9.D Otitis Media

A nurse is assessing an infant. Which of the following findings are clinical manifestations of acute otitis media? (Select all that apply.) A. Decreased pain in the supine position B. Rolling head side to side C. Loss of appetite D. Increased sensitivity to sound E. Crying

B, C, E

An infant who has clinical manifestations of acute otitis media is brought to an outpatient facility by his parent. The nurse should recognize that which of the following factors places the infant at risk for otitis media? (Select all that apply.) A. Breastfeeding without formula supplementation. B. Attends day care 4 days per week. C. Immunizations are up to date. D. History of cleft palate repair. E. Parents smoke cigarettes outside.

B, D, E

A nurse is caring for a toddler who has acute otitis media. Which of the following is the 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.

D. Administer analgesics.

What is a myringotomy?

A surgical incision of the tympanic membrane that is performed to relieve pressure associated with pus buildup found with otitis media

The position of the tympanic membrane in the neonate is more ________________, making it more difficult to visualize with the otoscope. A. horizontal B. vertical C. perpendicular D. oblique

A. horizontal The position of the eardrum is more horizontal in the neonate, making it more difficult to see completely and harder to differentiate from the canal wall.By 1 month of age, the eardrum is in the oblique position similar to an older child, and examination is easier.

Risk factors for otitis media include [SATA] a. Age < 2 years old b. Having seasonal allergies c. Participating in group care settings d. Gender e. Exposure to poor air quality

a, b, c, e

Which of the following are the most common causative organisms of acute otitis media? [SATA] a. Steptococcus pneumoniae b. Staphylococcus aureus c. Haemophilus influenzae d. Moraxella catarrhalis

a, c, d

Acute otitis media in adults is usually treated with antibiotic therapy, especially ________________ for ___ to ___ days. This time is long enough to eradicate the infective organism but short enough to reduce antibiotic resistance.

Acute otitis media in adults is usually treated with antibiotic therapy, especially amoxicillin for 5 to 10 days. This time is long enough to eradicate the infective organism but short enough to reduce antibiotic resistance.

________________ is a risk factor for ear infections in infants. A. Diarrhea B. Bottlefeeding C. Premature birth D. Being first born

B. Bottlefeeding Bottlefeeding is a risk factor for otitis media in infants. Breastfeeding passes immunity to the child that helps prevent acute otitis media. The position of the breastfeeding child is better than the bottlefeeding position for Eustachian tube function.If a child needs to be bottlefed, hold the infant instead of allowing the child to lie down with the bottle is best. A child should not take the bottle to bed. In addition to increasing the chance for acute otitis media, falling asleep with milk in the mouth increases the incidence of tooth decay.

There is no way to prevent ear infections in children and adults. A. True B. False

B. False Remember that the common cold is a key cause of ear infections. Because of the highly contagious nature of the common cold, one strategy for prevention of the cold itself and subsequent ear infections is to keep cold viruses at bay. The most effective way to do this is frequent and meticulous hand washing. Other strategies to prevent acute ear infections are to ensure a child is vaccinated. Ensuring that a child receives an annual flu vaccine and is up to date with his/her pneumococcal vaccine are excellent strategies used to prevent the most common causes of ear infections. Other lines of defense against ear infections include avoiding secondhand smoke and breastfeeding your baby for the first year of life.

For infants and children, what are some prevention techniques the nurse could teach the client?

Breastfeed for 12 months or more Bottle feed in upright position Keep up to date with immunizations Avoid air pollution, especially secondhand smoke Use a small daycare or private child care

Which of the following is the drug of choice for initial treatment of acute otitis media? A. Ciprofloxacin B. Erythromycin C. Amoxicillin D. Azithromycin

C. Amoxicillin Amoxicillin (Amoxil) is recommended for initialempiric therapy because it is inexpensive, effective,and convenient to administer. Higher dosagescan provide expanded coverage of resistant Streptococcuspneumoniae. First line drugs are Amoxil and Augmentin. Both drugs are given orally. Erythromycin, azithromycin, andcefaclor can be used alternatively in communitieswith high bacterial resistance rates. Ciprofloxacin (aquinolone) is not indicated for children youngerthan age 18 years. Antibiotic therapy is given for 10 to 14 days. Refer to ear, nose, and throat (ENT) physician if 6 ear infections occur in one year.

The tympanic membrane of a child with acute otitis media would be: A. flat and slightly pulled in at the center. B. mobile and would flutter with the Valsalva maneuver. C. bulging with a distinct red color. D. shiny and translucent, with a pearly gray color.

C. bulging with a distinct red color. The tympanic membrane would be bulging and red with acute otitis media.A normal tympanic membrane is flat and slightly pulled in at the center.A normal tympanic membrane is mobile and flutters with the Valsalva maneuver.A normal tympanic membrane is shiny and translucent, with a pearly gray color.

What are symptoms of an ear infection? A. Trouble hearing and fever B. Fluid drainage and dizziness C. Congestion in the ear D. All of the above

D. All of the above The hallmark of an acute ear infection is sudden, piercing pain in the ear. The pain may be worse when lying down, making it difficult to sleep. Other symptoms include difficulty hearing, fever, fluid drainage from the ears, dizziness, and congestion.Young children with otitis media may be irritable, fussy, or have problems feeding or sleeping. Older children may complain about pain and fullness in the ear (earache). Fever may be present in a child of any age. These symptoms are often associated with signs of upper respiratory infection such as a runny or stuffy nose, or a cough.

