Far Eastern University

Institute of Nursing
Associate in Health Science Education
2nd Semester S.Y. 2010-2011

Nursing Care
Process
Inigo, Lovely
Querubin, Jenkins
Reyes, Wilda Rio
Saladar, Kevin
Sonsing, Paula Monique
Tadle, Joanne Mae
Talamayan, Jestoni Morris
Tan, Patricia Andrea
Tranate, Antonio Jose
Turla, Lara Joy
Vicencio, Tosca Zyrille
Villabesa, Kristian
BSN142/Grp. 167 A

October 17, 2010

I. Introduction

About 6-12 million people, mainly children, are treated annually for head lice in the United States
alone. High levels of louse infestations have also been reported from all over the world including Israel,
Denmark, Sweden, U.K., France, Australia and Philippines. Normally head lice infest a new host only by
close contact between individuals, making social contacts among children and parent child interactions
more likely routes of infestation than shared combs, brushes, towels, clothing, beds or closets. Head-to-
head contact is by far the most common route of lice transmission. The United Kingdom's National
Health Service, and many American health agencies report that lice "prefer" clean hair, because it's easier
to attach eggs and to cling to the strands. Head lice (Pediculus humanus capitis) are not known to be
vectors of diseases, unlike body lice (Pediculus humanus humanus), which are known vectors of epidemic
or louse-borne typhus (Rickettsia prowazeki), trench fever (Rochalimaea quintana) and louseborne
relapsing fever (Borrellia recurrentis).

Pediculosis is an infestation of lice, blood-feeding ectoparasitic insects of the suborder Anoplura.

The condition can occur in almost any species of mammal, but is commonly used to refer to the
infestation of humans. Pediculosis is an infestation of the hairy parts of the body or clothing with the
eggs, larvae or adults of lice. The crawling stages of this insect feed on human blood, which can result in
severe itching. Head lice are usually located on the scalp, crab lice in the pubic area and body lice along
seams of clothing. Body lice travel to the skin to feed and return back to the clothing. Anyone may
become louse infested under suitable conditions of exposure. Pediculosis is easily transmitted from
person to person during direct contact. Head lice infestations are frequently found in school settings or
institutions. Crab lice infestations can be found among sexually active individuals. Body lice infestation
can be found in people living in crowded, unsanitary conditions where clothing is infrequently changed or
laundered.

Head lice occur in people of all ages, of all races, and of both sexes. Children aged 3– 10 are most
likely to become infested. In the United States, blacks are less commonly affected because the shape of
the louse claw is better suited to grabbing onto the hairs of white or Asian peoples. In addition, girls are
more likely to have head lice than are boys.
 Lice, also known as fly babies, are an order of over 3,000 species of wingless insects; three of
which are classified as human disease agents. As lice spend their entire lives on the host, they have
developed adaptations which enable them to maintain close contact with the host. These adaptations are
reflected in their size (0.5–8 mm), stout legs, and claws which are adapted to cling tightly to hair, fur and
feathers, and that they are wingless and dorsoventrally flattened. Lice feed on skin (epidermal) debris,
feather parts, [Chlorine] sebaceous secretions and blood. A louse's color varies from pale beige to dark
grey; however, if feeding on blood, it may become considerably darker. A louse's egg is commonly called
a nit. Lice attach their eggs to their host's hair with specialized saliva which results in a bond that is very
difficult to separate without specialized products. Living lice eggs tend to be pale white. Dead lice eggs
are more yellow. Lice are very annoying and are difficult to remove, but not imposible.

Head louse – The head louse (Pediculus humanus capitis) is an obligate ectoparasite of humans. Head lice
are wingless insects spending their entire life on human scalp and feeding exclusively on human blood.
Humans are the only known host of this parasite. Head lice are closely related to body lice (Pediculus
humanus humanus) which also infest humans. A more distantly-related species of louse, the pubic or crab
louse (Pthirus pubis), also infests humans. Lice infestation is known as pediculosis. The head louse (and
lice in general) differ from other hematophagic ectoparasites such as the flea in that lice spend their entire
life cycle on a host. Head lice cannot fly, and their short stumpy legs render them incapable of jumping,
or even walking efficiently on flat surfaces.

