Question

P.P 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

Questions

What other assessments should be included for this patient?

What questions are appropriate for a patient presenting with earache?

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

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

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

What are three nursing diagnoses?

What interventions should be included in the nursing care plan?

Answer 1

Earache is a common problem that can occur because of variety of pathologies.

The other assessment which are included for this patient are :

a) Assessment of tonsils for any tonsillitis.

b) Assessment of Upper Respiratory tract for any infections.

c) Assessment of Pharynx for any infections

d) Assessment of Temperomandibular joint for any disorders.

e) Assessment of dental condition for any disorders.

f) Assessment of cranial nerve 7,9,10,11.

These conditions must be assessed because there may be speed of infection from pharynx,tonsils, Upper Respiratory tract can spread to ear.

Incase of dental disorders and Temperomandibular joint disorders pain can be referred to ear because of sensory nerves.

Questions for the patient of earache:

When did the pain start?

Do you feel any irritation in the ear?

Is there any discharge you have removed from ear?

Does the movement of jaw increasing the pain?

Is there any loss of appetite?

Do you feel any popping sound while swallowing?

Risk factors for earache in children:

The eustachian tube of children is shorter and more horizontal,so the bacteria and viruses can find their way easily to the middle ear.

Low birth weight also.

Inadequate housing condition.

Exposure to cigarette smoking.

Mothers who smoke during pregnancy.

Lack of brest feeding.

Unclean playing environment.

Improper hygiene condition.

Otitis media Vs otitis externa.

Otitis media: Otitis media is a group of inflammatory disease affecting midlle ear.

It occurs when the area behind the eardrum i.e., middle become infected and inflamed.

Infection is of rapid onset and the patient usually present with pain.

Otitis externa:

Otitis externa is an infection of the outer ear canal that runs from earcanal to the outside of the head.

It is often caused by the water remaining in the ear after swimming.

The patient mainly presents with redness in the outer ear canal accompanied by warmth and pain.

The most probable cause of earache in this patient is Acute otitis media .

This is because the patient's tymapanic membrane is inflmmed,red and congested. Children experiencing severe pain that intially relieved by an anti inflammatory drug.

Nursing diagnoses:

Pain is related to inflammation of the middle ear.

Anxiety related to health status.

Impaired verbal communication related to effects of hearing loss.

Disturbed sensory perception related to obstruction, infection of middle ear or auditory nerve damage.

Intervention included in nursing care plan :

Positioning: Having the child sit up,raise head on pillows,lie on unaffected ear.

Heat application: apply heating pod or warmth hot bottle.

Proper diet.

Proper hygiene.

Moniter hearing loss.