesions. Dry, hyperpigmented, heavily encrusted, scaly skin with scars could also be the result.
 Excoriation/ chronic skin-picking, skin infection and impetigo/ bacterial infection of the skin may
occasionally occur.
 Loss of sleep caused by continuous itching is occasionally a problem.
 Anxiety and distress for children and parents.

7. What should your nursing actions include regarding J.C.'s classmates?

Nurses should emphasize that pediculosis may affect anybody, regardless of age, socioeconomic status,
or hygiene. Lice do not leap or fly, and pets do not carry them. Nurses should look for bit marks,
redness, and nits in children who scratch their heads more than usual. With two flat-sided sticks or
tongue depressors, the hair is spread systematically, and the scalp is examined for any movement that
suggests a louse. When inspecting the hair, nurses should use gloves. Children with head lice should be
permitted to return to school after receiving adequate treatment.
References:

Burgess IF, Brunton ER, Burgess NA; Single application of 4% dimeticone liquid gel versus two
applications of 1% permethrin creme rinse for treatment of head louse infestation: a randomised
controlled trial. BMC Dermatol. 2013 Apr 113:5. doi: 10.1186/1471-5945-13-5.

Bug Busting; Community Hygiene Concern, 2013

Durand R, Bouvresse S, Berdjane Z, et al; Insecticide resistance in head lice: clinical, parasitological and
genetic aspects. Clin Microbiol Infect. 2012 Apr18(4):338-44. doi: 10.1111/j.1469-
0691.2012.03806.x.

Guidance on infection control in schools and other childcare settings; Public Health England (September
2017 - last updated March 2019)

Head lice: Evidence-based Guidelines based on the Stafford Report; Public Health Medicine
Environmental Group, 2012

Head lice (Pediculosis); Public Health England

Head Lice: Questions and Answers for Healthcare Professionals; NHS Wales January 2014

Hockenberry, M. and Wilson, D., (2013), Wong’s Essentials of Pediatric Nursing. 9th Ed., Elsevier Mosby.

Pariser DM, Meinking TL, Bell M, et al; Topical 0.5% ivermectin lotion for treatment of head lice. N Engl J
Med. 2012 Nov367(18):1687-93. doi: 10.1056/NEJMoa1200107.

Smith CH, Goldman RD; An incurable itch: head lice. Can Fam Physician. 2012 Aug58(8):839-41.