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NCM 109: MCN LEC (FINAL)
CH 43: NURSING CARE OF A FAMILY
WHEN A CHILD HAS A PARASITIC
INFECTIONS
TOPICS
 PARASITIC INFECTIONS
o Helminthic Infections
A. Roundworms (Ascariasis)
B. Hookworms
C. Enterobiasis (Pinworms)
o Scabies
 PEDICULOSIS
o Parasites are organisms that live on and obtain
their food supply from other organisms.
o Although many of these can cause illness,
frequently associated with children including
head lice and scabies.
o Helminths are pathogenic or parasitic worms.
o They include roundworms (nematodes), flukes
(trematodes), or tapeworms (cestodes).
o Most helminths begin life when the eggs or larvae
are eliminated in the feces or urine of humans.
o They are then transmitted to the oral cavity by
contaminated foods or hands.
o Because children tend to be careless about
washing their hands before eating or tend to suck
their thumbs, it makes them prone to these
infections.
o Ascaris lumbricoides are generally asymptomatic
infections but when there is an extensive parasite
load, malnutrition and gastrointestinal
symptoms result (AAP, 2015).
o With an incubation period of 8 weeks, the nurse
must obtain a history of travel to underdeveloped
countries.
o The roundworm parasite lives in the intestinal
tract
o It is elongated, cylindrical, and tapering at both
ends.
o The female is longer than male, 20 – 35 cm long, 4
– 6 mm in diameter.
o Male is smaller being 15
– 30 cm long, 2 – 4 mm
in diameter
o Posterior end of male is
curved.
o You can become infected with ascariasis after
accidentally ingesting the eggs of the A.
lumbricoides roundworm.
o The eggs can be found in soil contaminated by
human feces or uncooked food contaminated by
soil that contains roundworm eggs.
o Children often become infected when they put
their hands in their mouths after playing in
contaminated soil, according to WHO.
o Can also be passed directly from person to person.
o People with ascariasis often have no symptoms.
o Symptoms become more noticeable when the
roundworm infestation grows.
o Roundworms in your lungs can cause:
1) coughing or gagging
2) wheezing or shortness of breath
3) aspiration pneumonia (rarely)
4) blood in mucus
5) chest discomfort
6) fever
o Roundworms in your intestines can cause:
1) nausea
2) vomiting
3) irregular stools or diarrhea
4) intestinal blockage, which causes severe pain
and vomiting
5) loss of appetite
6) visible worms in the stool

NCM 109: MCN LEC (FINAL)
7) abdominal discomfort or pain
8) weight loss
9) growth impairment in children due
malabsorption
Ingested A. lumbricoides eggs
Hatch in the duodenum
Larvae penetrate the wall of the small bowel
Migrate via the portal circulation through the liver
Heart and lungs
Larvae lodge in the alveolar capillaries
Penetrate alveolar walls
Ascend the bronchial tree into the oropharynx
They are swallowed and return to the small bowel
Develop into adult worms
Release eggs into the stool
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to o Sanitary disposal of feces to prevent
contamination of the soil.
o Vegetables should be thoroughly washed in a
mild solution of potassium permanganate and
properly cooked before consumption.
o Fingernails should be regularly cut to avoid the
collection of dirt and eggs below them.
o Hands should be properly washed with some
antiseptic soap before touch edibles or eating.
1) A single dose of albendazole 400 mg, with food
2) A single dose of mebendazole 500 mg
3) A single dose of Pyrantel pamoate, 10 mg/kg
4) A single dose of Levamisole, 2.5 mg/kg
5) A single dose of ivermectin, 150 – 200 mcg/kg
(not to be used in children less than 15 kg) (AAP,
2015).
6) Nitazoxanide, 100 – 500 mg, twice a day for 3
days
o Hookworm can spread when a person who has
the infection defecates in the soil or when people
use human feces on soil as a fertilizer.
o If eggs are present in the feces, they can hatch
after 1 to 2 days.
o After hatching, the larvae can survive for 3 to 4
weeks in the soil, according to the Merck Manuals.
o They take 5 to 10 days to mature in the soil.
o When a person comes into contact with this soil,
hookworm larvae can pass through their skin.
o This can happen if the person:
 Walks barefoot on soil that contains the
larvae
 Swallows soil particles, for example on
unwashed salad leaves
o After entering the body, the hookworm larvae
make their way into the body’s bloodstream and
lymphatic vessels.
o These systems carry the larvae to the lungs.

