Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)
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Outline
Lesson Objective for Nursing Care Plan (NCP) for Otitis Media/Acute Otitis Media (AOM)
By the end of this lesson, nursing students will be proficient in developing a Nursing Care Plan (NCP) for Otitis Media, specifically Acute Otitis Media (AOM).
- Understanding Otitis Media:
- Gain a comprehensive understanding of the pathophysiology and etiology of Otitis Media, with a focus on Acute Otitis Media (AOM).
- Differentiate between AOM and other types of ear infections.
- Assessment and Diagnosis:
- Learn how to perform a thorough nursing assessment to identify signs and symptoms of AOM.
- Understand diagnostic procedures, such as otoscopy and tympanometry, for accurate AOM diagnosis.
- Management Strategies:
- Explore nursing interventions and management strategies for AOM, including pharmacological and non-pharmacological approaches.
- Understand the role of pain management and the administration of prescribed medications.
- Patient Education and Prevention:
- Develop effective communication skills to educate patients and caregivers on AOM, its prevention, and treatment.
- Provide guidance on strategies to prevent recurrent ear infections.
- Collaborative Care and Referral:
- Understand the importance of collaboration with other healthcare providers, such as ENT specialists, in managing complicated cases of AOM.
- Learn when to refer patients for further evaluation and treatment.
Pathophysiology of Otitis Media/Acute Otitis Media (AOM)
- Inflammatory Response in the Middle Ear:
- The pathophysiology of AOM involves an inflammatory response within the middle ear in response to infection. Bacterial or viral pathogens infiltrate the middle ear cavity, leading to localized inflammation.
- Eustachian Tube Dysfunction:
- Eustachian tube dysfunction plays a crucial role in AOM. The tube, which normally equalizes pressure and drains fluid from the middle ear, may become blocked or fail to function properly, allowing pathogens to accumulate and multiply.
- Fluid Accumulation and Effusion:
- Inflammation of the middle ear mucosa results in the production of fluid. This accumulation of fluid, known as effusion, can lead to impaired hearing and creates an environment conducive to bacterial growth.
- Bacterial Invasion:
- In bacterial AOM, pathogens like Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis invade the middle ear space. The infection causes additional inflammation and contributes to the signs and symptoms associated with AOM.
- Viral Infections and Secondary Bacterial Involvement:
- Viral respiratory infections often precede AOM. Viruses such as respiratory syncytial virus can compromise the mucosal lining of the respiratory tract, making it more susceptible to secondary bacterial infection in the middle ear.
- Pressure Changes and Pain:
- As fluid accumulates and pressure within the middle ear increases, individuals with AOM may experience pain and discomfort. The pressure changes can also affect the movement of the tympanic membrane, contributing to hearing impairment.
Etiology of Otitis Media/Acute Otitis Media (AOM)
- Bacterial or Viral Infections:
- Acute Otitis Media often arises from infections, commonly bacterial (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) or viral (respiratory syncytial virus, influenza). These infections lead to inflammation and fluid accumulation in the middle ear.
- Eustachian Tube Dysfunction:
- Dysfunction of the Eustachian tube, which connects the middle ear to the back of the throat, can contribute to the development of Otitis Media. Impaired tube function may lead to poor ventilation and fluid retention in the middle ear.
- Respiratory Infections:
- AOM often follows upper respiratory tract infections, such as the common cold. Pathogens can travel from the upper respiratory system to the middle ear, causing infection and inflammation.
- Anatomical Factors:
- Anatomical factors, such as cleft palate or structural abnormalities in the nasopharynx, may increase the risk of Otitis Media by affecting the normal function of the Eustachian tube.
- Environmental Exposure:
- Exposure to secondhand smoke and other environmental pollutants can irritate the respiratory system and increase the susceptibility to ear infections, especially in children.
- Age:
- Infants and young children are more prone to Otitis Media due to the smaller and more horizontal orientation of the Eustachian tube in early life. This anatomical difference makes drainage less efficient and increases the risk of fluid accumulation.
Desired Outcome of Nursing Care for AOM
- Relief of Pain:
- Minimize pain and discomfort associated with AOM through effective pain management strategies.
- Resolution of Infection:
- Achieve resolution of the infection, as evidenced by the absence of signs and symptoms.
- Prevention of Complications:
- Prevent complications such as eardrum perforation or the spread of infection to adjacent structures.
- Patient and Family Education:
- Ensure understanding of AOM, its treatment, and preventive measures by providing comprehensive education.
- Improved Quality of Life:
- Enhance the overall quality of life by addressing symptoms promptly and preventing recurrence.
