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Otitis Media  & Adenoid Hypertrophy

 

Isabel is a 22-month-old toddler who lives with her parents and 3-year-old sister in a suburban area. She was born full term without complications, is up to date on her immunizations, and has regular well child visits.  It has been noted that she has a speech delay. Her father is a computer programmer, age 30 Y, and her mother, age 28 Y, is a part time dental hygienist.  Both parents are smokers.  Isabel and her sister attend daycare three days a week. She has had frequent upper respiratory tract infections, three ear infections in 6 months, chronic nasal congestion, rhinorrhea, and snoring.  Last week Isabel experienced a febrile illness with a temperature of 102 degrees Fahrenheit.  She had decreased appetite, vomiting, diarrhea, and pulling on her right ear. She was evaluated by her PCP who diagnosed a right Otitis media and she was placed on a cefdinir twice daily by mouth for 10 days.  Parents were instructed to give her acetaminophen or ibuprofen as needed for pain and to encourage fluids.  She was referred to an Ear Nose & Throat (ENT) Specialist.  At her ENT clinic evaluation, she was noted to have otitis media with effusion, right side; conductive hearing loss, right side; and lateral XR revealed 90% obstructing adenoids.  It was recommended that she undergo Bilateral Myringotomy with Tubes insertion as well as an Adenoidectomy.

 

Isabel and her family arrive at the ambulatory surgery center for her procedure.  She has had nothing by mouth since 2100 the night before. Her weight is 27 lbs.  T 36.7 temporal, P 110, R 20 BP 90/50, pulse oximetry on RA 99%.  The anesthesia team explains to the family that she will be given a preoperative sedative called midazolam.  The anesthesiologist has ordered midazolam 6 mg PO 20 minutes pre-procedure to be given by the RN. 

 

What Risk Factors for Otitis Media does Isabel have?
What is the difference between Recurrent Acute Otitis Media (RAOM) and Otitis Media with Effusion (OME).
Does OME require antibiotic therapy?
What clinical manifestations of adenoid hypertrophy does Isabel have?
What is the relationship between a history of otitis media and conductive hearing loss?
Discuss the effects of hearing impairment on growth and development.
How can the nurse approach Isabel’s parents about their cigarette smoking and how it compromises their children?
Is the midazolam dose within the safe weight-based dosing range?
SCIENCE
HEALTH SCIENCE
NURSING
NUR 4040

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