NCM 109: MCN LEC (FINAL)
 From there, the person can cough them
up and swallow them.
o If a person digests mature hookworms, the
worms attach to the small intestine and gain
nutrients through human blood.
o In some cases, the person may develop anemia as
they lose blood to the hookworms.
o Worms may live for over 2 years.
o Mating also occurs in the small intestine.
 From here, thousands of eggs can enter
the human feces.
o Hookworms cannot pass to another individual
through personal contact.
o Infection can only happen when the eggs mature
into larvae in soil.
1. Those who live in warm, tropical, or subtropical
areas
2. People who spend time in areas where there is
poor sanitation management and hygiene,
especially if walking barefoot or with skin-to-
soil contact
3. Those who are pregnant or of childbearing age
4. Young children who have contact with
contaminated soil or sandboxes
5. Workers who have contact with contaminated
soil, especially farmers, plumbers, electricians,
and exterminators
6. People who sunbathe on contaminated sand
o Abdominal pain which is colicky in nature,
nausea, and diarrhea with marked eosinophilia
can be a presenting sign 4 to 6 weeks after
exposure.
o If a great number of hookworms are present,
severe anemia may result.
1. A skin rash in
one area that is
typically red,
raised, and itchy
2. Weight loss
3. Loss of appetite
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4. Breathing complications, such as
wheezing and a cough
5. Fever
6. Abdominal pain which is colicky in nature
7. Diarrhea
8. Extreme tiredness and weakness
9. Iron deficiency anemia or malnutrition
10. Physical and thought development
problems in children due to severe
anemia
11. Heart failure and widespread tissue
swelling as a result of severe anemia
o A number of tests can help diagnose a
hookworm infection and its effects.
o These include:
1) A stool sample to check for hookworm eggs
2) Blood samples to check for the presence of
anemia or a lack of certain nutrients
o A doctor will normally recommend taking
certain medications — albendazole,
mebendazole, or pyrantel pamoate — for 1 to 3
to treat the parasitic infection, according to the
CDC.
 These drugs are antihelminthics or anti-
parasitic drugs.
o Those with severe anemia may need iron
supplementation.
o The drugs listed above have pregnancy
warnings. People should tell their healthcare
provider if they are or may be pregnant so that
they can have the right treatment.
o In places where hookworm is common, those
who are at risk may receive preventive drug
treatment to protect them from infection.
o Some preventive measures can help a person
avoid contracting a hookworm infection.
o These include:

NCM 109: MCN LEC (FINAL)
1) Wearing shoes, especially in soiled areas
with a high risk of contamination
2) Using a barrier to prevent the skin from
touching the soil when sitting on the ground
3) Avoiding consuming soil or unwashed foods
that may be contaminated with hookworm
4) Not passing stool in the soil or outdoors
5) Not using fertilizer made from human feces
6) Covering children’s sandboxes
7) Taking safety precautions, such as wearing
gloves and shoes when gardening
8) Treating pet dogs and cats for hookworm
o Pinworms are small, white, threadlike worms
that live in the cecum.
o After ingestion of the egg either by ingestion or
breathing, the mature worms develop over a
period of 2 months in the cecum.
o The mature female pinworm then migrates out
of the anus to deposit eggs on the skin in the anal
o The following methods can be used to diagnose
and perianal region (CDC, 2016f).
o The movement of the worms causes the anal
area to itch, and the child will awaken at night
crying and scratching.
o Some of the eggs are then carried from the
child’s fingernails to the mouth.
o After being ingested, they hatch in the child’s
intestinal tract, and the cycle is repeated (CDC,
2016f).
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o The worms are large enough that they can be
seen if the child’s buttocks are separated.
o Pressing a piece of cellophane tape against the
anus and then inspecting it under a microscope
will generally reveal pinworm eggs.
o If an individual only has a small number of adult
worms, the symptoms will be mild, or there may
be no symptoms at all.
o Symptoms are worse with heavy or moderate
infections.
o About 4 weeks after ingesting pinworm eggs, the
mature females make their way out from the
intestine to the anal area, where eggs are laid in
a jelly-like substance.
o It is this substance that is believed to cause a
person to itch, which usually happens at night.
o During the maturing and reproduction stages, a
person with pinworms may experience:
1) Disturbed sleep
2) Itching of the anal area, which may
sometimes be intense, especially at night
when the female worms are laying eggs
3) Mild nausea
o Individuals with severe infection may
experience:
1) Loss of appetite
2) Severe irritability
3) Intermittent abdominal pain
4) Sleeping difficulties
5) Weight loss
pinworms:
1. Tape Test
 This test uses cellophane tape.
 The doctor places a piece of clear
plastic tape against the skin around the
anus and then looks at the tape under a
microscope.
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NCM 109: MCN LEC (FINAL)
 As the worm tends to lay her eggs at 12. Toothbrushes should be kept in a closed
night, good samples are more likely cupboard and rinsed well before use.
early in the morning.
2. Moistened Swab
 A doctor or nurse may take a moistened
swab from around the anal area.
3. Sighting a Worm
 Sometimes the worms are visible in the
anal area, underwear, or in the toilet.
 It is best to search for pinworms at
night, when the female comes out to lay
her eggs.
 If you are checking children, it is best to
inspect about 2 to 3 hours after they
have fallen asleep.

