4 Otitis Media & Myringotomy Nursing Care Plans

Otitis media is a common ear infection that can cause pain, fever, and hearing loss. Effective nursing care plans should include comprehensive nursing management and interventions for otitis media to ensure optimal patient outcomes. Learn about the nursing diagnosis for otitis media and how it can be used to develop effective care plans in this article.

What is Otitis Media?

Otitis Media (OM) is an infection of the middle ear (the space behind the eardrum) caused by bacteria or viruses. It is most common in infants and toddlers during the winter months. Inflammatory obstruction of the eustachian tube causes accumulation of secretions in the middle ear and negative pressure from lack of ventilation. The negative pressure pulls fluid and microorganisms into the middle ear through the eustachian tube resulting in otitis media with effusion. The illness usually follows a URI or cold. The older child runs a fever, is irritable, and complains of a severe earache, while a neonate may be afebrile and appear lethargic. The child may or may not have a purulent discharge from the affected ear.

Myringotomy is a surgical procedure performed by inserting tubes through the tympanic membrane to equalize the pressure inside. The tympanostomy tubes remain in place until they spontaneously fall out. Most children outgrow the tendency for OM by the age of 6. There is a higher incidence in children exposed to passive tobacco smoke and a decreased incidence in breastfed infants.

What is Otitis Media?
Nursing Care Plans and Management
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Nursing Care Plans and Management

The goal of nursing care for a child with otitis media includes relief from pain, improved hearing and communication, avoidance of re-infection, and increased knowledge about the disease condition and its management.

Nursing Problem Priorities

The following are the nursing priorities for patients with otitis media (OM):

Ear pain and discomfort. Addressing the primary symptom of otitis media, which is often characterized by pain and discomfort in the affected ear.
Hearing loss. Assessing and managing any temporary or permanent hearing loss resulting from otitis media.
Infection control. Treating the underlying bacterial or viral infection responsible for otitis media to promote healing and prevent complications.
Recurrence prevention. Implementing preventive measures to minimize the risk of recurrent episodes of otitis media.
Speech and language development. Monitoring and supporting the development of speech and language skills, which may be affected by recurrent or chronic otitis media.
Eustachian tube dysfunction. Addressing any issues with the Eustachian tube, such as blockages or improper functioning, which can contribute to the development of otitis media.
Quality of life. Improving the overall well-being and quality of life for patients by effectively managing and minimizing the impact of otitis media symptoms and related complications.

Nursing Assessment

Assess for the following subjective and objective data:

See nursing assessment cues under Nursing Interventions and Actions.

Nursing Diagnosis

Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with otitis media (OM) based on the nurse’s clinical judgment and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.

Nursing Goals

Goals and expected outcomes may include:

The child will experience relief from pain as evidenced by sleeping through the night, not pulling the ear, and decreased crying episodes.
The client will regain and improve hearing.
The parents will gain knowledge about prevention of otitis media.
The child will remain free from further infection and complications from otitis media.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients with otitis media (OM) may include:

1. Alleviating Pain and Inflammation

Individuals diagnosed with otitis media, a middle ear infection, commonly suffer from pain caused by inflammation and pressure in the affected ear. This pain can be intense and disrupt everyday tasks like eating, sleeping, and communicating, making pain management an essential component of nursing care plans for otitis media patients.

Assess client’s description and frequency of pain; Use a pain rating scale. Observe if the infant is tugging or rubbing an ear.
Pain scale measures the changes in the level of pain by different providers. Preverbal infants vigorously pull or rub the affected ear, roll the head, and appear irritable.

Monitor and record vital signs closely.
A normal response to pain is an increase in respiratory rate, heart rate, and blood pressure; fever may cause discomfort.

Monitor child for relief of pain and any side effects of medication.
Provides information about the effectiveness of the medication and prevents untoward effects.

Encourage and assist the parent to hold and comfort the client.
Promotes physical comfort and distraction for a child experiencing illness.

Encourage the mother to provide and offer liquid to soft foods.
Movement of the eustachian tube, such as with chewing, may further aggravate the pain.

Administer pain medication such as acetaminophen or ibuprofen as prescribed.
Analgesic such as acetaminophen and ibuprofen alter response to pain.

Have the child sit up, put pillows behind the head, or lie on the unaffected ear.
Elevation promotes drainage and reduces pressure from fluid.

Reassure parents that the discomfort usually subsides within a day on antibiotics but reinstruct the importance of compliance with the whole prescription.
Parents may be concerned about their child’s pain but may not know to continue the antibiotic after symptoms subside.

