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:
Risk for Infection
May be related to
- Knowledge deficit about infection in children
Possibly evidenced by
- Ear pain
- Pulling on ears
- Child will remain free from further infection and complications from otitis media.
|Advice family members on handwashing techniques and the importance of covering their mouths and noses when sneezing or coughing.||Proper hygiene prevents spread of
|Encourage increased fluid intake, good nutrition, and adequate rest.||Decreases susceptibility to infection.|
|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.|
|Eliminate allergens and airway irritants such as tobacco, smoke, and dust.||Passive smoking contributes to increase
the incidence of otitis media.
|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|
|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.
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