Body louse - The body louse (Pediculus humanus humanus, sometimes called Pediculus humanus
corporis) is a louse which infests humans. The condition of being infested with head lice, body lice, or
pubic lice is known as Pediculosis.

Crab louse - The pubic or crab louse (Phthirus pubis) is a parasitic insect which spends its entire life on
human hair and feeds exclusively on blood. Humans are the only known host of this parasite. Humans can
also be infested with body lice (Pediculus humanus humanus) and with head lice (Pediculus humanus
capitis).
 A. BIOGRAPHIC DATA 
1. Name: Ms. AF
2. Address: 4432 Duhat St. San Vicente Camarin Caloocan City
3. Age: 15 Years Old
4. Gender: Female
5. Date of Birth: Jan. 17, 1995
6. Place of birth: Iloilo City
7. Ethnic group: Ilonggo 
8. Primary language spoken: Ilonggo, Tagalog 
9. Marital Status: Single
10. Educational: 1st Year High School 
11. Occupation: Student
12. Religious orientation: Roman Catholic
13. Health Care financing and usual source of medical care 
14. Income: 350 pesos per day (from father who works as construction worker), 200 pesos two
times every week (from mother who do laundry from neighbor)

B. PAST HEALTH HISTORY 

According to the mother Ms. AF had chicken pox and measles before, but she can no
longer recall at what age her child had contracted these diseases. She also noted that Ms. AF
never acquired mumps until now. She also had boil in her inner thigh before and contracted
bulutong tubig. Aside from the said illnesses, Ms. AF also have the usual illnesses like cough and
colds but never seek a doctor to cure it, instead her mother most likely to self-prescribe medicine
like carbocisteine. She verbalized “Nagtatanong lang ako sa kapit bahay namin kung ano ang
pwedeng igamot sa sipon, at lagnat at sinasamahan na din ng pagdadasal, sa awa naman ng Diyos
gumagaling naman siya”.
When they were still residing in Iloilo, her mother used to bring her in the nearest health
center whenever her fever is high and the mother recalled that the doctor there gave them
paracetamol to relieve it. She said that Ms. AF have completed her immunization before she
reach the age of 1 year old but she cannot recall what those vaccines are. According to her, she
has the chart of Ms. AF immunization but it’s already lost since they migrated in Manila.
Ms. AF is allergic to shrimps and crabs. Allergic reaction happened once to her when she
was a child. Her mother described the reaction as red patches all over the body including the face.
Her mother said that she was brought to a Doctor in Iloilo and was prescribed to take celestamine.
After the incidence happened, her mother restricted her to eat shrimps and crabs and the reaction
never happens again.
When she was a child, Ms. AF fell while climbing a mango tree. She was brought to the
health center to examine her and clean the wound on her forehead. No X-ray was perform to note
fracture in her head. While playing hide and seek she was accidentally bitten by a dog in the face
and hands. She recalled that she obtained lots of dog bites especially on her upper extremities.
She was brought to the health center and received shots of anti-rabies vaccines. She never
traveled abroad.

C. FAMILY HISTORY OF ILLNESS

(Nakay King or ands ang genogram)