Instruct the use of a warm heating pad or an ice pack application. Advise parents to turn the heating pad on low and cover it with a towel to ensure safety.
Heat promotes vasodilation thus reducing discomfort; Cold compress may decrease edema and pain.

2. Promoting Effective Hearing and Communication

Alterations or disruptions in the ability to accurately perceive or interpret auditory stimuli may occur in patients with otitis media due to the accumulation of fluid in the middle ear, which can impair the transmission of sound waves to the inner ear. This can result in a decreased ability to hear or perceive sounds accurately. Therefore, nursing care plans for patients with otitis media should include interventions to address this sensory disturbance, such as providing a quiet environment and facilitating communication.

Assess client’s hearing ability. Ask an older child to describe hearing loss (e.g., Is my hearing muffled in one ear? or is there an absence of sound in the affected ear?).
Provides baseline evaluation regarding the degree of hearing loss.

Provide information about the condition and answer any inquiries. Reassure parents and child that hearing loss is not permanent and will resolve with treatment.
Decreases anxiety over a sensory loss.

Reduce unnecessary environmental noise.
The child may be confused and startled by sounds he or she cannot hear properly.

Encourage parents to speak in a loud and clear voice and look at the child when talking.
Assists the client to hear what is being said.

Administer antibiotics as prescribed.
When indicated for bacterial infection, a full 10-day course of an antibiotic is given to resolve otitis media and regain hearing.

Notify caregiver of changes in hearing ability or drainage from the affected ear.
Complications of OM may include perforation of the eardrum, mastoiditis, or conductive hearing loss.

3. Preventing Infections

Patients with otitis media are at risk for infection due to the presence of bacteria or viruses in the middle ear. This can lead to the spread of infection to other parts of the ear or even to other areas of the body. Therefore, nursing care plans for patients with otitis media should include measures to prevent the spread of infection, such as hand hygiene, isolation precautions, and appropriate use of antibiotics.

1. Advise family members on handwashing techniques and the importance of covering their mouths and noses when sneezing or coughing.
Proper hygiene prevents the spread of pathogens.

2. Encourage increased fluid intake, good nutrition, and adequate rest.
Decreases the susceptibility to infection.

3. Limit visitors and avoid exposure to people with existing upper respiratory infections.
Other people can spread infections or colds to a susceptible patient through direct contact, contaminated objects, or through air currents.

4. Eliminate allergens and airway irritants such as tobacco, smoke, and dust.
Passive smoking contributes to increasing the incidence of otitis media.

5. Place the infant in an upright position when feeding. Do not prop bottles.
Elevated position prevents injection of milk and pathogens into the eustachian tube

6. If infection occurs, teach the patient to take antibiotics as prescribed. Instruct patient to take the full course of antibiotics even if symptoms improve or disappear.
Completing the duration of the prescribed antibiotics lessens the chance for growth
of a microorganism. Not completing the prescribed antibiotic regimen can lead to drug resistance in the pathogen and reactivation of symptoms.

4. Initiating Patient Education and Health Teachings

Patients with otitis media may not have enough knowledge regarding the cause, symptoms, and management of their condition, which can lead to poor treatment adherence and increased risk of complications. Therefore, nursing care plans for patients with otitis media should include patient education to improve their understanding of the condition and its management, including the importance of completing the full course of antibiotics, managing pain, and avoiding activities that can exacerbate symptoms.

Assess parent’s current knowledge of the condition, the risks of exposing the infant/child to passive smoking, feeding activities with the infant, and exposure to illness.
Provides baseline information about the parent’s awareness.

Explain possible causes of OM: exposure to illness of others, irritation from environmental smoke, or formula entering the eustachian tube when the infant is fed in a supine position.
Provides information about health promotion.

Provide privacy for discussion, promote trust, remain nonjudgmental, and support parents.
Shows respect for the parents and opens communication.

Teach parents (and child if age- appropriate) about OM using an ear model for demonstration. Ask parents to verbalize their understanding of teaching.
Provides information by auditory and visual means and assesses understanding.

Provide praise for decisions that will promote wellness for the child and lifestyle.
Positive reinforcement supports the decision to improve family.

Refer parents to specialized classes such as caregiving, smoking cessation, or parenting skills as needed.
Encourages follow-up and gaining additional knowledge and skills.

Assist parents to plan measures to decrease the chances of recurrent OM such as completing the course of antibiotics, avoiding exposure to persons with infection, maintaining a smoke-free environment, and feeding the infant in a sitting position.
Allow parents to make good parenting decisions for their child to help prevent OM.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.