NUR 307 - QCA: Otitis Media

A toddler has been diagnosed with otitis media with effusion. The parents of a toddler tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond?

"The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." Otitis media with effusion refers to the presence of fluid within the middle ear space, without signs or symptoms of infection. It may occur independent of AOM or may persist after the infectious process of AOM has resolved.

The nurse is caring for a 6-year-old boy with sensorineural hearing loss. Which is the least likely cause of the child's hearing loss?

Acute otitis media Acute otitis media can cause damage to the middle ear, bringing about conductive hearing loss. Ototoxic medications can damage the hair cells of the cochlea or along the auditory pathway, in turn causing sensorineural hearing loss. Intrauterine infection with rubella causes damage to the hair cells in the cochlea or along the auditory pathway, which in turn causes sensorineural hearing loss. Excess noise exposure causes damage to the hair cells in the cochlea or along the auditory pathway, which in turn causes sensorineural hearing loss.

The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which will be included in the discussion?

Prevention and treatment of otitis media The most common cause of conductive hearing impairment is otitis media. Suddenly doing poorly in school, acting silly in the classroom, and playing the radio loudly are symptoms of hearing loss in children.

A nurse is assessing a toddler who is brought to the clinic by his mother. The mother states, "He's been so irritable lately and I've noticed him frequently pulling on his right ear." The nurse suspects acute otitis media based on which assessment findings? Select all that apply.

- Low-grade fever - Red bulging tympanic membrane - Loss of appetite Manifestations of acute otitis media include fever (low-grade or higher); dull or opaque, bulging or red tympanic membrane; loss of appetite or poor feeding; immobile eardrum; and recent upper respiratory infection.

The nurse is caring for a child who has been diagnosed with acute otitis media three times in the past year. Which factors noted in the medical record would be considered contributing factors to this condition? Select all that apply.

- The child's father smokes. - The child's older siblings have been diagnosed with acute otitis media in the past. - The child shares a bedroom at home with 3 siblings. - The family home is occupied by 10 family members. Acute otitis media may be linked to a series of factors in a child's medical / social history. Exposure to secondhand smoke is associated with acute otitis media. Additional factors include a family history, crowding in the home environment, and a large family size. Breastfeeding is considered a factor that reduced the incidence of acute otitis media.

The nurse is preparing an educational program for members of the office staff. The topic is the warning signs of primary immunodeficiency. What information should be included? Select all apply.

- Two or more episodes of severe sinusitis in 1 year. - Failure to thrive in an infant. - Two or more serious infections such as sepsis. - History of infections requiring IV antibiotics to clear. Warning signs of primary immunodeficiency include four, not two, or more new episodes of acute otitis media in 1 year. Other warning signs include failure to thrive in the infant, two or more episodes of severe sinusitis in 1 year, two or more serious infections such as sepsis and/or a history of infections requiring IV antibiotics to clear.

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with otitis media. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of otitis media?

"After the eardrum ruptures, the child's pain is relieved." Spontaneous rupture of the eardrum may occur, in which case there will be purulent drainage, and the pain caused by the pressure buildup in the ear will be relieved. The ear in the infant is examined with an otoscope by pulling the ear down and back to straighten the ear canal. In the older child, the ear is pulled up and back. Symptoms may include fever, irritability, and hearing impairment. Antibiotics are used during the period of infection and for several days after to prevent mastoiditis or chronic infection.

An 8-month-old child is diagnosed with a second ear infection and the father is concerned the infections are being caused by something he is doing or by something in the child's development. Which question should the nurse prioritize to collect more information to answer this father's questions?

"Does the baby go to bed with a bottle of formula each night?" In addition to nursing bottle caries, liquid from milk, formula, or juice can pool in the mouth and flow into the eustachian tube, causing otitis media if an infant falls asleep with a bottle. Teething and shampooing the scalp and hair would not be a factor in the development of ear infections. Vitamin C is a needed supplement for the infant who is fed home-prepared formula; it does not cause ear infections.

A child with persistent otitis media with effusion is to undergo insertion of pressure-equalizing tubes via a myringotomy. The child is to be discharged later that day. After teaching the parents about caring for their child after discharge, which statement indicates that the teaching was successful?

"He should wear earplugs when swimming in a pool or a lake." When pressure-equalizing tubes are inserted, the surgeon may recommend avoiding water entry into the ears. Therefore, earplugs are suggested when the child is in the bathtub or swimming. When swimming in a lake, earplugs are especially important because lake water is contaminated with bacteria and entry of that water into the middle ear must be avoided. Typically, the tubes remain in place for at least several months and generally fall out on their own. Placement of pressure-equalizing tubes does not prevent middle ear infection. Other than earplugs for bathing and swimming, nothing else is placed in the child's ear.

When providing education to a parent regarding pain management for a toddler with otitis media, which statement by the parent indicates further teaching needs?

"I should give my toddler one baby aspirin." Children including toddlers should not use acetylsalicylic acid for routine pain management because of the increased risk of Reye syndrome. The use of the other options is appropriate and all indicate an understanding of pain management for this child.

The nurse is teaching parents of a 6-year-old child about otitis media (OM). What predisposes the child to OM infections?

Bacteria entering through the eustachian tube Organisms that cause otitis media gain entrance to the middle ear through the eustachian tubes. A cotton swab may damage the eardrum but will not cause otitis media. Children's eustachian tubes are shorter, wider, and more horizontal than adults. Swimming and other water activity is associated with "swimmer's ear" and not otitis media.

The nurse is caring for an 8-year-old boy with otitis media with effusion. Which situation may have caused this disorder?

He is experiencing recurrent nasal congestion. Recurrent nasal congestion contributes to the presence of otitis media with effusion. Frequent swimming would put the child at risk for otitis externa. Attendance at school is a risk factor for infective conjunctivitis. Although otitis media is a risk factor for infective conjunctivitis, infective conjunctivitis is not a risk factor for otitis media with effusion.

The nurse is caring for an 11-year-old with otalgia and fever. When reviewing the child's medical record, which factor would place the client at risk for acute otitis media?

Her mother has had recurrent otitis media. A positive family history of acute otitis media, as evidenced by the report that her mother has had recurrent otitis media, is a risk factor. Breastfeeding is associated with decreasing the risk for otitis media. A first episode of acute otitis media before 3 months of age would be a risk factor. Crowding in homes or a large family size would be considered a risk factor.

The nurse is examining a 3-year-old boy with acute otitis media who has a mild earache and a temperature of 101.3°F (38.5ºC). Which action will be taken?

Instruct the parents to watch for worsening symptoms. In this case, the child will be continually observed. If the symptoms persist or become worse, antibiotics will be prescribed. This clinical practice guideline was developed by the American Academy of Pediatrics and the American Academy of Family Physicians in order to avoid overusing antibiotics or obtaining a middle ear fluid culture with every occurrence of acute otitis media. Administering antiviral agents would not be appropriate for this child.

What health teaching should the nurse provide to the parents of a child recovering from surgery to repair a cleft palate?

The child may have increased episodes of otitis media. Surgery to correct a cleft palate changes the contour of the palate and the slope of the eustachian tube to the middle ear. This can lead to a high incidence of middle ear infection or otitis media because organisms are able to reach this area from the oral cavity more readily than usual. The child is not expected to have chronic maxillary pain, inability to sense the temperature of food, or a poor appetite from a decreased sense of taste.