Otitis Media

Audiology testing is recommended for a patient upon completion of antibiotic therapy for otitis media. The patient asks the nurse why this has to be done. Which response by the nurse is accurate? "Audiology testing is needed to determine if hearing has improved after treatment." "Audiology testing is the standard of care for everyone before and after the antibiotic treatment." "Audiology testing should be performed before treatment begins, not after the course of antibiotics." "Audiology testing is important to determine the causative organism for otitis media."

"Audiology testing is needed to determine if hearing has improved after treatment." Audiology testing is used before and after treatment of otitis media if conductive hearing loss is suspected. Audiology testing is not a standard of care that is performed on everyone. If audiology testing is used, it will be used before and after treatment. A culture and sensitivity test, not audiology testing, is performed to determine the causative organism.

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." "Feed the child every 2 hours." "Provide a bottle for the child in bed." "Allow the child to use a pacifier all day."

"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?" "Have you had any bleeding from your ears?" "Have you heard any snapping or popping sounds?" "Have you experienced any drainage from your ears?"

"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. Additional Learning

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." "It is used to obtain a specimen for culture and sensitivity." "It will help fluid drain from the middle ear to the inner ear space." "It helps prevent ventilation of the middle ear space."

"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 caring for a child with repeated episodes of otitis media. The parents ask what is causing the infection. Which response by the nurse is best? "The most common cause of otitis media is eustachian tube dysfunction." "It is often caused by swimming frequently in a lake." "We need to be vigilant about watching for infections, since they happen so often." "Since these happen so often, we will just monitor for hearing loss."

"The most common cause of otitis media is eustachian tube dysfunction." The best response is to offer the parents information about otitis media. Otitis media occurs most often due to malfunctioning eustachian tubes. The parents informed the nurse that the child wears earplugs, so the nurse would not question their statement. Although it is important to be vigilant about monitoring for further infections and hearing loss, this does not explain the cause to the parents.

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." "Treatment includes the use of prescription antibiotics that are safe for the fetus." "Treatment includes surgical intervention with myringotomy and tube insertion." "Treatment includes analgesics, antipyretics, and antihistamines."

"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.

A client presents with bleeding behind the tympanic membrane. Which term should the nurse use when documenting this​ condition? A. Myringotomy B. Vertigo C. Hemotympanum D. Insufflation

C. Hemotympanum ​Rationale: Hemotympanum refers to bleeding into or behind the tympanic membrane. Vertigo refers to a sensation of whirling or rotating. Insufflation is the introduction of air into a body region or​ cavity, such as the ear. A myringotomy is a surgical procedure that involves incision of the tympanic membrane.

Which finding should the nurse expect in relation to the increased pressure behind the tympanic membrane in a patient with otitis media? Ear pain Mastoiditis Meningitis Purulent drainage

Ear pain Ear pain occurs from an increase in pressure from fluid accumulation behind the tympanic membrane. Mastoiditis and bacterial meningitis are complications of otitis media. Purulent discharge occurs after the tympanic membrane has ruptured. The ear pain resolves when the membrane is ruptured.

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 Hiring a nanny to care for the infant at home Breastfeeding the infant for nutrition Feeding the baby in an upright position

Giving the infant a bottle to drink in bed In order to prevent episodes of otitis media, the parents should refrain from giving the infant a bottle to keep in the crib. This not only causes dental caries and malformations, but it can lead to repeated episodes of otitis media. This practice needs to be corrected. Using a nanny in the infant's house decreases exposure to infections. Breastfeeding enhances immunity, so it would benefit the infant's health. The infant should be fed in an upright position to decrease the risk of breast milk or formula from refluxing into the eustachian tubes.

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." "It is okay for my child to take swimming and diving lessons." "Bottle feeding my child will provide adequate protection from infections." "I should allow my child to continue using the pacifier to provide comfort."

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 nurse is performing a physical assessment of the ear for a patient admitted with labyrinthitis. Which site should the nurse expect the infection to be located? Inner ear Middle ear External ear Tympanic membrane

Inner ear Labyrinthitis is an infection in the inner ear. An infection of the middle ear is otitis media. An infection of the external ear is otitis externa. An effusion involves a buildup of fluid behind the tympanic membrane that can cause the membrane to leak fluid or burst.

