Infection: Otitis Media Ricci, pp. 1376-1379

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

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

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

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

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

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

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

“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

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

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

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

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

Infection: Conjunctivitis Ricci, pp. 1359-1364

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

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

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

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

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

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

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.

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