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 mediainclude 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) for otitis media:
1. Acute Pain
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”
- - 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 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. |
2. Disturbed Sensory Perception: Auditory
Disturbed Sensory Perception: Change in the amount or patterning of incoming stimuli accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli.
May be related to
- - Inflammation and edema of middle ear
Possibly evidenced by
- - Obstructed middle ear
- - Child complains of not being able to hear
- - Does not respond when spoken to
- - Infant does not respond to sounds as usual
Desired Outcomes
- - Client will regain and improve hearing.
| Nursing Interventions | Rationale |
|---|
| 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. Deficient Knowledge
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
Desired Outcomes
- - Parents will gain knowledge about prevention of Otitis Media.
| Nursing Interventions | Rationale |
|---|
| 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. |
4. Risk for Infection
Risk for Infection: At increased risk for being invaded by pathogenic organisms.
May be related to
- - Knowledge deficit about infection in children
Possibly evidenced by
- - Ear pain
- - Irritability
- - Pulling on ears
Desired Outcomes
- - Child will remain free from further infection and complications from otitis media.
| Nursing Interventions | Rationale |
|---|
| Advice family members on handwashing techniques and the importance of covering their mouths and noses when sneezing or coughing. | Proper hygiene prevents spread of pathogens. |
| 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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