Otitis Media dsm

The nurse is caring for a 3-year-old patient experiencing otitis media. The patient's mother asks, "Why isn't my child being put on an antibiotic?" Which response by the nurse is accurate?

"Conservative antibiotic administration when treating otitis media helps reduce antibiotic resistance."

The nurse is working with parents on feeding an infant with a cleft lip. Which instructions should the nurse include?

"Feed the child in an upright position." In order to prevent reflux of feeding into the ear, the nurse would instruct the parents to feed the child in the upright position. The frequency of feedings is not based on otitis media risks, but the child's hunger. The nurse would not give the child a bottle in bed or allow pacifier use all day. These increase dental problems, risk of suffocation, and otitis media.

The nurse is reviewing the medical record of a patient diagnosed with otitis media who reports slight hearing loss and vertigo. Based on these findings, which question should the nurse ask the patient?

"Have you experienced any dizziness or lightheadedness?" Vertigo is a sense of disequilibrium that occurs in the inner ear and can be caused by ear infections that have worsened. Therefore, the nurse would ask if the patient has experienced any lightheadedness or dizziness. Bleeding, any other type of drainage, or snapping or popping sounds are not related to vertigo, but to the infection itself.

The nurse is teaching a patient with narrow eustachian tubes how to prevent an ear infection. Which patient statement indicates a need for further teaching?

"I plan on flying to Hawaii and taking a helicopter ride over volcanoes."

The nurse is giving discharge instructions to the parents of a child who had a tympanoplasty. Which statement by the parents indicates an understanding of the instructions provided?

"I will not allow anyone who smokes to be around my child." When the parents inform the nurse that they will not smoke around the child, nor allow the child to be exposed to smoking, this indicates an understanding of instructions provided. Swimming is not allowed without waterproof earplugs. Diving is not permitted due to change in atmospheric pressure. Breastfeeding provides more immunity than bottle feeding. Pacifier use increases the incidence of otitis media and should not be permitted.

The patient experiencing recurrent otitis media asks the nurse, "Why is my doctor going to do a tympanostomy tube insertion?" Which response by the nurse is accurate?

"It promotes fluid drainage from the middle ear space." Following myringotomy, a tympanostomy tube (pressure-equalizing tube) is inserted to promote ventilation and drainage of the middle ear to the external environment during healing. Tympanocentesis involves insertion of a spinal needle through the inferior portion of the tympanic membrane, allowing aspiration of fluid and pus from the middle ear to decrease pressure. The tube is eventually extruded from the ear. While a culture and sensitivity test can be performed, this is not the primary reason for tube insertion.

The nurse is teaching a group of new mothers about ways to prevent otitis media in infants. Which instruction should the nurse include?

"Refrain from pacifier use."

The parents of a child being treated for otitis media inform the nurse that the child reports sudden pain relief. Which information should the nurse provide?

"Sudden pain relief indicates the tympanic membrane has ruptured." When the child with otitis media reports sudden relief from ear pain, this indicates the tympanic membrane has ruptured. The effectiveness of antibiotic eardrops is determined by otoscopic exam. Pain relief does not indicate the child is not following restrictions. Dampness in the ear canal would indicate the child is getting the ear canal wet. Worsening pain or decreased hearing indicates the infection is getting worse.

The nurse discusses a treatment plan for otitis media with a pregnant patient. Which patient statement indicates an understanding?

"Treatment includes comfort measures and avoiding the use of medications." Treating otitis media in the pregnant patient is done conservatively so as to avoid fetal harm. This includes keeping the patient comfortable and refraining from using medications including antibiotics, analgesics, antipyretics, and antihistamines. One occurrence of otitis media would not necessitate surgical intervention.

The parents ask the nurse if there is a test that can be performed to determine the cause of repeated bouts of otitis media with their child. Which response by the nurse is appropriate?

"We can culture the fluid that drains from the ear to determine if there are bacteria present." The nurse would inform the parents that obtaining a culture and sensitivity can determine the causative organism of the repeated infections. The nurse would not recommend undergoing a special gradient acoustic reflectometry, because this determines hearing loss, not the cause of the infections. The nurse should not pass off the repeated infections as something children get, because this does not answer the parents' question. A complete blood count will only measure the presence of white blood cell count (possible infection) but will not determine the cause.

Clinical manifestations of acute otitis media include the following:

Acute pain Conductive hearing loss Bleeding Purulent drainage Dizziness/vertigo Tinnitus Bulging or ruptured eardrums Elevated temperature Mastoid tenderness Red and inflamed tympanic membrane

Common antibiotics used to treat otitis media include:

Amoxicillin with clavulanate. Trimethoprim-sulfamethoxazole. Cefaclor. Azithromycin. Cedfinir. Cefpodoxime. Ceftriaxone. Clarithromycin. Clindamycin. Levofloxacin.

Which over-the-counter medication should the nurse recommend to be most effective in managing pain for a patient with otitis media?

Anti-inflammatory Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to decrease inflammation and alleviate pain. Antihistamines would help dry up any serous drainage. Non-aspirin analgesics will alleviate pain, but do not decrease inflammation. Antibiotics fight bacterial infections but do not decrease inflammation or alleviate pain.

The nurse is discussing possible pharmacologic treatments for acute otitis media with the parents of a 3-year-old patient who presents with severe otalgia and a temperature of 102.2°F (39°C). Which medication, unless contraindicated, should the nurse list as the first-line therapy used for treatment for this patient?

