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4 Otitis Media Nursing Care Plans

Otitis Media Nursing Care Plans|Otitis Media (OM) is an infection of the middle ear to begin with (the space behind the eardrum) caused by bacteria or virus. It is however the most common in infants and toddlers during the winter months. Inflammatory obstruction of the eustachian tube therefore causes accumulation of secretions in the middle ear and negative pressure from lack of ventilation. Therefore negative pressure pulls fluid and thus 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.

Nursing Care Plans

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:
  1. Acute Pain
  2. Disturbed Sensory Perception: Auditory
  3. Deficient Knowledge
  4. Risk for Infection

Acute Pain

Nursing Diagnosis May be related to
  • Inflammation and increased pressure in the middle ear
Possibly evidenced by
  • Child verbalizes “my ear hurts”
  • Crying episodes
  • Infant is pulling at ear
  • Rate pain on an appropriate pain scale for age and development
Desired Outcomes
  • Child will experience relief from pain as evidenced by sleeping through the night, not pulling the ear and decrease crying episodes.
Nursing Interventions Rationale
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 therefore 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 therefore an increase in respiratory rate, heart rate, and blood pressure; fever may cause discomfort.
As an example encourage and assist the parent to hold and comfort the client. Therefore 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.Otitis Media Nursing Care Plans
Monitor child for relief of pain and any side effects of medication. Provides information about the effectiveness of the medication and prevents untoward effects.
Have the child sit up, put pillows behind the head, or lie on the unaffected ear. Hence 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. Therefore 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. Hence heat promotes vasodilation thus reduces discomfort; Cold compress may decrease edema and pain.
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