Otitis Media / Acute Otitis Media (AOM) Nursing Care Plan
Subjective Data:
- Ear pain
- Fussiness/irritability
- Headache
- Hearing loss
Objective Data:
- Tugging/pulling at ear
- Fever
- Fluid drainage from ear
- Vomiting
- Diarrhea
- Lack of balance
Nursing Assessment for Otitis Media/Acute Otitis Media (AOM)
- History Taking:
- Obtain a detailed medical history, including the onset and duration of symptoms, previous ear infections, and any recent upper respiratory infections.
- Pain Assessment:
- Evaluate the intensity and characteristics of ear pain, considering the use of a pain scale appropriate for the patient’s age.
- Otoscopic Examination:
- Perform an otoscopic examination to visualize the tympanic membrane, looking for signs of inflammation, redness, or bulging.
- Assessment of Fever:
- Monitor body temperature to assess for fever, a common symptom of AOM.
- Hearing Assessment:
- Evaluate hearing status, as AOM can temporarily affect hearing due to the accumulation of fluid in the middle ear.
- Assessment of Drainage:
- Note any discharge from the ear, as purulent drainage may indicate a ruptured eardrum.
- Assessment of Balance:
- Inquire about balance disturbances, as severe cases of AOM may affect the vestibular system.
- Assessment of Behavior:
- Observe changes in behavior, especially in pediatric patients, as irritability and changes in sleep patterns may be indicative of AOM.
Implementation of Nursing Care Plan for Otitis Media/Acute Otitis Media AOM
- Pain Management:
- Administer analgesics as prescribed and provide comfort measures to alleviate pain.
- Antibiotic Administration:
- Administer antibiotics as prescribed for bacterial AOM to eliminate the causative pathogen.
- Warm Compress Application:
- Apply warm compresses to the affected ear to provide relief and promote drainage.
- Encourage Fluid Intake:
- Encourage increased fluid intake to prevent dehydration and facilitate recovery.
- Promote Rest and Comfort:
- Advocate for adequate rest and comfort to support the body’s healing process.
Nursing Interventions and Rationales
| Nursing Intervention (ADPIE) | Rationale |
| Assess Vital Signs | pain and fever can increase HR, RR, and BP. (Fever most common symptom) |
| Observe ears and throat for signs of drainage or discharge | Congestion, post-nasal drip, and drainage of the ears may be present. Co-infections such as strep throat, a cold or the flu may also be present |
| Assess pain level | Wong-Baker FACES and FLACC scales may be used to assess pain in young children and infants. Pulling at the ears and tilting the head are also signs of ear pain. Use numeric scale for adults (1-10) |
| Assess for hearing loss/changes in speech | Sounds may be distorted or muffled in the affected ear. Toddlers learning to talk may have changes in speech due to impaired ability to hear. |
| Position patient for comfort; sitting up or lying on side of unaffected ear | Lying flat or on the side of the affected ear can cause more swelling and fluid accumulation in the eustachian tube, resulting in increased pain. Encourage the parent to hold infants and young children upright to reduce discomfort |
| Give medications (pain, antibiotics) & non-pharmacologic interventions | Analgesics such as acetaminophen may be given. Other methods include applying warm (not hot) moist compresses to the ears
Antibiotics are usually given for bacterial infections. A full 10-day course is generally required (DO NOT stop taking course even if they feel better. Take full therapy as a worsening reoccurrence can happen |
| Prepare family/patient/caregiver for Tympanostomy Tube Placement | tube placement may be needed if a child has 3 ear infections within 6 months or 4 infections a year. These tubes will allow the fluid to drain from the ear and reduce complications of hearing loss, speech delay, spread of infection, and tearing of eardrum |
| Provide education for parent/caregiver
-F/U care |
-Avoid giving bottles or sippy cups while lying down
Practice good hand hygiene to prevent the spread of bacteria that cause ear infections -Some infections may be resistant to certain antibiotics. Encourage follow-up after treatment to determine if the infection has cleared, even if symptoms seem to subside or resolve. |
Evaluation of Nursing Care for AOM
- Pain Assessment:
- Regularly reassess pain levels and evaluate the effectiveness of pain management interventions.
- Resolution of Infection:
- Monitor for resolution of infection by assessing the reduction of signs and symptoms.
- Adherence to Antibiotic Therapy:
- Evaluate the patient’s adherence to antibiotic therapy and address any concerns or side effects.
- Patient and Family Education:
- Assess understanding of AOM, treatment, and preventive measures through verbal feedback or demonstration.