The patient asks the nurse, "What factor can increase my risk for developing barotitis media?" Which factor should the nurse include? Answer Narrowed eustachian tubes Environmental allergies Respiratory infections Middle ear effusion

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.

The nurse is preparing to examine the ear of a 2-year-old child. Which assessment technique should the nurse use? Answer Pull the pinna down and back. Pull the pinna up and forward. Pull the pinna up and back. Pull the pinna down and forward.

Pull the pinna down and back. Due to the angle of the eustachian tube in children, the nurse should pull the pinna down and back. Pulling the pinna forward prevents the nurse from examining the eustachian tube. The nurse should pull the pinna up and back to view the tympanic membrane in adults.

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 Conductive hearing loss Whirling and rotating sensation Snapping or popping sounds

Purulent drainage from the ear A patient who has sustained a rupture of the tympanic membrane will report a sudden discharge of purulent drainage from the affected ear. Conductive hearing loss occurs due to fluid buildup and is usually temporary. A whirling or rotating sensation is characteristic of vertigo that can happen due to otitis media but not from tympanic membrane rupture. Snapping or popping sounds occur from fluid in the middle ear.

The nurse is teaching the parents of a child diagnosed with otitis media regarding complications to report immediately. Which manifestation should the nurse include? Sudden pain relief Being afebrile Improved hearing Diminished irritability

Sudden pain relief The nurse should instruct the parents of a child with otitis media to report sudden pain relief, because this could signal tympanic membrane rupture. When the child is afebrile, has improved hearing, and has diminished irritability, this indicates improvement in the child's condition.

The nurse is developing a plan of care for an adult patient experiencing acute otitis media. Which statement best meets the criteria for a patient goal? The patient will complete all antibiotics as ordered. The patient will experience less pain. The patient will feel more rested each morning. The patient will be more comfortable.

The patient will complete all antibiotics as ordered. Patient goals and outcomes should be measurable, patient-specific, and tailored to meet the patient's needs. Only the patient goal related to completion of antibiotics as ordered is measurable. While experiencing less pain, feeling more rested, and being comfortable are desirable outcomes, these outcomes are not measurable.

The nurse preceptor is teaching a new graduate nurse about the plan of care for the adult client experiencing acute otitis media. Which class of medication should the nurse include as the most appropriate class of pharmacologic agents commonly used to treat the adult client with otitis​ media? (Select all that​ apply.) A. Analgesics B. Antibiotics C. Antipyretics D. Antihistamines E. Anesthetics

​A. Analgesics B. Antibiotics C. Antipyretics D. Antihistamines Rationale: Treatment of acute otitis media in the adult client commonly includes antibiotic therapy. Pharmacologic measures used for symptomatic relief may include​ analgesics, antipyretics, and antihistamines. For treatment of acute otitis media in the pediatric​ client, topical anesthetic eardrops may be prescribed for pain relief if the tympanic membrane is intact.

Which finding during an otoscopic exam of the tympanic membrane would confirm the presence of otitis​ media? (Select all that​ apply.) A. Movement B. Amber color C. Bulging D. Bleeding E. ​Semi-transparent

​B. Amber color C. Bulging D. Bleeding Rationale: The tympanic membrane will be​ bulging, have possible​ bleeding, and be amber in color in a client with otitis media. Normal findings in a healthy eardrum include the ability to move and​ semi-transparent in color.B.

The nurse is planning a teaching session on otitis media for a community with a high prevalence of this condition. The nurse is most likely selecting a community that is predominantly of which ethic group? Answer American Indian Eastern European Asian American African American

American Indian American Indian and Native Alaskan children have a very high rate of otitis media, perhaps related to differences in eustachian tube structure in these individuals. These children are seen about 3 times more frequently in outpatient clinics for otitis media than are other U.S. children. Nurses should be alert for the common incidence in these population groups, plan prevention programs, and ensure prompt care and teaching about treatments for families of children affected. Otitis media is not high in prevalence in those of Eastern European, Asian American, or African American descent.

Which over-the-counter medication should the nurse recommend to be most effective in managing pain for a patient with otitis media? Anti-inflammatory Antihistamine Non-aspirin analgesic Amoxicillin

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.