FUNCTIONAL HEALTH PATTERNS 

D. HEALTH PERCEPTION AND HEALTH MANAGEMENT PATTERN 
According to Ms. AF, she rates her own health as 5 out of 10, 1 being the lowest and 10
as the highest score. She said that she is not sure if she is healthy, for her 5 is the middle score as
she verbalized “Kasi pag 5 katamtaman lang”. She perceives health in terms of moderation, she
verbalized “Ang kalusugan ay dapat katamtaman lang, hindi sa mataba at mapayat dapat tama
lang”. She is not sure if there is something healthy that she can consider in herself since she is a
working student, she verbalized “Nangangamuhan ako, kung minsan napapabayaan ko ang sarili
ko dahil madaming ginagawa at hindi na ako nakakain sa tamang oras at madalas din ako
mapagod”. In order to correct this, she stated that her health goal is to eat food at the right time
and take more rest.
Their family believes that during holy week they should not take a bath, as well as to
avoid injuries because it will heal slowly. She said that they cannot afford a routine physical
examination since their income is low, so she admits that she never had one before until now. She
doesn’t perform self breast examination and also not aware about it. According to her, the only
health care provider she knows is the nurse in their school clinic. She goes there if she has a fever
or if she feels dizzy. She said that she doesn’t have any difficulty following the nurse advices or
suggestion. Some of the safety measures she follows are wearing slippers when going outside of
the house and hand washing before and after eating. For her, the most important thing to keep
health is to eat healthy food like vegetables.
She describes how she takes good care of her body by stating her daily hygienic practices
which includes, taking a bath once a day, brushing her teeth three times a day after eating, using
deodorant to avoid body odor and trimming her nails. She doesn’t smoke cigarette, drink
alcoholic beverages and take prohibited drugs.
The house in which she resides is measured 24 square meters in terms of area-6 meters in
width and 4 meters in length. There is a small canal located near the side of the house. They only
have one room which is lighted by a fluorescent bulb. Their kitchen is composing of faucet, a
stove and a small refrigerator. A curtain is used to separate it and the living room. There is only
one fluorescent bulb use to light the kitchen and the living room. Their toilet is flush type which
is lighted by an incandescent bulb. They have four windows, one in their room and the other three
in their living room. They get their water supply from NAWASA. They use plastics as a trash can
and they have at least three cats inside their house and one turkey in their backyard. Presence of
flies are everywhere even inside their house. They cover the food left in their table using a food
cover.
According to Ms. AF, in their room the bed is occupied by her mother and father and she,
together with her sisters sleep on the floor. Her brothers sleep in the living room, some of them
occupy the couch and the others sleep on the floor.

I. COGNITIVE PERCEPTUAL PATTERN

Ms. AF can read, write, hear, smell and taste without any difficulties. For her the best
method to learn is to listen while her teacher is discussing. She watches T.V whenever she is
reviewing and for her it is also an effective way to learn things. She said that her performance in
school is a little bit good but not really excellent. There are times that she gets low grades and it
bothers her a lot. She verbalize “Ewan ko, kinakabahan nga ako e, kasi baka magalit si mama
kapag mababa ang grades ko ngaun, pero kasi kung minsan nakakatamad lang talaga mag-aral”
J. SELF-PERCEPTION AND SELF-CONCEPT PATTERN 

` Ms. AF describes herself as an average girl. According to her, she is a happy type person
She still doesn’t consider herself as a grown up. According to her, sometimes she feels inferior
when she compare herself to other girls same age as her for the reason that their daily allowance
is so big unlike her. She expresses her feelings to other people by talking to them and telling them
her problems especially to her friends in school and to her mother. Whenever she feels angry at a
person, she used to be silent and let the feelings fade away but according to her when she can no
longer hold it she confront the person that she is angry at and talk about everything to solve it.
She stated that her goals for the next five years is to become a nurse and in order to achieve it, she
will study hard. The people she likes most are those that are kind to her, makes her happy
whenever she is sad and those people that are always there to help whenever she have a problem.
She hates people that are boastful and disrespectful. Some of the things that made her mood
change are her grades especially when she receives low or failing grades because her mother is
scolding her. In order to cope up, she studies hard in order to compensate. She stated that, she is
satisfied about herself and verbalized “Wala namang perpektong tao e”.

K. ROLE-RELATIONSHIP PATTERN 
Ms. AF is the second child in a nuclear family consisting of 8 members. She has 2 sisters
and 3 brothers. She describes her relationship with her family as loving and care free. She has a
close bond with her mother and father as well as to her siblings. But there are instances that she
and her siblings are fighting especially in the toys that they shared. Whenever there are problems
in the family, they talk together and find solutions together. Her mother is the one who initiates
the problem solving. She admits that they have financial problems but for her it’s part of the rise
and fall of life. According to her, things are generally going well. Their usual family activities are
going to church and doing house chores and because of low income they less likely to go into
malls or any amusement parks. She said that she is satisfied with the role she is playing inside
their house. As a big sister, she knows to herself that she fulfills her role very well.

L. SEXUALITY-REPRODUCTIVE PATTERN
According to Ms. AF, she expresses herself as a woman by being a big sister to her
siblings and by being attracted to the opposite sex. She admits that she has a crush on one of her
schoolmate and is sure that she doesn’t have any identity confusion before until now. She
verbalized “Kapag nakikita ko siya, kinikilig ako”. Her menarche started when she was 14 years
old. She doesn’t engage herself to any sexual activities.

