Posted: February 28th, 2022

An 8-year-old girl comes to your ambulatory care clinic

An 8-year-old girl comes to your ambulatory care clinic with complaints of left ear pain for the past 3 days. She had respiratory infection a week ago. On physical examination, the tympanic membrane is bulging.

Answer the following questions:

What else should you ask the client?
What teaching would you reinforce to prevent the recurrence of otitis media?
What expected outcomes would be specific to this situation?

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What else should you ask the client?
When evaluating a child with ear pain and a bulging tympanic membrane suggestive of otitis media, there are several additional questions you should ask the client and/or their parents/guardians:
a. Duration and onset of symptoms: Ask about the exact timing and progression of the ear pain. Determine if the pain started suddenly or gradually, and how long it has been present.
b. Severity of pain: Assess the intensity of the pain and how it affects the child’s daily activities and sleep.
c. Other associated symptoms: Inquire about any accompanying symptoms such as fever, hearing loss, ear discharge, dizziness, or difficulty balancing.
d. Previous history of ear infections: Determine if the child has had previous episodes of otitis media and if there is a pattern of recurring infections.
e. Recent upper respiratory infection: Ask about the respiratory infection the child had a week ago, including symptoms, duration, and treatment received.
f. Allergies or known sensitivities: Inquire about any known allergies, especially to medications, as this may impact the choice of treatment options.
g. Exposure to tobacco smoke: Determine if the child is exposed to secondhand smoke, which can increase the risk of recurrent ear infections.

What teaching would you reinforce to prevent the recurrence of otitis media?
To prevent the recurrence of otitis media in children, you can reinforce the following teaching points:
a. Proper hand hygiene: Encourage regular handwashing with soap and water, especially before meals and after using the restroom or coming into contact with potentially contaminated surfaces.
b. Avoidance of secondhand smoke: Advise parents to keep their child away from tobacco smoke as exposure to smoke increases the risk of ear infections.
c. Vaccinations: Ensure that the child is up-to-date with recommended immunizations, including the pneumococcal conjugate vaccine and the annual influenza vaccine.
d. Breastfeeding: Promote breastfeeding as it has been shown to reduce the incidence and severity of otitis media.
e. Bottle-feeding practices: Educate parents on proper bottle-feeding techniques, such as holding the baby in an upright position during feeding and avoiding propping the bottle, as these practices can help prevent the backflow of milk into the Eustachian tube.
f. Avoiding prolonged pacifier use: Discourage prolonged pacifier use, particularly during sleep, as it has been associated with an increased risk of ear infections.
g. Avoiding exposure to sick individuals: Advise parents to minimize their child’s exposure to individuals with respiratory infections, as these infections can increase the likelihood of developing otitis media.

What expected outcomes would be specific to this situation?
In this situation, the expected outcomes would include:
a. Relief of ear pain: The primary symptom of ear pain should subside with appropriate treatment.
b. Resolution of signs of infection: The bulging of the tympanic membrane should improve, and the membrane may return to its normal appearance.
c. Resolution of other associated symptoms: If present, other symptoms such as fever, hearing loss, and dizziness should also resolve.
d. Prevention of complications: Appropriate treatment and management should help prevent complications, such as a ruptured eardrum or the spread of infection to nearby structures.
e. Reduced frequency of recurrent infections: By implementing preventive measures, the frequency of recurrent otitis media should decrease, leading to improved overall ear health.

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