Which pathogen is the most common causative agent of otitis​ media? A. Escherichia coli B. Streptococcus pneumoniae C. ​Methicillin-resistant Staphylococcus aureus ​(MRSA) D. Pseudomonas aeruginosa

B. Streptococcus pneumoniae Streptococcus pneumoniae is the most common cause of otitis media. Others include Haemophilus influenzae and Moraxella catarrhalis. Escherichia​ coli, Pseudomonas​ aeruginosa, and MRSA cause other infections such as urinary tract or wound infections.

Which professional would benefit a child with repeated episodes of otitis media who presents with impaired verbal​ communication? A. Physical therapist B. Primary healthcare provider C. Speech language pathologist D. Occupational therapist

C. Speech language pathologist Rationale: The speech language pathologist would be best to assist a child in developing better speech patterns and improved verbal communication. Physical therapy helps clients increase mobility and function and decrease pain. Occupational therapy helps to train clients in activities of daily living. The primary healthcare provider coordinates all care.

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." "Administer antibiotics." "Use child care centers." "Smoke inside the house, away from the infant."

"Refrain from pacifier use." Pacifiers can not only alter dental structure but cause eustachian tube dysfunction as well. This can increase a child's risk of developing otitis media. Antibiotics are given to adults with otitis media, not children. If at all possible, children should be cared for at home or in smaller numbers. Infections spread easier in larger child care centers. Children should not be around cigarette smoke at all.

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? Answer "Sudden pain relief indicates the tympanic membrane has ruptured." "Sudden pain relief indicates the antibiotic eardrops are effective." "Sudden pain relief indicates the child is not following activity restrictions." "Sudden pain relief indicates the infection is becoming worse."

"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.

Which clinical manifestation displayed by the child would necessitate the insertion of tympanostomy​ tubes? (Select all that​ apply.) A. Serous otitis media lasting longer than 4 months B. Barotitis media for those who frequently fly C. Recurrent episodes of acute otitis media D. Severe otitis media unresponsive to antibiotics E. Persistent conductive hearing loss

A. Serous otitis media lasting longer than 4 months E. Persistent conductive hearing loss ​Rationale: The child who has persistent conductive hearing loss or serous otitis media that lasts longer than 4 months is a good candidate for tympanostomy tube insertion. Recurrent episodes of acute otitis media are treated with antibiotics and do not require tympanostomy tube insertion. Tubes are not used for barotitis media.​ Instead, lifestyle modifications are​ incorporated, such as decreasing the amount of flying. Neither antibiotics nor tympanostomy tubes are used in the treatment of severe otitis media.

The nurse is teaching a group of expectant women about situations that increase an​ infant's risk of developing otitis media. Which situation should the nurse​ include? (Select all that​ apply.) A. Using a pacifier B. Breastfeeding C. Allergies D. Down syndrome E. Attending daycare

A. Using a pacifier C. Allergies D. Down syndrome E. Attending daycare Rationale: Risk factors for developing otitis media include having​ allergies, attending​ daycare, using a​ pacifier, and having preexisting medical conditions including Down syndrome. Breastfeeding appears to have a protective effect against the development of otitis media.

Which information should the nurse plan to include for a teaching session regarding health promotion and prevention of otitis media with a group of new​ mothers? (Select all that​ apply.) A. ​"Promote breastfeeding." B. ​"Encourage pacifier​ use." C. ​"Use child care​ centers." D. ​"Keep infants away from​ smoke." E. ​"Know signs of ear​ infection."

A. ​"Promote breastfeeding." D. ​"Keep infants away from​ smoke." E. ​"Know signs of ear​ infection." ​Rationale: The nurse should instruct parents to report signs of otitis​ media, such as ear​ tugging, fever, increased​ irritability, and poor appetite. Breastfeeding decreases the risk of otitis media.​ Therefore, the nurse would promote breastfeeding over bottle feeding.​ Second-hand smoke exposure can cause otitis media in children. The nurse should instruct the parents to smoke outside the buildings in which the child is staying. Child care centers have greater numbers of​ children, and otitis media can spread more easily. It is better to use​ in-home child care. Pacifier use increases the incidence of otitis​ media; therefore, the nurse would discourage the use of pacifiers.

