Eye, Ear, Nose and Throat Disorders Essay

Eye, Ear, Nose and Throat Disorders Essay

Eye, Ear, Nose and Throat Disorders Essay

 

In case study 1, the mother brought in a 2-year-old patient complaining of ear pain, decreased sleep, congested and running nose and mild cough. Upon conducting physical examination, the child displayed shotty anterior cervical adenopathy, clear postnasal drainage, mild nasal congestion, and lungs clear to auscultation. An ear examination revealed that the patient’s right tympanic membrane is red, translucent and in a neutral position with no purse or fluid noted. Her left tympanic membrane is full and reddish orange in appearance, and opaque with pus. She has a body temperature of 100.7^oF.

Additional Questions

It is important to ask about the health of the child. Some of the additional questions include has your child had a sore throat or head cold recently? Is your child pulling at his ears? Additional information should also be provided on the alleviating factors and aggravating factors by responding to questions such as when are her symptoms worse? How have you been managing her symptoms or making your child feel better? It is also important for the nurse to ask the patient mother about her allergies, past medical history, current medications that he is taking if any, family medical history and her immunization status (Ito et al., 2017).

Additional Examinations and Diagnostic Tests

            A physical examination of a patient with otitis media will reveal sinuses, which are palpable, and shotty auricles cervical adenopathy. The external auditory canal must also be examined to reveal the degree of translucency, and color of the tympanic membrane. Inability to visualize the middle ear landmarks and air fluid level bubbles will suggest effusion. The nose and the pharynx must also be assessed. Radiological imaging may also be required to rule out the presence of foreign bodies in the external auditory canal. A pneumatic otoscope can also be used, which blows a puff of air into the ear canal to check for fluids behind the eardrum (Rappaport et al., 2016). A tympanometer can also be used.

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Differential Diagnoses

1. Acute Otitis Media (AOM): This is an infection of the middle ear and is common among children. It is usually accompanied by the common cold. It is associated with symptoms such as headache, fever, sinus pressure, and otorrhea. The patient might
   

   Eye, Ear, Nose and Throat Disorders Essay

   also present with GI symptoms such as diarrhea, and irritability leading to difficulty in sleeping. In the provided case scenario, the child presented with running nose, cough, and congestion prior to ear pain (Le Saux, Nicole, & Robinson, 2016). Consequently, the physical findings on ear examination also indicate a reddish and translucent right tympanic membrane in a neutral position, with no fluids or pus noted. The left tympanic membrane is also full and reddish orange in appearance. It is also opaque with pus. All the above signs and symptoms reveal otitis media as the most likely diagnosis (Adams et al., 2016). AOM can also be followed with otitis media with effusion (OME) in which the patient will present with ringing in the ears, vertigo, hearing loss, and tinnitus.

2. Acute otitis externa (AOE): This is a common condition among children and is also known as ‘swimmer’s ear.’ It is characterized by diffuse inflammation of the external ear. Diagnostically, it has a rapid onset of generally within 48 hours in the past three weeks (Le Saux, Nicole, & Robinson, 2016). it is associated with symptoms of ear canal inflammation such as otalgia, itchiness or fullness, and may present with or without jaw pain or hearing loss. Other symptoms include diffuse ear canal edema and erythema.
3. Foreign bodies in the external auditory canal: Presence of foreign bodies in the external auditory canal can also result to symptoms such as persistent cough, otorrhea, unilateral otalgia, fullness, buzzing and severe pain (Le Saux, Nicole, & Robinson, 2016).

Treatment and Management Plan

            To manage the patient’s symptoms, both pharmacological and nonpharmacological approaches will be used. Starting with the pharmacological approaches, the patient needs to be put on antibiotics. If the patient is at high risk of DRSP, then the dose needs to be increased to 80-90mg/kg/day. Pediatric clinical guideline for the management of otitis media recommends amoxicillin 40-45mg/kg/day as the first line treatment (Le Saux, Nicole, & Robinson, 2016). The patient needs to be given cefdinir14mg/kg/day after every 12-24hours for a maximum of 10day. In case the patient is allergic to penicillin, then ceftriaxone 50mg/kg/IM should be administered in 1or 3 consecutive daily doses together with Ciprodex suspension ear otic 0.3%/0.1% 4gtt in the ear twice a day for I week. The patient’s mother should also be provided with information regarding the importance of tympanostomy tubes in draining fluids from the child middle ear to reduce the chances of getting an infection. For the pain, the patient should be given Ibuprofen 10ml PO after every 6-8 hours PRN with a maximum dose of 40mg/kg/day. For topical relief of pain, Auralgan Otic solution is recommended after every 1-2hours only when the patient’s tympanic membrane is not ruptured (Valdez, & Vallejo, 2016). Additionally, non-pharmacological approaches such as the use of zinc supplements and xylitol oral solution are recommended. The patient should also be given sugar-free gums, for chewing to reduces the recurrence rate.

Patient Education, Health Promotion & Anticipatory guidance

The mother needs to be educated on preventive measures that she can use to promote the health of her baby such as:

• Making sure that you feed your child properly with highly nutritious food.
• Enhance high hand hygiene when handling the child. This helps to prevent the spread of flu or cold germs, which might cause a viral or bacterial infection that might lead to an ear infection.
• Avoid second-hand smoke. Exposing your child to cigarette smoke can put them at high risk of developing an ear infection among other complications (Valdez, & Vallejo, 2016).
• Ensure that the immunization status of your child is up to date. At this age the child should have been administered all the Hepatitis B three doses, at least two doses of Rotavirus and three doses of Hib, four doses of DTaP, four doses of pneumococcal and three doses of IPV in addition to the initial dose of MMR and varicella (Valdez, & Vallejo, 2016).

It is also important for the physician to address the sociocultural barriers that might interfere with the treatment and management of the patient condition such as mistrust, emotional reaction, interference by relatives, unintended offense, folk beliefs, and physical distraction.

Follow up: The child should be brought in for her 30 months well child visit. During this visit, several physical examinations will be conducted, growth and development assessed and vaccinate only when necessary.