Otitis Media (OM) is an inflammation or infection of the middle ear that commonly affects children but can occur at any age. This nursing diagnosis focuses on identifying and treating ear infection symptoms, preventing complications, and promoting comfort and healing.
Causes (Related to)
Otitis Media can develop due to various factors that affect middle ear function and health:
- Bacterial or viral infections
- Upper respiratory tract infections
- Eustachian tube dysfunction
- Allergies or environmental irritants
Risk Factors include:
- Young age (6-24 months)
- Exposure to secondhand smoke
- Bottle feeding while lying down
- Family history of ear infections
- Compromised immune system
- Cleft palate or other anatomical abnormalities
Signs and Symptoms (As evidenced by)
Subjective: (Patient/caregiver reports)
- Ear pain or tugging at ears
- Irritability and crying
- Difficulty sleeping
- Decreased appetite
- Hearing difficulties
- Balance problems
- Fever
- Headache
Objective: (Nurse assesses)
- Redness and bulging of the tympanic membrane
- Decreased tympanic membrane mobility
- Purulent drainage from the ear
- Elevated temperature
- Decreased hearing acuity
- Balance disturbances
- Feeding difficulties in infants
Expected Outcomes
- The patient will demonstrate reduced pain and discomfort
- The patient will maintain a normal temperature
- The patient will show improved hearing ability
- The patient will remain free from complications
- The patient/caregiver will demonstrate an understanding of the treatment plan.
- The patient will complete the prescribed antibiotic therapy if indicated
- The patient will show signs of healing within 48-72 hours
Nursing Assessment
Evaluate Pain Level
- Assess pain intensity and characteristics
- Note pain-related behaviors
- Document pain patterns
- Monitor response to pain interventions
Monitor Vital Signs
- Check temperature
- Monitor heart rate
- Assess respiratory rate
- Document blood pressure as appropriate
Assess Ear Status
- Examine external ear
- Note the presence of drainage
- Document tympanic membrane appearance
- Monitor hearing ability
Evaluate Associated Symptoms
- Check for signs of upper respiratory infection
- Assess feeding patterns
- Monitor sleep patterns
- Document balance issues
Review Risk Factors
- Assess environmental exposures
- Document medical history
- Review vaccination status
- Note anatomical considerations
Nursing Care Plans
Nursing Care Plan 1: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to middle ear inflammation as evidenced by ear pulling, crying, and verbal reports of ear pain.
Related Factors:
- Middle ear inflammation
- Increased pressure in the ear canal
- Tympanic membrane distension
- Nerve irritation
Nursing Interventions and Rationales:
- Assess pain level and characteristics
Rationale: Establishes baseline and monitors treatment effectiveness - Administer prescribed pain medications
Rationale: Reduces pain and inflammation - Apply a warm compress to the affected ear
Rationale: Promotes comfort and reduces pain
Desired Outcomes:
- The patient will report decreased pain levels
- The patient will demonstrate improved comfort
- The patient will maintain normal activity levels
Nursing Care Plan 2: Hyperthermia
Nursing Diagnosis Statement:
Hyperthermia related to inflammatory response to infection as evidenced by elevated temperature and warm skin.
Related Factors:
- Infectious process
- Inflammatory response
- Immune system activation
- Increased metabolic rate
Nursing Interventions and Rationales:
- Monitor temperature q4h
Rationale: Tracks fever progression and response to treatment - Administer antipyretics as ordered
Rationale: Reduces fever and associated discomfort - Promote adequate hydration
Rationale: Prevents dehydration from increased temperature
Desired Outcomes:
- The patient will maintain a normal temperature
- The patient will demonstrate adequate hydration
- Patient will show an improved comfort level
Nursing Care Plan 3: Disturbed Sleep Pattern
Nursing Diagnosis Statement:
Disturbed Sleep Pattern related to ear pain and discomfort as evidenced by difficulty falling asleep and frequent night awakening.
Related Factors:
- Physical discomfort
- Pain
- Anxiety
- Position changes
Nursing Interventions and Rationales:
- Elevate the head of the bed
Rationale: Promotes drainage and reduces pressure - Establish bedtime routine
Rationale: Promotes relaxation and sleep - Manage pain before sleep
Rationale: Reduces sleep disruption
Desired Outcomes:
- The patient will demonstrate an improved sleep pattern
- The patient will report feeling rested
- The patient will maintain a normal sleep-wake cycle
Nursing Care Plan 4: Risk for Impaired Hearing
Nursing Diagnosis Statement:
Risk for Impaired Hearing related to middle ear inflammation and fluid accumulation.
Related Factors:
- Middle ear effusion
- Tympanic membrane inflammation
- Eustachian tube dysfunction
- Chronic ear infections
Nursing Interventions and Rationales:
- Monitor hearing ability
Rationale: Identifies early signs of hearing loss - Position patient appropriately during feeding
Rationale: Prevents fluid accumulation in the middle ear - Teach communication strategies
Rationale: Compensates for temporary hearing difficulties
Desired Outcomes:
- The patient will maintain or improve hearing ability
- The patient will demonstrate effective communication
- The patient will avoid complications affecting hearing
Nursing Care Plan 5: Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to lack of information about otitis media management as evidenced by inappropriate home care practices.
Related Factors:
- Limited exposure to information
- Misunderstanding of condition
- Language barriers
- Cultural beliefs
Nursing Interventions and Rationales:
- Provide education about the treatment plan
Rationale: Ensures proper medication administration - Teach prevention strategies
Rationale: Reduces risk of recurrence - Demonstrate proper ear care
Rationale: Promotes healing and prevents complications
Desired Outcomes:
- The patient/caregiver will verbalize understanding of the condition.
- The patient/caregiver will demonstrate proper medication administration
- The patient/caregiver will identify signs of complications
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Danishyar A, Ashurst JV. Acute Otitis Media. [Updated 2023 Apr 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470332/
- Dube AR, Zhao AR, Odozor CU, Jordan K, Garuba FO, Kennedy A, Niesen A, Kyrouac RC, Stortz D, Lodhi H, Newland JG, Adeyanju O. Improving Prescribing for Otitis Media in a Pediatric Emergency Unit: A Quality Improvement Initiative. Pediatr Qual Saf. 2023 Jan 16;8(1):e625. doi: 10.1097/pq9.0000000000000625. PMID: 36698438; PMCID: PMC9845014.
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- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Le Saux N, Robinson JL; Canadian Paediatric Society, Infectious Diseases and Immunization Committee. Management of acute otitis media in children six months of age and older. Paediatr Child Health. 2016 Jan-Feb;21(1):39-50. doi: 10.1093/pch/21.1.39. PMID: 26941560; PMCID: PMC4758427.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
