Child otitis media

1. Alterations in Eye, Ear, Nose, and Throat Function ■707
■Analgesics alter perception or
response to pain.
■Elevation decreases pressure from
fluid.
■Heat increases blood supply and
reduces discomfort.
■Attempts to open the eustachian
tube may help aerate the middle
ear.
■Breastfeeding affords natural
immunity to infectious agents.
■Taking antibiotics as prescribed
minimizes chance for overgrowth
of pathogens.
■If symptoms have not improved in
36 hours, treatment should be
evaluated.
■Check-up determines if treatment is
effective.
■Many parents can treat children at
home. Knowledge of condition
allows parents to make informed
decisions and to manage condition
effectively.
■Active participation increases
confidence and ability to manage
condition.
■Reacting empathically encourages
parents to communicate.
NOC Suggested Outcome: Pain
Level:Amount of reported or
demonstrated pain.
Verbal child states that pain is
relieved. Nonverbal child has
improved disposition and comfort.
NOC Suggested Outcome: Risk
Control:Actions to eliminate or
reduce health threats.
The child’s temperature is normal,
symptoms have disappeared, and
tympanic membrane shows no signs
of infection.
NOC Suggested Outcome:
Caregiver Performance:Provision
by family care provider of health care
for child.
The parents express confidence about
treating the child and state that stress
is reduced.
NIC Priority Intervention: Pain
Management:Alleviation or
reduction in pain to a level of comfort
acceptable to patient and family.
■Give analgesic such as
acetaminophen. Use analgesic
eardrops.
■Have the child sit up, raise head on
pillows, or lie on unaffected ear.
■Apply heating pad or warm hot
water bottle.
■Have the child chew gum or blow
on balloon to relieve pressure in
ear.
NIC Priority Intervention: Infection
Control:Minimizing the acquisition
and transmission of infectious agents
■Encourage breastfeeding of infants.
■Instruct the parents to administer
antibiotics exactly as directed and
to complete prescribed course of
medication.
■Telephone the parents 2–3 days
after initial examination.
■Examine ear 3–4 days after
completion of antibiotic treatment,
or if symptoms worsen in child on
symptomatic treatment.
NIC Priority Intervention: Caregiver
Support:Provision of necessary
support, information, and advocacy to
facilitate care by parents.
■Determine the parents’ ability to
manage condition. Provide
frequent information and feedback.
■Encourage parental input in
managing care.
■Listen carefully to parental
expressions of frustration and
fatigue and try to understand
parents’ feelings.
NURSING CARE PLAN The Child with Otitis Media
GOAL INTERVENTION RATIONALE EXPECTED OUTCOME
1. Pain related to inflammation and pressure on tympanic membrane
The child or parent will indicate
absence of pain.
2. Infection related to presence of pathogens
The child will be free of infection.
3. Risk for Caregiver Role Strain related to chronic disease
The parents will manage the child’s condition with minimal stress.
(continued)

2. 708 ■CHAPTER 19
and disillusioned because of the inability of the health care system to cure the child and may
fear a permanent hearing impairment. Reassure parents that as the child grows older, the re-
current infections eventually cease. Teach them that asking for courses of antibiotics for
every infection may not be the treatment of choice. Parents of children with tympanostomy
tubes need to be taught how to care for the child and what symptoms to report.
Evaluation
Expected outcomes of nursing care for the child with otitis media include:
■Return to normal sleep and feeding patterns.
■Maintenance of normal hearing
■Effective pain and temperature management
■Understanding of treatment regimen by parents.
HEARING IMPAIRMENT
Approximately 1 million children in the United States have some form of hearing impair-
ment. These hearing impairments are expressed in terms ofdecibels (dB),which are units of
loudness, and rated according to severity (Table 19-7). Children who have only a mild hear-
■Good hygiene prevents spread of
pathogens.
■Physical well-being helps the body
fight disease.
■Elevated position prevents injection
of milk and pathogens into the
eustachian tube.
■Fewer irritants and allergens may
decrease susceptibility to
respiratory infections. Secondhand
smoke contributes to higher
incidence of otitis media.
■Monitoring detects hearing loss
early.
■Early detection of developmental
delays can lead to appropriate
intervention.
NOC Suggested Outcome:
Knowledge:Extent of understanding
conveyed about infectious disease
prevention.
Parents express understanding of
measures to lead fewer to infections.
NOC Suggested Outcome: Growth
and Development:Milestones of
developmental progression.
The child’s general health and hearing
improve, and incidence of condition
decreases.
The child has language and motor
development within norms for age
group.
NIC Priority Intervention: Infection
Control:Minimizing the acquisition
and transmission of infectious agents
■Teach family members to cover
mouths and noses when sneezing
or coughing and to wash hands
frequently. Have parents isolate sick
children.
■Encourage optimal nutrition, rest,
and exercise.
■Position bottle-fed infants upright
when feeding. Do not prop bottles.
■Eliminate allergens and upper
respiratory irritants such as
tobacco, smoke, and dust.
NIC Priority Intervention:
Developmental Enhancement:
Facilitating optimal growth and
development of the child.
■Assess hearing ability frequently.
■Assess motor and language
development at each health care
visit.
NURSING CARE PLAN The Child with Otitis Media (continued)
GOAL INTERVENTION RATIONALE EXPECTED OUTCOME
4. Risk for Infection related to knowledge deficit about infection in children
The parents will state understanding
of preventive measures.
5. Risk for Altered Growth and Development related to hearing loss
The child will have normal hearing.
The child will have normal motor and
language development.