- Prevention of Complications:
- Monitor for the prevention of complications, such as the absence of eardrum perforation or the spread of infection.
References
- https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616
- https://my.clevelandclinic.org/health/diseases/8613-ear-infection-otitis-media
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Transcript
Hey everyone. Today, we are going to be feeling out a nursing care plan for otitis media or acute otitis media. So, let’s get started. So, we’re going to start off with the pathophysiology. So, otitis media is an infection of the middle ear behind the tympanic membrane or the ear drum that contains the tiny vibrating bones of the ear. Otitis media may be viral or bacterial, and depending on the cause, it’s generally treated with antibiotics. Nursing considerations: you want to assess vital signs. You want to observe the ear and throat for pain, hearing, changes in speech, administer medications, prepare the patient for surgery and educate the family or care caregiver. The desired outcomes are that the patient will be free from pain and infection and the patient will have an optimal hearing.
So, if we’re going to go ahead and go through with our care plan, we’re going to go through some of our subjective data and our objective data. So, what we’re going to see in our patient. So, some very common subjective data is they’re going to have ear pain and some hearing loss. Some objective data that you’re going to see is tugging at the ear and a fever and lack of balance – if you remember that cranial nerve eight is also part of your balance. Other things are fussiness, irritability, a headache, fluid drainage from the ear, vomiting, and diarrhea.
So, nursing interventions: one of the first things we’re going to look for is we’re going to monitor vital signs. So, pain and fever can increase the heart rate and also the blood pressure. Another thing we’re going to be looking for is we’re going to observe the ears in the throat for any sort of signs of drainage or discharge. So, congestion, maybe some postnasal drip, drainage of the ears that might be present when you’re looking at the patient. Co-infections such as strep throat, a cold, or maybe the flu, can also be present with these patients. Another thing we want to assess is the patient’s pain, making sure you’re using the right pain scale. So, you want to use the faces or the numeric and get pain medication as needed. Another thing we’re going to assess is that we’re going to be assessing for any sort of hearing loss or changes in speech. So, sounds might be disordered, or they might be muffled in the affected ear. So, toddlers learning to talk, they may have changes in speech due to the impaired ability to hear properly. Another assessment that we want to be doing is we want to make sure that we’re positioning the patient for comfort sitting up or lying down, making sure we’re having them set up so that they have increased ability for breathing. But also, just to make sure that we’re not keeping any of that from the pain from the ear, we want to give medication. So, we want to give any sort of antibiotics and or pain medication as we had talked about earlier. So, Tylenol may be given or any other methods such as applying a warm, not a hot, but a warm, moist compress to the affected ear. Antibiotics are usually given for bacterial infections. So, a full 10-day course is generally required, but you do not. One of the main things with antibiotics is you want to make sure that they do not stop taking, even if they feel better – you want to make sure you’re telling the patient or the caregiver to complete the entirety of that antibiotic therapy. Another thing that we’re going to want to be helping with the patient is possibly preparing them for a tympanostomy tube placement. So, this is going to allow that fluid to drain from the ear. Another invention to keep in mind is obviously some education for the caregiver or the parents. You want to make sure you’re educating on any sort of follow up care that may be needed, because you want to keep in mind. Some of these infections may be restricted from certain antibiotics. So, you want to encourage them to get treatment and determine if the infection has cleared. If not, you may have to change course of treatment or have another treatment of antibiotics given. You want to avoid giving bottles or sippy cups because bottles and sippy cups enable the pain and are going to cause some issues. You want to make sure you’re teaching them about good hand hygiene to avoid spreading the bacteria.
So, some key points, some patho and etiology; infection of the middle ear can be viral, and it could be bacterial depending on the cause. It can be caused by allergies, a cold, sinus infection, very common or a small eustachian tube because children’s ears are more horizontal than diagonal. So, it’s easy to have fluid buildup in that middle ear. That can cause an infection. Some subjective and objective: ear pain, fussing, irritability, headache, hearing loss, tugging and pulling at the ear. Very common with children are fever, fluid drainage from the ear, vomiting, diarrhea, lack of balance. You want to assess proper positioning. Assess vital signs, pain level, hearing loss, changes in speech, and ears and throat for drainage. Position the patient for comfort. We want to give medication, surgery if needed. Give pain medication antibiotic therapy or apply a cold heat. Compress, prepare the patient for tympanostomy tube placement if needed and able to help with the drainage of the ear.
Excellent job guys. We will love having you guys here. Go out, be your best self today and as always happy nursing.
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