M. COPING-STRESS TOLERANCE PATTERN 

According to Ms. AF, she feels stress when she does a lot of household chores in their
neighbor. She serves as “Nangangamuhan” there and she does the laundry and cleaning of the
house every morning until 11am. She handles this by having long rest and she said that it is
effective because she regain her strength immediately. When she have big problems in her life
she copes to it by praying and conveying her thoughts and feelings to her mother. She verbalized
“Sa awa naman ng Diyos, nareresolba din ang mga problema”

N. VALUE-BELIEF PATTERN 
According to Ms. AF, as part of their weekly routine, they go to church to send their
gratitude to God. Since they are Roman Catholic, it was their practice to pray before eating. She
said that whenever they are eating, they should not sing a song or even hum because their parents
believe that it’s a form of disrespect to the blessings that they have, if they will continue to do
this, the blessings will fade and runs away. They were also thought to say “po” and “opo” when
 addressing older people. They also believe in albularyo and other forms of faith healing. The
mother verbalized “May mga bagay din kasi na di nagagamot ng Doctor”.

F. ELIMINATION PATTERN
Ms. AF estimated that she usually defecate 5 times every week whenever she take a bath
to prepare to go to school. She verbalized “Dapat 2 beses dumudumi ang tao sa isang araw”. She
describes her stool as cylindrical, yellow in color and with aromatic smell. She doesn’t hold the
urge and immediately go to the toilet to remove her bowel. She doesn’t have any difficulty in
defecating but she admits that sometimes she tends to constipate. But it only happens once in a
month. She verbalized “Baka siguro kulang ako sa tubig mahilig kasi ako magsoft drink e”.
According to her, in order to alleviate the constipation she drinks a lot of water and the next day,
the constipation is gone.
She urinates at least 3 times a day amounting half a glass of urine (360ml). She
verbalized“Dapat hindi pinipigil ang pag-ihi, kaya nga lang kung minsan pinipigil ko lalo na
kapag nasa school”. She describes her urine as dark yellow, but whenever she drinks a lot of
water, the color changes into yellow transparent. She doesn’t have any discomfort in urinating but
she admits that the lower quadrant of her abdomen is aching especially when the temperature is
cold.
ECOLOGIC MODEL

A. Hypothesis
Frequent exposure to the sun and inadequate hygienic measures could cause the lice infestation
leading to scalp damage
B. Predisposing Factors
a. Host
 Behaviour – poor hygiene and poor health maintenance in the family.
 Age- 15 years old
 Gender: female is twice as likely to have present lice since they have more hair.

b. Agent
 Pediculus Humanus Capitis (head lice) is present in the patient.

c. Environment
 She lives in a small house, crowded with 8 other members on the family. She sleeps on the floor
along with her sisters who also have pediculosis. Her school schedules usually falls in the
afternoon and is most often exposed to the sun without any protection.

C. Ecologic Model

The lever model is used to show the relationship between the host, agent and the

environment and to determine if there is an imbalance between the three (3) predisposing factors

that may lead to an occurrence of disease.

The diagram below shows the possible imbalance of the ecologic model caused by the environment of

the client, pediculosis she is experiencing and the her susceptibility to the infestation.
 Lever Model
(Agent-Host-Environment)

15 year-old
female client
Pediculus Humanus
Capitis (Head lice)

ENVV

D. Analysis

Pediculosis is described as an infestation with lice, which causes intense itching; continued

scratching by the patient may result in secondary bacterial infection on the skin. It is also common in

schoolchildren and may indicate poor hygiene. In some cases, pediculosis are commonly relapsing if not

treated well (Oxford Concise Medical Dictionary 6 th Edition, 2002)

E Conclusion and Recommendations

We therefore conclude that living in crowded areas and sleeping with other people infested with

the disease predisposes the occurrence of the infestation and makes if difficult to be treated when non-

compliance is shown. In addition to that, pediculosis can lead to infection of the scalp and may harbour

microorganisms that can greatly contribute to serious complications. To eradicate the said infestation,

client must improve her hygiene and commit to the treatments. Not only is subjected to the treatment but

also the other members of the family since it is easily transmitted from one person to another. Frequent

change of linens and pillowcases, avoid sharing of combs, towels and other personal belongings are

highly recommended.