Antibiotics An antibiotic, usually amoxicillin, is the first-line medication used in the treatment of pediatric patients with otitis media, as long as the child has not had this drug within the past 30 days and is not allergic to it. The American Academy of Pediatrics in 2009 updated their 2004 recommendations. The updated recommendations suggest that the clinician should prescribe antibiotic therapy for acute otitis media (bilateral or unilateral) in children 6 months and older with severe signs or symptoms (that is, moderate or severe otalgia or otalgia for at least 48 hours or temperature of 102.2°F [39°C] or higher). Neither decongestants nor antihistamines have been shown to be effective in treating otitis media with or without effusion. Steroids also do not appear to have any long-term beneficial effect. Analgesics, antipyretics, and antihistamines are acceptable treatments for symptomatic relief.

Teaching points in case of ear inflammation and pain include:

Apply heat to affected side. avoid air travel, rapid elevation changes, and diving. Report signs of recurrent infection. Elevate head of the bed. Use eardrop administration technique for children.

Teaching points for managing pain are as follows:

Assess severity, quality, and location of pain Use mild analgesics to dull the pain Advise patients to use complementary health practices such as application of heat Avoid activities that will expose patient to changes in barometric pressure such as diving or air travel Elevate head of bed Teach patient when to report to healthcare provider immediately

Nursing interventions related to care of patients with otitis media include:

Care of tympanostomy tubes. Keep ear canals clean and dry. Elevate the head of the bed. Instruct on use of eardrops. Explain pain management. Emphasize preventive measures. Teach the patient and family members about the surgery and postoperative care, if surgical intervention is required. Explain to parents and patients the problem of developing resistant strains of bacteria.

Otitis media with effusion:

Collection of fluid in the middle ear behind the tympanic membrane, which is not infected with bacteria Clinical Manifestation Behavioral: Difficulty hearing or responding as expected to sounds. An adult may complain of not hearing the phone, the TV, or other people speaking to them. Examination: Signs of acute inflammation NOT present; tympanic membrane retracted or neutral; immobile or partly mobile tympanic membrane; yellow or gray tympanic membrane; opaque or thickened tympanic membrane with visibility of landmarks reduced Clinical Therapy Symptomatic treatment for pain Careful observation of hearing acuity over several months In children: Speech assessment if loss of hearing acuity occurs Developmental assessment

Which finding should the nurse expect in relation to the increased pressure behind the tympanic membrane in a patient with otitis media?

Ear pain

Acute otitis media:

Etiology Bacterial infection in the middle ear from pathogens transferred from the Clinical Manifestation Behavioral: Ear pain, rapid onset. Among children you may also see: pulling at ear, irritability, malaise, and poor feeding Examination: Bulging tympanic membrane; air or fluid bubbles present behind tympanic membrane; immobile or poorly mobile tympanic membrane; red tympanic membrane, or other color change (for example, white, gray, or yellow) as long as bulging is present; and reduced visibility of tympanic membrane landmarks with displaced light reflex Clinical Therapy Treatment of ear pain with local anesthetic, local herbal pain products, or systemic acetaminophen or ibuprofen Observation of the patient's condition for 48-72 hours; if not improved, treatment with course of antibiotics

Etiology of otitis media includes:

Eustachian tube dysfunction. Upper respiratory infections.Streptococcus pneumoniae.Haemophilusinfluenzae.Moraxella catarrhalis. Allergies. Viral infections predisposing the child to otitis media.

To reduce risk for otitis media teach parents to:

Feed infants in an upright position. Avoid giving children a bottle in bed. Breastfeed.

The nurse is caring for an infant for repeated episodes of otitis media. Which action by the parent indicates a need for teaching on ways to prevent further infection?

Giving the infant a bottle to drink in bed

The nurse is preparing to use an otoscope to examine a 4-year-old child's ear. Which should the nurse consider when using the otoscope to prevent damaging the eardrum?

Hold the otoscope with a hand between the otoscope and the head.

Which term is appropriate for the nurse to use when describing inflammation of the inner ear to a colleague?

Labyrinthitis Inflammation of the inner ear is called otitis interna, or labyrinthitis. Inflammation of the ear canal is called otitis externa, or swimmer's ear, because it commonly occurs among individuals who spend significant time in the water. Inflammation of the middle ear is called otitis media.

The patient asks the nurse, "What factor can increase my risk for developing barotitis media?" Which factor should the nurse include?

Narrowed eustachian tubes Patients with narrowed or edematous eustachian tubes may be at risk for developing barotrauma or barotitis media. For these patients, the middle ear cannot adapt to rapid changes in barometric pressure, such as those associated with underwater diving or air travel. Viral upper respiratory infection can increase the patient's risk for developing acute otitis media, while upper respiratory infection or allergies (such as hay fever) can lead to the development of serous otitis media. Otitis media can cause persistent conductive hearing loss, which typically resolves with clearance of the middle ear effusion.

Risk factors for barotitis media include:

Narrowed or edematous eustachian tubes. Rapid changes in barometric pressure.

Treatment for pregnant women should focus on:

Nonpharmacologic health approaches. Complementary health approaches. If discomfort or symptoms worsen, the pregnant woman should consult with the obstetrician.

The nurse is preparing to examine the ear of a 2-year-old child. Which assessment technique should the nurse use?

Pull the pinna down and back.

A patient presents to the urgent care center stating, "I have a problem with my right ear." Which patient complaint prompts the nurse to suspect tympanic membrane rupture prior to inspection of the right ear of the patient?

Purulent drainage from the ear

The nurse is caring for an adult patient who has ear pain. Which action is most appropriate for the nurse to implement when using an otoscope to examine the patient's ear?

Selecting a speculum with the largest diameter that will fit comfortably in the patient's ear