o Scabies is one of several skin conditions that can

cause itching and a rash.
1. Single dose of mebendazole (Vermox) or o It is caused by Sarcoptes scabiei, which is a
pyrantel pamoate (antihelminthic) (CDC, 2016f). species of eight-legged microscopic mite.
2. Underclothing, bedding, towels, and o Scabies is contagious and can spread very easily
nightclothes should be washed before reuse. from person to person through close physical
3. All family members need to be treated for contact.
pinworm infestation because the worms are o However, it can affect people of all ages,
easily transmitted from person to person. whatever their living situation and
4. Wash your hands thoroughly and frequently, socioeconomic status.
and scrub under the fingernails. Before eating, o If an individual has scabies, they and anyone
after going to the toilet, and after changing they have close contact with should all receive
diapers, make sure to wash your hands. treatment at the same time.
5. Do not shake things that may have eggs on
them, such as clothing, pajamas, bed linen, or
towels.
6. Make sure the fingernails of every member of
the household are cut short.
7. Refrain from nail biting and finger sucking.
8. At night, wear close-fitting underwear. Be sure to
change underwear every morning.
9. Cotton gloves may help prevent scratching
during sleep.
10. Take a bath or shower regularly.
 Thoroughly clean the body, paying
particular attention to the anal and
vaginal areas.
 Showering is preferred to avoid
contaminating bath water.
11. Do not share towels or face flannels.
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contact due to the food provided by the crusts
themselves.
o The most common sites of infestation in adults
and older children include:
o The onset of scabies symptoms varies
1) Between the fingers
depending on whether or not a person has
2) Around the fingernails
previously had exposure to mites.
3) The armpits
o The first time a person has exposure to the
4) The waistline
scabies mite, it can take 4–8 weeks for
5) The inner parts of the wrists
symptoms to develop.
6) The inner elbow
o This timeframe is significantly shorter in
7) The soles of the feet
subsequent infestations, as the body’s immune
8) The breasts, particularly the areas around
system is quicker to react. This is typically
the nipples
within 1–4 days.
9) The male genitalia
o Some symptoms of scabies include:
10) The buttocks
1) Itching
11) The knees
 This is often worse at night, and it
12) The shoulder blades
can be severe and intense.
 Itching is one of the most common
scabies symptoms
2) Rash
 When the mite burrows into the
skin, it forms burrow tracks, or
lines, which are most commonly
present in skin folds.
 The rash may look like hives, bites,
knots, pimples, or patches of scaly
skin.
 Blisters may also be present.
3) Sores
 These occur in infested areas where
a person has scratched the skin.
 Open sores can lead to impetigo, o Infants and young children tend to experience
which is commonly caused by a infestations in other areas of the body, including
secondary infection with the:
Staphylococcus aureus. 1) scalp
4) Thick Crusts 2) face
 Crusted scabies is a form of severe 3) neck
scabies in which hundreds to 4) palms of the hands
thousands of mites and mite eggs 5) soles of the feet
are present within skin crusts. o At times, children can present with a widespread
 This causes severe skin symptoms. infestation that covers the majority of the body.
o Most often, people with crusted scabies exhibit o Infants with scabies tend to exhibit symptoms of
widespread gray, thick, and crumbling crusts. irritability as well as sleeping and eating
o Mites living in the detached crusts can live for difficulties.
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NCM 109: MCN LEC (FINAL)
o Scabies is an infestation with the Sarcoptes
scabiei var. hominis mite, which is also known as
the human itch mite.
o After burrowing under the skin, the female mite
lays its eggs in the tunnel it has created.
o Once hatched, the larvae move to the surface of
the skin and spread across the body or to
another host through close physical contact.
o Scabies is highly contagious and spreads
through direct skin-to-skin contact or by using
a towel, piece of bedding, or furniture item
infested with the mites.
o Because of this, some of the most likely people
to experience an infestation include:
1) children attending daycare or school
2) parents or caregivers of young children
3) sexually active young adults
4) people with multiple sexual partners
5) residents of extended care facilities
6) older adults
7) people with weakened immune systems,
including those with HIV, transplant
recipients, and others taking
immunosuppressant medications
o Anyone living with someone who has the
condition will most likely need to receive
treatment for scabies even if they do not have
any symptoms.
 This includes anyone with whom the
person has had recent intimate
contact.
o Doctors generally treat scabies with topical
medications such as:
 5% permethrin cream
 Crotamiton cream
 Lindane lotion
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 In some cases, a 25% benzyl benzoate
lotion or 10% sulfur ointment may be
necessary.
o For most topical preparations, people should
apply them at night, leave them on during
sleep, and wash them off in the morning.
o Ivermectin, which is an oral medication, may be
a good option for people with weakened
immune systems, those with crusted scabies, or
those who do not respond to topical therapy.
 People should not use ivermectin
during pregnancy or while
breastfeeding.
 Children weighing under 33 pounds (15
kilograms) should also avoid this
medication.
o A doctor might prescribe other medications to
offer relief from symptoms such as:
 Antihistamines
 Anti-itching lotions such as pramoxine
lotion
 Antibiotics
 Steroid creams
o A person can sometimes mistake scabies for
dermatitis or eczema, as these skin conditions
also cause itching and bumps on the skin.
o Anyone who is unsure about the cause of a skin
condition should contact a doctor, as over-the-
counter remedies cannot eradicate scabies.
o People can prevent scabies infestations by
limiting contact with the skin of someone who
already has one and items such as their
bedding or clothing.
o However, this may be difficult when it comes to
members of the same household or people who
are in close proximity to someone with an
infestation, as that person can sometimes be
symptom-free for as long as 4–8 weeks.