Which treatment should the nurse question for a pregnant client diagnosed with otitis​ media? A. Acetaminophen B. Warm compresses C. Humidified air D. Amoxicillin

D. Amoxicillin ​Rationale: Any medication taken by a pregnant client would lead to fetal exposure.​ Therefore, the nurse would question the order for amoxicillin. Humidified​ air, acetaminophen, and warm compresses are safe during pregnancy.

Which clinical finding in a 3-year-old child with recurrent otitis media infection warrants audiologist intervention? Lack of clear speech Ear pain Purulent drainage Dizziness

Lack of clear speech An audiologist measures hearing. The major complication of repeated episodes of otitis media is hearing loss. Therefore, when a 3-year-old child fails to develop clear speech due to recurrent otitis media infections, this requires audiology intervention to determine hearing loss. Ear pain, purulent drainage, and dizziness are all symptoms that should be addressed by the healthcare provider, not the audiologist.

The nurse is caring for an adult client with acute otitis media and plans to develop a teaching plan on the prevention of further infections. Which assessment increases the​ client's risk of otitis​ media? A. Frequent flying for business trips B. Recent bout of basilar pneumonia C. Swimming and water activities D. Receipt of recommended vaccinations

​C. Swimming and water activities Rationale: Any activity that increases exposure to​ water, such as swimming and water​ activities, can lead to acute otitis media. Frequent flying increases the risk of barotitis​ media, not acute otitis media. Upper respiratory infections such as bronchitis increase the risk of acute otitis media. These would not include lower respiratory infections such as pneumonia. It is important to receive recommended vaccinations to help prevent otitis media.

A client presents to the clinic with inflammation of the inner ear. How should the nurse communicate this condition to​ colleagues? A. ​"Otitis media" B. ​"Otitis externa" C. ​"Labyrinthitis" D. ​"Swimmer's ear"

​C. ​"Labyrinthitis" Rationale: Inflammation of the inner ear is called otitis​ interna, or labyrinthitis. Inflammation of the middle ear is referred to as otitis media. Inflammation of the ear canal is called otitis​ externa, or​ swimmer's ear.

The parents of a child present to the urgent care center reporting the child is tugging on the right ear. Which question should the nurse ask to determine the​ cause, based on the​ parents' observation? A. ​"Does your child drink from a bottle or sippy​ cup?" B. ​"When did you first notice the symptoms​ start?" C. ​"Did your child receive the influenza​ immunization?" D. ​"Has your child had an upper respiratory​ infection?"

​D. ​"Has your child had an upper respiratory​ infection?" Rationale: Upper respiratory infections are a causative factor for the development of otitis media in children because of the angle of the eustachian tubes.​ So, the nurse should ask about recent upper respiratory infections. It is important for the nurse to ask when the symptoms​ began, but this will not determine the cause. Drinking from a bottle rather than a sippy cup does not lead to otitis media. Bottle feeding at night is a risk factor for frequent infections. Whether or not the child has received the flu vaccine is not a causative factor for otitis media.

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." "We can schedule a special gradient acoustic reflectometry to determine the cause of these infections." "We can discuss this with your healthcare provider, but sometimes these infections just happen in children." "We can obtain a complete blood count to determine the cause of the repeated ear infections."

"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.

he parents of a​ 4-month-old infant with otitis media ask the nurse why the healthcare provider did not prescribe antibiotics. Under which parameter would the nurse explain that antibiotics are​ warranted? (Select all that​ apply.) A. Adults with acute otitis media B. Pregnant clients in the third trimester C. Children with otalgia for 48 hours D. Children over 6 months of age E. Children with temperature over 39 degrees C ​(102degrees ​F)

A. Adults with acute otitis media C. Children with otalgia for 48 hours D. Children over 6 months of age E. Children with temperature over 39 degrees C(102degreesF) ​Rationale: Because of the possibility of developing antibiotic​ resistance, healthcare providers do not prescribe antibiotics for the treatment of otitis media unless the following parameters are​ present: adults with acute otitis​ media, children over the age of 6 months with the presence of otalgia for longer than 48​ hours, or a temperature over​ 39°C (102°F). Antibiotics are not administered for otitis media for pregnant clients because of the risk of fetal harm.

