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

Pathophysiology

Otitis media (OM) is an infection of the middle ear behind the tympanic membrane  and is one of the most common illnesses in children, accounting for approximately 20% of primary care visits. OM may be viral or bacterial and, depending on 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 are common reasons 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

Patient will be free from pain and infection; patient will have optimal hearing; patient will be afebrile

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

Subjective Data:

  • Ear pain
  • Fussiness / irritability
  • Feeling of fullness in the ear
  • Hearing loss or distortion
  • Headache

Objective Data:

  • Fever
  • Pulling at ears
  • Fluid drainage from the ear
  • Vomiting
  • Diarrhea
  • Lack of balance

Nursing Interventions and Rationales

  1. Assess vitals

    • Get baseline to determine if interventions are effective.
    • Fever is a common symptom.
    • Pain and fever may cause increase in heart rate, respiratory rate and blood pressure

  2. Observe ears and throat for signs of drainage or discharge

  3. 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

  4. Assess pain with appropriate pain scale

  5. 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.

  6. Assess for hearing loss or changes in speech

  7. 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

  8. Position patient for comfort; sitting up or lying on side of unaffected ear

  9. 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

  10. Manage pain with medications and non-pharmacologic interventions

  11. Analgesics such as acetaminophen may be given. Other methods include applying warm (not hot) moist compresses to the ears

  12. Administer medications as required

  13. Antibiotics are usually given for bacterial infections. A full 10-day course is generally required

  14. Recommend follow-up after treatment

  15. Some infections may be resistant to certain antibiotics. Encourage follow-up after treatment  to determine if infection has cleared, even if symptoms seem to subside or resolve.

  16. Provide education for parent / caregiver

    • Avoid giving bottles or sippy cups while lying down
    • Avoid exposure to cigarette smoke
    • Practice good hand hygiene to prevent spread of bacteria that cause ear infections
  17. Teach parents how to prevent future infections and prevent complications


References

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