Otitis Media (OM) is an infection of the middle ear (the space behind the eardrum) caused by bacteria or virus. It is the 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 breast-fed infants.
The goal of nursing care to a child with otitis media include relief from pain, improved hearing and communication, avoidance of re-infection, and increased knowledge about the disease condition and its management.
Here are four (4) nursing care plans (NCP) and nursing diagnosis (NDx) for otitis media:
Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.
May be related to
- Lack of information
- Lack of recall of information
- Misinterpreted information
Possibly evidenced by
- Parents allow smoking in the home so child is exposed to passive smoke
- Infant is bottle-fed and sometimes the infant lies flat with the bottle propped
- Parents will gain knowledge about prevention of Otitis Media.
|Assess parent’s current knowledge|
on 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 class 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 antibiotic, 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.|
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