The nurse is reviewing the medication administration record of a 5-year-old child who presents with acute otitis media, mild otalgia, and a fever of 101.1°F (38.4°C) for 1 day. Which medication order should the nurse question? Antibiotic Antipyretic Analgesic Antihistamine

Antibiotic Concern in the medical community has grown over the increasing appearance of drug-resistant bacteria as causative agents in otitis media. Therefore, the nurse should question the antibiotic administration. The updated recommendations prescribe 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). Of note is that amoxicillin remains the drug of choice, with recommendations not to prescribe if the child has had this drug within the past 30 days. Analgesics, antipyretics, and antihistamines are acceptable treatments for symptomatic relief.

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 Decongestants Antihistamines Steroids

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.

Which action by a client can increase the risk of developing barotitis​ media? A. Bottle feeding while lying down B. Swimming in a lake C. Smoking cigarettes D. ​Deep-sea diving

D. ​Deep-sea diving Rationale: Deep-sea diving can increase the risk for barotitis media because this disorder occurs during changes in barometric pressure such as flying or deep diving. Swimming in a​ lake, cigarette​ smoking, and giving an infant a bottle at night when the infant is lying down all increase the risk of otitis​ media, not barotitis media.

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? Answer Hold the otoscope with a hand between the otoscope and the head. Ask the parents to restrain the child to prevent movement of the child. Instruct the child to hold absolutely still and not move during the exam. Defer the otoscopic exam to the primary healthcare provider to prevent injury.

Hold the otoscope with a hand between the otoscope and the head. The nurse should hold the otoscope with a hand between the otoscope and the head. This allows the nurse to stabilize the hand in case the child moves. This prevents the otoscope from slipping and injuring the child. The parents can restrain the child, but this can be traumatic and should be the last resort. A 4-year-old child may not be able to sit still during an exam even if reminded. The nurse should try the otoscopic exam before deferring to the primary healthcare provider.

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." "I want to go camping and hiking the trails this summer." "I am taking my family to the beach this summer to relax." "I am going kayaking and swimming in the lake with my family."

I plan on flying to Hawaii and taking a helicopter ride over volcanoes." "I want to go camping and hiking the trails this summer." "I am taking my family to the beach this summer to relax." "I am going kayaking and swimming in the lake with my family." Barotitis media happens because of narrowed or edematous eustachian tubes. This in combination with rapid barometric pressure changes causes trauma to the middle ear. Therefore, the patient who plans on flying to Hawaii and riding in a helicopter would make the condition worse. This statement indicates a need for further instruction. Camping, going to the beach, and kayaking or swimming in a lake would not worsen the condition.

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 Gently pulling the pinna of the patient's ear down and back to straighten the ear canal Inserting the speculum of the otoscope no more than 0.75 to 1 in Using a pneumatoscope to evaluate the color and transparency of the tympanic membrane

Selecting a speculum with the largest diameter that will fit comfortably in the patient's ear Gently pulling the pinna of the patient's ear down and back to straighten the ear canal Inserting the speculum of the otoscope no more than 0.75 to 1 in Using a pneumatoscope to evaluate the color and transparency of the tympanic membrane The nurse should select a speculum that provides the largest diameter that will fit comfortably in the patient's ear to maximize vision of the ear canal. Inspection should include examining the tympanic membrane for color, gloss, transparency, mobility, bulging, presence of fluid or blood, perforation, and other abnormalities. For adults, during otoscopic examination, the nurse should gently pull the pinna up and back to straighten the ear canal. To prevent injury, the nurse should insert the speculum of the otoscope no more than 0.25-0.5 in. The nurse should select a speculum that provides the largest diameter that will fit comfortably in the patient's ear to maximize vision of the ear canal. Inspection should include examining the tympanic membrane for color, gloss, transparency, mobility, bulging, presence of fluid or blood, perforation, and other abnormalities. A pneumatoscope (an otoscope with a bulb attachment to introduce air into the ear canal) can be used to test mobility of the eardrum.

The nurse is examining the​ client's ear with an otoscope. Which quality of the​ client's tympanic membrane is most appropriate to include in the​ assessment? (Select all that​ apply.) A. Color B. Light reflex C. Diameter D. Mobility E. Transparency

​A. Color B. Light reflex D. Mobility E. Transparency Rationale: Otoscopic examination includes assessment of the tympanic membrane to include​ color, transparency,​ mobility, presence of​ landmarks, and light reflex. Diameter of the tympanic membrane is not included in otoscopic assessment.

