Pre Chapter 60: Drug Therapy for Disorders of the Ear

A toddler has been diagnosed with otitis media and prescribed amoxicillin. The nurse is performing a follow-up assessment, during which the mother states, "I'm careful to give him his antibiotics on schedule, and a small dose of aspirin when his pain looks like it's flaring up." What is the nurse's priority response?

"Aspirin isn't recommended for use by children because of safety risks"-Children should not take aspirin due to the risk for Reye syndrome. The nurse should certainly assess further, but this safety guideline is a priority because of the risk for harm. There is no safe recommended dose of aspirin for very young children.

A young child has been brought to the clinic with signs and symptoms that are consistent with otitis externa. What assessment question should the nurse ask to address the etiology of this health problem?

"Has your child been swimming a lot lately?"-Otitis externa in children is often attributable to moisture in the ear, often because of swimming. Poor hygiene, interaction with animals, and lack of immunizations are not likely to be relevant factors.

A nurse in an extended care facility has instilled medicated ear drops into a resident's left ear as prescribed. What instruction should the nurse provide to a client after instilling ear drops into the client's left ear?

"Keep lying on your right side for the next 20 minutes or so."-After instillation of ear drops, the client should lie on the side opposite the side of administration for 20 minutes to prevent the instillation from running out of the ear canal. It would be inappropriate to reinsert a hearing aid immediately since the medication could harm the hearing aid. It is unnecessary to massage the ear or, conversely, to avoid touching the ear.

A mother is frustrated that her 2-year-old daughter keeps developing ear infections. "I don't understand. Her older brother seldom has any. Why does she have so many?" The nurse explains there can be several different reasons for this. Which of the following might be one of those reasons?

"The eustachian tube is straighter in younger children, allowing easy access to pathogens."

The parent of a young child diagnosed with otitis media is alarmed at the possibility of the child being prescribed amoxicillin, stating, "She's absolutely terrified of needles, so I don't know how we'd get her to take the medication." What is the nurse's most appropriate response?

"This drug is given by mouth, so there is no need for needles."

An older adult diagnosed with necrotizing otitis externa has been receiving IV ciprofloxacin and is now transitioning to the oral form of the drug. What health education should the nurse provide to the client?

"You can take this medication with food to reduce the chance that it will upset your stomach."-

A client has presented with otalgia and otorrhea and has been diagnosed with acute otitis media. The health care provider has prescribed oral amoxicillin. The client asks the nurse, "Will the medication help me to get my hearing back?" What is the nurse's best response?

"Your hearing should return to normal as the infection clears."Hearing loss often accompanies otitis media and should resolve with treatment. It would be very unlikely for this hearing loss to be unrelated to the infection if the client has correlated the two.

Pain and fever are frequent issues with ear infections. What would be a safe treatment for toddlers who have pain and/or fever?

Acetaminophen

A school-aged child was diagnosed with otitis media and prescribed a 10-day course of oral amoxicillin. On the seventh day of treatment, the child's mother has contacted the nurse and stated that the child has been symptom-free for the past three days. What is the nurse's best action?

Advise completion of the antibiotics as prescribed.

The nurse is reviewing a client's medication list before teaching the client about Cipro, a new drug the health care provider has ordered. The nurse warns the client to avoid what until the client finishes the Cipro?

Antacids-Individuals should not take antacids, zinc, or iron supplements during the course of Cipro treatment.

The nurse is caring for a child who has just been diagnosed with otitis media and will be treated with amoxicillin. It is most important for the nurse to instruct the mother to administer this medication on what schedule?

Around the clock

A child has been diagnosed with acute otitis media. Before the child begins antibiotic treatment, what assessment should the nurse perform?

Assess the child for allergies to penicillins.

After teaching a group of nursing students about various ophthalmic drugs, the instructor determines that the teaching was successful when the students correctly choose which drug as a carbonic anhydrase inhibitor?

Brinzolamide-Brinzolamide is a carbonic anhydrase inhibitor. Pilocarpine is a miotic, direct-acing cholinesterase inhibitor. Latanoprost and travoprost are prostaglandin agonists.

The nurse recognizes that the preferred drug of choice for children with necrotizing otitis externa is which of the following?

Cephalexin (Keflex)-For necrotizing otitis externa, ciprofloxacin is the drug of choice for adults, while cephalexin (Keflex) is the preferred drug for children.

A client is admitted to the health care facility with acute glaucoma. After administering the prescribed ophthalmic drugs, the nurse continues to assess the client for pain relief at which frequency?

Every 2 hours-Clients admitted for treatment of acute glaucoma should be assessed every 2 hours for relief of pain. Pain in the eye may indicate increased intraocular pressure.

A nurse is preparing to administer an ophthalmic solution to a client who is diagnosed with a bacterial ocular infection. Which drug(s) would the nurse predict will be prescribed? Select all that apply.

Gatifloxacin and tobramycin are antibiotic ophthalmic preparations used to treat bacterial infections. Brimonidine is used to decrease intraocular pressure. Betaxolol is used to treat chronic open-angle glaucoma. Natamycin is an antifungal agent.

A nurse is teaching a client with glaucoma about the prescribed eye drops. The nurse emphasizes the importance of therapy to prevent which complication(s)? Select all that apply.

