Maternal Child Reading Notes CH 45
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Shelton State Community College *
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Course
114
Subject
Medicine
Date
Apr 3, 2024
Type
docx
Pages
3
Uploaded by PresidentDanger13727
September 11, 2023
MATERNAL CHILD CH. 45 READING NOTES
I.
OTITIS MEDIA
Effusion/fluid and infection/blockage of middle ear
Acute otitis media/AOM: effusion and inflammation that occurs suddenly and associated with other s/s of illness
Otitis media with effusion/OME: presence of fluid behind tympanic membrane w/out signs of infection
Usually resolves in 1-3 months
B.
Etiology
Viruses don’t cause but thought to predispose by altering host defenses and contributing to eustachian tube dysfunction
Other precipitating factors:
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Allergies
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Attending daycare centers
a.
Infants younger than 1 yr who attend daycare have significant risk for acquiring AOM
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Age
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Ethnicity
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Exposure to household cigarette smoke
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Poverty
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Bottle feeding can contribute because of position of infant during feeding
a.
Breastfeeding offers some protection from ear infection by providing maternal antibodies and decreasing incidence of allergy
C.
Incidence
Incidence peaks between ages 6 months- 2 yrs
Boys have a slightly higher incidence
Incidence higher in winter and spring
D.
Manifestations
AOM characterized by:
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Otalgia/earache
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Bulging, opaque tympanic membrane that usually looks red
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Drainage, usually yellowish green, purulent, and foul smelling
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Irritability
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Sleep disturbances
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Persistent crying in infants
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Fever
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Vomiting
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Anorexia
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Diarrhea
OME:
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No signs of acute infection
-
Tympanic membrane appears retracted and either dull grey/yellow
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Air filled/air bubbles may be visible through tympanic membrane
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Tinnitus/popping sounds
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Hearing loss
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Mild balance disturbances
Recurrent if child experiences more than 3 episodes over 6-month period or 4 episodes in a yr
E.
Diagnostic Evaluation
The provider must visualize child’s tympanic membrane
Pneumatic otoscopy: small puff of air is blown into ear canal through otoscope
-
Examiner can discern appearance and mobility of tympanic membrane
Tympanometry/tympanography can be used to confirm
F.
Therapeutic Management
Admin of antibiotics has little influence on child’s experience of pain
-
Updated guidelines place more emphasis on pain relief
Recommendations include:
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Accurate diagnosis
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Optimal pain relief with appropriate analgesic
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Symptomatic treatment and observation for 48-72 hrs
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Use of amoxicillin at dose of 80-90 mg/kg/day for 5-10 days
a.
Cephalosporin for children allergic to penicillin
-
Encouraging reduction of risk factors as method of prevention
For OME that persists >3 months and is associated with hearing loss: myringotomy with insertion of tympanostomy tubes/pressure equalizing tubes may be performed
2
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Tympanostomy tube: small polyethylene tube inserted into middle ear to equalize pressure on both sides of tympanic membrane and to keep ear aerated
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Usually falls out spontaneously in 6-12 months
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Inserted under general anesthesia, usually in outpt setting
Preventative intervention: use of xylitol
-
Sugar like substance that interferes with organism adherence to mucous
membranes
-
Different types of preparations: chewing gum, syrup, nasal spray, and lozenges
-
To be effective: must be admin between 3-5x’s/day
II.
NURSING CARE: CHILD WITH OTITIS MEDIA
A.
Assessment
Assess for fever and pain
Assess for not only obvious signs of ear pain, such as head rolling and pulling at the ear, but also for nonspecific findings, such as irritability, diarrhea, and decreased appetite
Examine the ear with a pneumatic otoscope
-
Noting the color, mobility, and translucency of tympanic membrane and appearance of external canal
Obtain a culture of any drainage and note the color, consistency, and odor
Hearing and language development should be assessed
B.
Interventions
Acetaminophen can be given to relieve discomfort
Fluid intake should be increased if fever is present
Myringotomy with insertion of tympanostomy tubes
-
Postop: monitor for ear drainage
-
Small amount of reddish drainage normal for first few days
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Report any heavier bleeding/bleeding that occurs after 3 days
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Report any fever/increased pain
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Child should avoid blowing nose for 7-10 days
Usual recommendation: place ear plugs/cotton balls covered with petroleum jelly in ears during baths/shampoos
Otitis media usually chronic problem, with frequent recurrences of infection and
effusion
Chronic otitis media should undergo periodic hearing evaluations
3
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