Which of the following children is at risk of recurrent otitis media (OM)? A. An 18-month-old infant who lives with a smoker B. A 2-year-old child who has had two ear infections in the past 6 months C. A 6-month-old infant who has a sibling who had tubes inserted at 3 years of age D. An 18-month-old infant who has had three episodes of ear infections in a 5-month period

D. An 18-month-old infant who has had three episodes of ear infections in a 5-month period A first episode of OM that occurs within 3 months of life increases risk of recurrent OM. Recurrent OM is three episodes within the past 3 months or four episodes within the past year.

Why might hearing loss occur during an ear infection? A. Itching in the ear dulls the ability to hear well. B. The ear tubes are off balance. C. An ear tube has been lost. D. Pus buildup dampens ear drum vibrations.

D. Pus buildup dampens ear drum vibrations.

A pediatric client has been diagnosed with otitis media. The nurse should place highest priority on teaching the parent: A. How to administer ophthalmic medication B. About eliminating environmental allergens C. About myringotomy and tympanostomy tube insertion D. The importance of completing the full course of antibiotic therapy

D. The importance of completing the full course of antibiotic therapy The nurse must emphasize the importance of completing the full course of antibiotic therapy, even though symptoms may have resolved before the antibiotic is finished. Otitis media is inflammation of middle ear. Ophthalmic medications would be used for the eye. Otic medications are used for ear conditions. The other choices have lower priority.

TRUE/FALSE: Ear infections are highly contagious.

False An ear infection itself is not contagious. Ear infections are often the result of a previous infection of the throat, mouth, or nose that has relocated and settled in the ears.

What are the first line antibiotics to treat acute otitis media? What is the second line?

First: Amoxicillin Second: Amoxicillin-clavulanate (Augmentin)

TRUE/FALSE: An upper respiratory infection often precedes the development of otitis media

True

TRUE/FALSE: Untreated ear infections can lead to complications such as meningitis.

True Untreated ear infections can lead to more serious complications, including mastoiditis (a rare inflammation of a bone adjacent to the ear), hearing loss, scarring and/or perforation of the eardrum, meningitis, speech and language development problems, facial nerve paralysis, and possibly -- in adults -- Meniere's disease. Note: Meniere's disease is likely a disorder of the flow of fluids of the inner with symptoms that include vertigo, tinnitus, and hearing loss.

Which of the following are expected findings in the client with otitis media? a. "Snapping" or "popping" in the ear b. Subnormal temperature c. Mild to severe pain in affected ear d. Dizziness, vertigo, and tinnitus e. Tympanic membrane that is red and inflamed or dull and bulging

a, c, d, e Client's temperature is often elevated

The nurse is assessing a 2 year old client. During the assessment, the child is frequently pulling at the ear, is demonstrating irritability and malaise, and the mother reports that the child hasn't been eating well. The nurse would suspect which condition to be the cause? a. Otitis media b. Conjunctivitis c. Hemotympanum d. Vertigo

a. Otitis media These are presentations associated with pediatric clients with otitis media

Occurs when obstruction of the eustachian tube is prolonged. Negative pressure eventually causes sterile serous fluid to move from the capillaries into the middle ear space, a process called middle ear effusion. a. Serous otitis media b. Acute otitis media c. Chronic otitis media

a. Serous otitis media

Separates middle ear from external auditory canal a. Tympanic membrane b. Eustachian tube c. Cochlea d. Pinna

a. Tympanic membrane

The nurse is educating the parents of an infant on ways to prevent the occurrence of acute otitis media. Which of the following should be included in the teaching? Select all that apply. a. The benefits of giving prophylactic antibiotics b. The importance of routine immunizations c. Avoiding exposure to secondhand smoke d. Feeding in an upright position

b, c, d

Follows an upper respiratory tract infection. Edema in eustachian tube impairs drainage, causing mucus and serous fluid to accumulate. This allows bacterial colonization to occur. a. Serous otitis media b. Acute otitis media c. Chronic otitis media

b. Acute otitis media

Connects the middle ear with the nasopharynx to help equalize the pressure in the middle ear with the atmospheric pressure. Typically only opens during yawning and swallowing. a. Tympanic membrane b. Eustachian tube c. Cochlea d. Pinna

b. Eustachian tube

A toddler with acute otitis media (AOM) is taking amoxicillin. The nurse should instruct the parents about which of the following? a) If the AOM does not resolve with amoxicillin, a myringotomy will be necessary. b) If the child is older than 24 months, a shorter course of antibiotics is sufficient. c) If the child improves clinically, continue the entire duration of antibiotics d) If the child experiences ear pain, alternate acetaminophen (Tylenol) and ibuprofen for pain control.

c) If the child improves clinically, continue the entire duration of antibiotics Parents should always be encouraged to complete the entire course of therapy, even if the child starts to feel better; in children 6 years of age and older, shorter courses may be sufficient. Amoxicillin is the treatment of choice for AOM and is a first-line drug, thus a myringotomy would not be considered this early. Acetaminophen (Tylenol) and ibuprofen are only alternated for pain control in select situations in which the parent is very clear about dosing schedules as the risk of error is too significant.

Involves permanent perforation of the tympanic membrane. Often times a result of recurrent acute otitis media infections. Can be accompanied by a cholesteatoma, which can cause conductive hearing loss if not treated. a. Serous otitis media b. Acute otitis media c. Chronic otitis media

c. Chronic otitis media