Page 1009 - Saunders Comprehensive Review For NCLEX-RN

3. Crying, irritability, lethargy
4. Loss of appetite
5. Rolling of head from side to side
6. Pulling on or rubbing the ear
7. Purulent ear drainage may be present
8. Red, opaque, bulging, immobile tympanic membrane
on otoscopic examination
9. Signs of hearing loss (indicative of chronic otitis
media)
D. Interventions
1. Encourage fluid intake (may be difficult if the child is
in pain).
2. Instruct the child to avoid chewing as much as
possible during the acute period, because chewing
increases pain.
3. Provide local heat or cold as prescribed to relieve
discomfort, and have the child lie with the affected
ear down.
4. Instruct the parents in the appropriate procedure to
clean drainage from the external ear canal with sterile
swabs or gauze; frequent cleansing and the
application of moisture barriers may be prescribed to
prevent ear excoriation from the drainage.
5. Instruct the parents in the administration of analgesics
or antipyretics such as acetaminophen or ibuprofen as
prescribed to decrease fever and pain.
6. Instruct the parents in the administration of antibiotics
if prescribed, emphasizing that the prescribed period
of administration is necessary to eliminate infective
organisms.
7. In healthy infants older than 6 months and children,
careful use of antibiotics is recommended because of
concerns about medication-resistant Streptococcus
pneumoniae; usually, waiting up to 72 hours for
spontaneous resolution is a safe and appropriate
management of acute otitis media.
8. Instruct the parents that screening for hearing loss
may be necessary.

9. Instruct the parents about the procedure for

administering ear medications such as topical pain-
relief drops, if prescribed.
E. Otitis Externa
1. Description: Inflammation of the external auditory
canal, which can occur with or without infection; also
known as “swimmer’s ear.”
2. Assessment
a. Rapid onset of symptoms within 48

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