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o To prevent subsequent infestations and
spreading, a person should wash or dry-clean
all clothes, towels, and linens.
 Use hot, soapy water and dry on a high
heat.
o People should place any items that they cannot
wash into a sealed plastic bag for at least 3 days
to starve the mites.
o People should also vacuum the entire home —
including carpets, rugs, and upholstery — on
the day that treatment is initiated and either
discard the bag or thoroughly clean the
vacuum’s canister.
o Pediculosis is an infestation of the hairy parts of
the body or clothing with the eggs, larvae or
adults of lice.
o The crawling stages of this insect feed on human
blood, which can result in severe itching.
o Head lice are usually located on the scalp, crab
lice in the pubic area and body lice along seams
of clothing.
o Body lice travel to the skin to feed and return
back to the clothing.
o Anyone may become louse infested under
suitable conditions of exposure.
o Pediculosis is easily transmitted from person to
person during direct contact.
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o Head lice infestations are frequently found in
school settings or institutions.
o Crab lice infestations can be found among
sexually active individuals.
o Body lice infestation can be found in people
living in crowded, unsanitary conditions where
clothing is infrequently changed or laundered
o For both head lice and body lice, transmission
can occur during direct contact with an infested
individual.
o Sharing of clothing and combs or brushes may
also result in transmission of these insects.
o Crab lice are most often transmitted through
sexual contact.
 Pediculosis can be spread as long as lice or eggs
remain alive on the infested person or clothing.
o Usually, the first indication of an infestation is
the itching or scratching in the area of the body
where the lice feed.
o Scratching at the back of the head or around
the ears should lead to an examination for head
louse eggs (nits) on the hair.
o Itching around the genital area should lead to
an examination for crab lice or their eggs.
o Scratching can be sufficiently intense to result
in secondary bacterial infection in these areas.
 It may take as long as two to three weeks or longer
for a person to notice the intense itching associated
with this infestation.
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o Medicated shampoos or cream rinses

containing pyrethrins or permethrin are
preferred for treating people with head lice.
o Products containing pyrethrins, permethrin or
malathion are available over-the-counter, but
those containing lindane or malathion are
available only through a physician's
prescription.
o Lindane-based shampoos are not
recommended for infants, young children,
pregnant women, lactating women, the
elderly, and persons with HIV or seizure
disorders, persons who have very irritated skin
or sores where the lidane will be applied and
persons who weigh less than 110 pounds.
o Retreatment after 7 to 10 days is often
recommended to ensure that no eggs have
survived.
o Nit combs are available to help remove nits
from hair.
o Dose and duration of shampoo treatment
should be followed carefully according to label
instructions.