Flashcards in Ch. 37: Acute Otitis Media Deck (38):
Acute otitis media (AOM) is an infection of the structures of the _____ with rapid clinical symptoms of infection
Otitis media with effusion (OME) is a collection of ______ but no infection
Fluid in the middle ear
What is the majority of incidence of ear infections related to?
Eustachian tube malfunction
How are children eustachian tubes?
Shorter and more horizontal than adults
When is otitis media most common?
First 24 months of life and again when children enter school (age 5-6)
What is otitis media usually triggered by?
-Bacterial infection (streptococcus pneumonia, haem flu, moraxella catarrhalis)
-Viral infection (RSV or influenza)
Why do they think there is lower incidence in otitis media in infants who are breast fed?
Possible due to the presence of immunoglobulin A (IgA), which is found in breast milk. IgA protects against infection
When is otitis media have higher incidence?
What other problems/disorders are risk factors for otitis media?
-What does the child do to their ear?
-What color is TM?
-What is in middle ear?
-What may happen with external canal?
-TM is yellow or red and bulging
-Purluent material in middle ear
-Drainage from external canal
-_______ of the head and neck
-What may temp get to?
-What may happen if AOM becomes a chronic condition?
Lymphadenopathy of head and neck
Fever may get to 40C (104F)
If it becomes chronic, hearing difficulties and speech delays
-Feeling of ____ in the ear
-What color is TM?
-Vague findings: rhinitis, cough, diarrhea
-Transient hearing loss and balance disturbances
What does a pneumatic otoscope do?
Used to visualize the TM and middle ear; also assess TM movement
How will TM movement be in AOM?
Decreased or no TM
How will TM movement be in OME?
How do we visualize the TM of a child younger than 3?
Pull pinna down and back
How do we visualize the TM of a child older than 3?
Pull pinna up and back
Nursing care: How should child be placed
What antibiotics would be given PO for 10-14 days?
What antibiotic would be given IM once?
Sometimes otitis media resolves on its own. We should wait ____ for spontaneous resolution before starting antibiotics
What is the usual treatment course for children younger than 6?
PO 10-14 days
*administer in high dose, orally (80-90mg/kg/day)
*course may be shorter for older children
Why would an IM med be given?
For resistant organisms or client specific reasons (difficulty taking oral, won't complete oral course)
We should tell the family to look for signs of allergy to the antibiotic. What would a sign be?
What is benzocaine?
Ear drops for topical pain relief
*Discourage the parents to use decongestants or antihistamines
What may be indicated for a child who has multiple episodes of otitis media? How is this done?
Myringotomy and placement of tymphanplasty tubes
May now be performed by laser treatment
Is the myringotomy and placement of tympanoplasty tubes done inpatient or outpatient? Explain.
Outpatient--general anesthesia--usually completed in 15 minutes
How is the myringotomy and placement of tympanoplasty done?
A small incision is made in the TM..tiny plastic or metal tubes are placed in the eardrum to equalize pressure and minimize effusion
How long is recovery for myringotomy and placement of tympanoplasty tubes?
Takes place in PACU--discharge within an hour
Is there pain with the myringotomy and placement of tympanoplasty tubes procedure?
Not common and if it is present, it will be mild
When do the tubes come out and how do they come out?
Spontaneously within 6-12 months
Should we notify the prescriber when the tubes fall out?
Instruct parents to notify the provider when tubes come out. This usually does not require replacement of the tubes
Is it ok if water gets in the childs tubes when they are in place? Do ear plugs work well?
Avoid getting water in tubes
Effectiveness of earplugs= not conclusive
*follow health care providers instructions regarding this
A nurse is caring for a toddler who has acute otitis media. Which of the following is a priority action for the nurse to take?
A. Provide emotional support to the family
B. Educate the family on care of the child
C. Prevent clinical complications
D. Administer analgesics
A nurse is caring for a 2 year old child who has had 3 ear infections in the past 5 months. The nurse should know that the child is at risk for developing which of the following as a long-term complications?
A. Balanced difficulties
B. Prolonged hearing lose
C. Speech delays
An infant who has clinical manifestations of acute otitis media (AOM) is brought to an outpatient facility by his parents. The nurse should recognize that which of the following factors places the infant at risk for otitis media? (SATA)
A. Breastfeeding without formula supplementation
B. Attends day care 4 days per week
C. Immunizations are up to date
D. History of a cleft palate repair
E. Parents smoke cigs outside
B, D, E
A nurse is caring for a toddler who has rhinitis, cough, and diarrhea for 2 days. Upon assessment, it is noted that the TM has an orange discoloration and decreased movement. Which of the following is an appropriate statement for the nurse to make.
A. Your child has an ear infection that requires antibiotics
B. You child could experience transient hearing loss
C. Your child will need to be on a decongestant until this clears
D. Your child will need to have a myringotomy