Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)

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Outline

Pathophysiology

Otitis media (OM) is an infection of the middle ear behind the tympanic membrane (eardrum) that contains the tiny vibrating bones of the ear.  OM may be viral or bacterial and, depending on the cause, is generally treated with antibiotics.

Etiology

In young children, the eustachian tube that connects the middle ear to the back of the throat is shorter and more horizontal than in older children and adults, making it easier for fluid to get trapped and become infected. Congestion from allergies, a cold, or sinus infection is a common reason for fluid to become trapped. Other causes include exposure to cigarette smoke and drinking while lying down. Untreated infections can lead to complications such as ruptured eardrum, cholesteatoma, and delays in speech.

Desired Outcome

A patient will be free from pain and infection; a patient will have an optimal hearing; the patient will be afebrile.

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 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.

Writing a Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)

A Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


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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