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.
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:
Disturbed Sensory Perception: Auditory
Risk for Infection
Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.
May be related to
Inflammation and increased pressure in the middle ear
Possibly evidenced by
Child verbalizes “my ear hurts”
Infant is pulling at ear
Rate pain on an appropriate pain scale for age and development
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 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.
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.
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. 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 reduces discomfort; Cold compress may decrease edema and pain.