Increased intraocular pressure can lead to optic nerve damage, visual loss, and blindness. A headache may be a potential adverse effect to some of the drugs used to treat glaucoma. Corneal tears are not noted as a potential complication from glaucoma.

The nurse is evaluating the effectiveness of antibiotic therapy for a client who has been treated for acute otitis media. What assessments will indicate a resolution of the infection? (Select all that apply.)

Indications of a resolution of otitis media include the absence of otalgia and otorrhea; improved hearing; a gray, dull tympanic membrane with a cone of light; no bulging of the tympanic membrane; and normal body temperature.

When teaching a client about Cortisporin Otic, the nurse will mention which of the following as a potential adverse effect?

Ototoxicity-Adverse effects of Cortisporin Otic include burning, stinging, and ototoxicity.

A client with acute otitis externa in the left ear has been prescribed neomycin-polymyxin B-hydrocortisone ear drops. The client is unable to self-administer the drops independently, so the nurse will administer them. The nurse has instilled the medication into the affected ear, and should do what action next?

Position the client side-lying on the right.

The nurse is aware that what is the most common bacterium found in clients with otitis externa?

Pseudomonas aeruginosa-Pseudomonas aeruginosa is the most common bacteria that causes otitis externa.

The nurse is preparing to initiate IV Cipro in a patient with necrotizing otitis externa. The nurse is aware that dosage adjustment will be necessary if the patient has a history of which of the following?

Renal impairment

A client has nearly completed a prescribed course of ciprofloxacin for the treatment of necrotizing otitis externa. During the nurse's most recent assessment, the client describes pain to his Achilles tendon, increasing in recent days. What is the nurse's best action?

Report this finding promptly to the health care provider.-Tendon pain can signal the onset of a grave complication of ciprofloxacin, and one that may lead to spontaneous tendon rupture. The nurse should inform the health care provider promptly since this warrants medical follow-up. The medication is likely to be discontinued, but the nurse should not unilaterally suggest this without consulting with the health care provider. Cold compresses and mobility limitation may provide temporary comfort but do nothing to reduce the likelihood of tendon rupture.

A client receiving ophthalmic drugs reports blurred vision. The client tells the nurse, "I almost fell yesterday." The nurse will prioritize which nursing diagnosis for this client?

Risk for injury-The client's report of blurred vision and the report of almost falling support the nursing diagnosis of risk for injury. Risk for infection would be appropriate if the client had an infection or did not correctly instill the eyedrops, contaminating the container and/or solution. Acute pain would be more appropriate if the client reported pain either from the disorder or as an adverse effect. Although the client may be anxious, there is no evidence to support it.

The nurse is admitting a client with necrotizing otitis externa. The nurse expects the client to exhibit which symptoms? (Select all that apply.)

Symptoms of necrotizing otitis externa include otalgia, otorrhea, and pain while chewing.

The nurse will notify the health care provider immediately if the client taking amoxicillin for otitis media is also taking what medication?

Tetracycline for acne- Tetracycline, if taken with amoxicillin, inhibits the action of amoxicillin.

After teaching a group of nursing students about otic preparations, the instructor determines that the teaching was successful when the students match which ingredient(s) to its correct action? Select all that apply.

The following ingredients found in miscellaneous otic preparations are correctly matched with their action: benzocaine—local anesthetic, hydrocortisone—corticosteroid, and acetic acid—antimicrobial. Antipyrine is an analgesic; carbamide peroxide aids in removing cerumen.

The nurse is instructing a client who developed otitis externa. The nurse understands that what is the most important action the client can take to prevent this infection from recurring?

Use earplugs when swimming

A client has a diagnosis of otitis media and has just begun antibiotic treatment. The client reports otalgia and has asked for medication. The nurse should anticipate the administration of:

acetaminophen (Tylenol).-Tylenol is the first-line analgesic for most cases of otalgia accompanying otitis. Opioids and ketorolac are not normally indicated.

A 10-year-old client is diagnosed with acute otitis media. What does the nurse anticipate the health care provider will prescribe?

amoxicillin-Amoxicillin is the drug of choice for a client with acute otitis media. Ciprofloxacin is prescribed for necrotizing otitis external. Ibuprofen is over the counter and does not require a prescription; although it can be used for pain associated with acute otitis media, it will not treat the infection. Neomycin-polymyxin B is used for external otitis media.

The nurse identifies which as the correct method to instill ear drops in the adult client?

pull the pinna of the ear up and back-

The nurse is preparing to administer ear drops to a client diagnosed with otitis externa. What action should the nurse perform prior to administration?

removing any excess cerumen from the client's ear-Cerumen should be removed from the ear canal with a cotton swab prior to instillation of the medication. Irrigation is unnecessary, and assessment of balance is not required. The client should lie on the unaffected side following administration of ear drops.

A client has sought care reporting ear pain and small amounts of drainage from the affected ear. The health care provider has diagnosed otitis externa. The nurse should anticipate what prescription for the client?

topical antibiotics-Otitis externa normally warrants antibiotic treatment and the etiology is normally bacterial, not viral. Consequently, antivirals would be ineffective. In most cases, topical treatment is preferred over systemic therapy due to the greater risk of adverse effects.