Infection: Otitis Media Ricci, pp. 1376- 1379. Etiology Most common in childhood—usually in first...
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Transcript of Infection: Otitis Media Ricci, pp. 1376- 1379. Etiology Most common in childhood—usually in first...
![Page 1: Infection: Otitis Media Ricci, pp. 1376- 1379. Etiology Most common in childhood—usually in first 24 mos Viral or bacterial (Haemophilus, Streptococcus,or.](https://reader035.fdocuments.in/reader035/viewer/2022062620/551ab86e55034656628b5429/html5/thumbnails/1.jpg)
Infection: Otitis Media
Ricci, pp. 1376-1379
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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
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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
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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
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Risk Factors Otitis media with effusion Malfunctioning eustacian tube Horizontal feeding Limited exposure or immunity Hx allergies, cleft palate, Down
syndrome
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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
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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
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Antibiotic Treatment All children < 6 months old because of
immature immunity All children > 6 mos if severe illness Med choices:
Amoxicillin 80-90 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
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“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
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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
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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
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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
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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
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Infection: Conjunctivitis
Ricci, pp. 1359-1364
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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
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Risk Factors Newborn, esp in first 2 wks Crowds—day care, school URI—cold, pharyngitis, otitis
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Manifestations Redness Edema Pain, scratchy or itchy feeling Mild photophobia Watery or purulent drainage
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Diagnostics Most are not cultured C & S for bacterial or viral Conjunctival scrapings can also
detect microorganisms Fluorescein dye to detect FBs and
trauma
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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
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Supportive Care Warm or cool compresses Cleaning away drainage Eye irrigations Analgesics Avoid bright lights, reading Sunglasses No contact lenses
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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.
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Parent Education How to do eye drops Wash hands before eye drops Don’t contaminate eye dropper Reduce lighting No reading