1. Infection: Otitis Media
Ricci, pp

2. Etiology Most common in childhood—usually in first 24 mos
Viral or bacterial (Haemophilus, Streptococcus,or Moxarella) infection of middle ear with inflammation of canal and eardrum
Usually preceded by URI, RSV specifically, or flu

3. Pathophysiology
Infection travels thru nose or throat and goes up eustachian tube
Blocked eustachian tubes from edema or enlarged adenoids fail to drain middle ear
Tubes can become contaminated from reflux, aspiration, sneezing, blowing nose

4. Risk Factors Normally small, short airways and eustacian tubes
Family hx
Second-hand smoke—causes pathogens to attach to middle ear
Day care or other crowded settings

5. Risk Factors Otitis media with effusion Malfunctioning eustacian tube
Horizontal feeding
Limited exposure or immunity
Hx allergies, cleft palate, Down syndrome

6. Manifestations
Purulent matter and fluid collection causes bulging and pain; popping sensation, pressure. Sudden relief of pain may indicate perforation.
Fever
Otitis media with effusion may have no overt sx

7. Otoscopic Exam
Otoscopic exam reveals loss of light reflex and bony landmarks; bulging, red, immobile eardrum; bubbles behind eardrum with serous (OME)
Tympanogram is flat

8. Antibiotic Treatment
All children < 6 months old because of immature immunity
All children > 6 mos if severe illness
Med choices:
Amoxicillin mg/kg/d bid x 5-7d
If allergic—azithromycin, cephalosporins
IM Rocephin for resistance or noncompliance (use with lidocaine if approved by HCP)
Viral types need no antibiotics—resolve spontaneously

9. “Watchful Waiting”
In all children over 6 mos, if fever and pain are not present, then observation is OK x 72h.
No antibiotics are needed if improved

10. Supportive Care Analgesic/antipyretic
Benzocaine or herbal ear drops (Allium sativum, Verbascum thapsus, Calendula flores, Hypericum perforatum, lavender, and vitamin E)
Topical pain relief with heat

11. Complications
Repeated & resistant cases and persistent perfusion and hearing loss may require myringotomy with placement of tympanostomy tubes and possible adenoidectomy
Perforation—may need patching
Meningitis
Mastoiditis
Hearing loss, speech delay

12. Nursing Responsibilities
Pain relief with supportive care
Manage ear drainage
Encourage parent to give child all of medication
Encourage immunizations esp. PCV and Hib, influenza
Follow orders and educate regarding management of tubes
Refer children who have hearing loss

13. Parent Education Causes of infection S/S of infection
Prevention—breastfeeding, no smoking, no bottle propping, feeding in semi-reclining position, stay away from people with URIs, xylitol
Recognition and prevention of complications
Med administration
Avoid air travel

14. Infection: Conjunctivitis
Ricci, pp

15. Etiology & Pathophysiology
Most common eye disease
Inflammation of the conjunctiva
Viral, bacterial, allergic, foreign body
Viral caused by adenoviruses and influenza
Bacterial called “pink eye” and caused by Staph, Haemophilus, or Strep. In newborn, Chlamydia or Gonorrhea
Allergic is usually seasonal, bilateral,and occurs more in older children and teens

16. Risk Factors Newborn, esp in first 2 wks Crowds—day care, school
URI—cold, pharyngitis, otitis

17. Manifestations Redness Edema Pain, scratchy or itchy feeling
Mild photophobia
Watery or purulent drainage

18. Diagnostics Most are not cultured C & S for bacterial or viral
Conjunctival scrapings can also detect microorganisms
Fluorescein dye to detect FBs and trauma

19. Treatment Eye drops for newborns to prevent Chlamydia and gonorrhea
Topical anti-infectives applied as eye drops or ointments usually erythromycin, gentamicin, or penicillin, acyclovir
Severe cases require systemic tx
Antihistamines, either gtts or po for allergic

20. Supportive Care Warm or cool compresses Cleaning away drainage
Eye irrigations
Analgesics
Avoid bright lights, reading
Sunglasses
No contact lenses

21. Parent Education
Prevent spread of bacterial—wash hands, don’t share stuff, don’t return to school until 24h of med
With allergic, make sure child irrigates eyes and washes hands when he comes in. Shower and wash hair before bedtime.

22. Parent Education How to do eye drops Wash hands before eye drops
Don’t contaminate eye dropper
Reduce lighting
No reading