Question

Case study 4

M.M. is a 4-year-old boy who presents to the pediatrician’s office with pain in his right ear. Subjective Data:

Mom states that her son woke up in the middle of the night, crying, 2 nights ago. She gave the child ibuprofen, and he went back to sleep. Last night he woke up in pain, and he was inconsolable. She felt the physician should see him.

Attends preschool program

Lives with mother

Father estranged

Objective Data:

TM appears inflamed—it is red and may be bulging and immobile

T = 100.3

Last ibuprofen 3 hours ago

1. What other assessments should be included for this patient?

2. What questions are appropriate for a patient presenting with earache?

3. What risk factors are associated with earaches for this age group?

4. From the readings, what is the difference between otitis media and otitis externa?

5. From the readings, what is the most probable cause of the earache in this patient?

6. What are three nursing diagnosis

7. What interventions should be included in the nursing care plan?

Answer 1

1. The tympanic membrane should be assessed by pneumatic otoscopy for color, mobility, position and perforation.

Screening techniques include tympanometry and acoustic reflectometry.

Head and neck assessment for any infections, tonsillitis is required.

2. Questionaire for earache includes:

- from how long is the patient experiencing symptoms

- does patient have any throat infections, sinusitis or cold

- was the ear exposed to cold air

- does patient feels reduced hearing in one or both ear

- is there any kind of discharge from ear

- does patient experiences dizziness or vertigo

3. Risk factors associated are hearing loss, mastoiditis, labrunthitis, meningitis, brain abcess, epidural abcess, cholesteatoma, facial paralysis.

4 otitis media : otitis media is the inflammation and infection of middle ear

otitis externa is inflammation of external ear

5. Otitis media

6. Three nursing diagnosis are:

otitis media

otitis externa

acute sinusitis

7. Nursing intervention:

- proper and timely administration of prescribed antibiotics and ointments

- protectibg ear from cold air exposure

- educating caregivers on proper bottle feeding and protecting children from tobacco smole exposure

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