The community health nurse is giving a presentation to a group of new mothers about infant wellness promotion. The nurse teaches about factors that increase an​ infant's risk of developing otitis media. Which item is most appropriate for the nurse to include in the​ presentation? (Select all that​ apply.) A. Enlarged adenoids B. Breastfeeding C. Allergic rhinitis D. Pacifier use E. Down syndrome

​A. Enlarged adenoids C. Allergic rhinitis D. Pacifier use E. Down syndrome Rationale: Factors that may increase an​ infant's risk of developing otitis media include Down​ syndrome, enlarged​ adenoids, allergic​ rhinitis, and pacifier use. Breastfeeding appears to be protective against otitis media.

The nurse is developing a plan of care for the child who has experienced multiple episodes of otitis media and now presents with conductive hearing loss. Which goal would be appropriate for this​ child? A. The child will have normal motor and language development. B. The child will report relief of pain after treatment. C. The child will be​ infection-free after completion of treatment. D. The caregivers will administer medications as prescribed.

​A. The child will have normal motor and language development. Rationale: A child with new conductive hearing loss should still meet developmental milestones for growth and development. These include normal motor and language development. Receiving pain relief and being​ infection-free after treatment are goals related to otitis​ media, but not related to conductive hearing loss. Encouraging caregivers to administer medications appropriately is an important​ goal; however, it is unrelated to hearing loss.

he nurse educator is teaching a class about pharmacologic agents that are used in the prevention and treatment of otitis media in children. Which statement is most appropriate to​ include? (Select all that​ apply.) A. ​"Amoxicillin is the drug of choice for treatment of pediatric otitis​ media." B. ​"Topical anesthetic eardrops may be​ prescribed." C. ​"Oral prednisone is always​ prescribed." D. ​"Vaccines may help reduce the risk of developing otitis​ media." E. ​"Treatment always includes​ antibiotics."

​A. ​"Amoxicillin is the drug of choice for treatment of pediatric otitis​ media." B. ​"Topical anesthetic eardrops may be​ prescribed." D. ​"Vaccines may help reduce the risk of developing otitis​ media." Rationale: Treatment of acute otitis media in children may or may not include antibiotics. If antibiotics are​ indicated, amoxicillin is the​ first-line therapy for children. Topical anesthetic eardrops may be prescribed for pain relief if the tympanic membrane is intact. Immunizations such as the Haemophilus influenzae type B​ (Hib) vaccine and pneumococcal vaccine appear to decrease the incidence of otitis media caused by these pathogens. Treatment of serous otitis media may include an​ anti-inflammatory drug​ (for example, oral prednisone for 7​ days) to reduce mucosal edema of the eustachian tube.

The nurse is caring for an infant experiencing a third incidence of otitis media in 6 months. Which question should the nurse ask the parents to determine the cause of these​ infections? (Select all that​ apply.) A. ​"In what position do you hold the baby to​ eat?" B. ​"Do you or anyone else in your house​ smoke?" C. ​"Has your baby been more irritable​ lately?" D. ​"Have you noticed any bleeding or ear​ drainage?" E. ​"Do you breastfeed or​ bottle-feed your​ infant?"

​A. ​"In what position do you hold the baby to​ eat?" B. ​"Do you or anyone else in your house​ smoke?" E. ​"Do you breastfeed or​ bottle-feed your​ infant?" Rationale: An infant who is exposed to cigarette smoke is at higher risk of developing otitis media. The position of the infant during feedings can cause otitis media. Babies should be positioned upright to prevent feedings from refluxing into the eustachian tubes. Breastfeeding provides more immune properties and decreases the risk of otitis media. Increased irritability and bleeding or ear drainage are clinical manifestations of otitis media. They are not preventive measures.

Which clinical manifestation should the nurse expect when caring for a child with acute otitis​ media? (Select all that​ apply.) A. Slow onset of symptoms B. Bulging tympanic membrane C. Increased mobility of tympanic membrane D. Increased appetite E. Pulling at ear

​B. Bulging tympanic membrane E. Pulling at ear Rationale: Acute otitis media typically has a fast onset. Manifestations of acute otitis media in children may include pulling at the affected ear and poor feeding. On otoscopic​ examination, findings associated with acute otitis media include a bulging tympanic membrane that demonstrates decreased mobility or immobility.