Valerie Bazile Vetisha Joseph

September 4, 2012

TLC - Noah Heer 2. S pneumoniae is the most common etiologic agent responsible for AOM and for invasive bacterial infections in children of all age group. 3. No symptoms were noted on the chart compared to Otis media effusion (ex. pain, redness of the eardrum, pus in the ear, and fever). Pt was irritable, and had changes in hearing. 4. Children have Eustachian tubes that are shorter, more horizontal, and straighter than those of adults. These factors make the journey for the bacteria quick and relatively easy. It also makes it harder for the ears to clear the fluid, since it cannot drain with the help of gravity. 10. At age 6 referred to as the Ego Development Outcome: Industry vs. Inferiority Basic Strengths: Method and Competence During this stage, often called the Latency, we are capable of learning, creating and accomplishing numerous new skills and knowledge, thus developing a sense of industry. This is also a very social stage of development and if we experience unresolved feelings of inadequacy and inferiority among our peers, we can have serious problems in terms of competence and self-esteem. Children are out of school and generally this condition not only affects physical functioning but also general well-being of the child and there family. 1. It causes delay in the development of receptive and expressive communication skills (speech and language). 2. The language deficit causes learning problems that result in reduced academic achievement. 3. Communication difficulties often lead to social isolation and poor self-concept. 4. It may have an impact on vocational choices. 11. As in earlier years, feelings that the illness/injury is a punishment for bad behavior may occur, but may take some time to express. They may also become fearful of the loss of control or loss of wholeness that an illness or injury can produce. 12. Common stressors and fears include: Thinks that he is in the hospital because he is in trouble or being punished. Having a part of the body destroyed or injured. Loss of control. Pain or the possibility of pain. Needles and shots. Dying during surgery. 13. School-age children have an increased awareness of internal body parts and body function. They are also able to understand a series of actions and can therefore benefit from hearing about all steps involved in the surgical process. Allow the school-age child to participate in care when possible. For example, to provide a sense of control and encourage acceptance of treatment, ask the child to help hold the anesthesia mask. Provide choices when possible such as asking, "Which arm should we use to measure your blood pressure?" Offer simple explanations about sensory and procedural information as well as what's expected of the child. When starting an I.V., tell him, "your job is to hold your arm very still." Try to use language that's accurate, but not scary. For example, "The doctor will make a small opening" is less scary than, "the doctor will make a cut."

Be honest if something is going to hurt. When asked, the nurse can respond, "some kids say it feels like a pinch and some kids say they don't feel anything at all. You'll have to tell me how it felt to you." These children can express their feelings in words and have a greater grasp of time, so separation from parents tends to be less of an issue. 19. Noahs mother mentioned that he has noticeable hearing loss. Children with severe to profound hearing losses often report feeling isolated, without friends, and unhappy in school, particularly when their socialization with other children with hearing loss is limited. 20. Noahs hearing loss has no complication on his cognitive skills. Cognitive skills are part of brain function. 25. Noahs vitals are WNL of a 6 yr old vitals. 27. Acetaminophen should be given initially for the pain. 325mg PO every 4 hours as needed. Phenergen can be given for the nausea. 12.5 mg PR every 6 hours as needed. This is what should be given initially for the discomfort and nausea. 28. Acetaminophen is a non-narcotic analgesic. It inhibits CNS synthesis of prostaglandins. The most serious side effect is liver damage due to large doses, chronic use or concomitant use with alcohol or other drugs that also damage the liver. Chronic alcohol use may also increase the risk of stomach bleeding. The typical pediatric dose for a 6 year old is 10-15 mg/kg/dose PO or PR every 4 to 6 hours. The max daily dose is 2.6 g (2600 mg). 29. Ancef (cefazolin) is an antibiotic. It works by fighting bacterial infections in the body. The most common side effects are diarrhea, rash and pain at the injection site. The typical pediatric dose for a 6 year old is 25-100 mg/kg/d IV divided doses every 6 to 8 hours. 35. A bilateral myringotomy is a surgery to treat children who have otitis media or middle ear infections that wont go away with medication; middle ear fluid that wont go away; or hearing loss or speech delays caused by frequent ear infections. The surgeon will put small tubes in your childs eardrums to allow air to get inside. These tubes are called pressure equalizer tubes. When air is able to get behind the eardrum, the fluid inside the ear can flow out or dry up, taking away the pain or pressure your child may have been feeling and making future infections less likely. An ear tube is made of plastic and looks like a tiny spool. More than 25 of them could fit on the face of a dime. They are so small that you usually cannot see the tubes just by looking into your childs ear. In most cases, ear tubes do not need to be removed and usually are pushed out on their own after about 6 to 18 months, as the eardrum heals. If a tube remains in the eardrum for more than 2 or 3 years, however, it may need to be removed by your doctor. 36. Noah has allergies to pollen, dust and mold, which could be a factor in the cause of the multiple diagnosis of otitis media. Noah enjoys playing outside, he needs to rest when discharged and should only engage in low level activities for 7 days. Play time should be limited, especially during allergy season. Extra precaution should be taken to eliminate possible allergens in the home. 41. The physicians discharge plan included initially a 200 mg IV before discharge. The patient has orders to return to the physicians office in 2 weeks. Ceclor (liquid) has been prescribed 150 mg PO 2 times a day for 7 days as well as Gentamicin eardrops, 5 drops in each ear canal 3 times a day for 3 days starting the day after discharge. 45. No discharge from ears, denies nausea. Patient in stable condition. Vital signs within acceptable limits. Mother is able to demonstrate correct administration of ear drops and able to verbalize signs and symptoms of complications and measures to prevent infection. 48. Nursing Diagnoses; Risk for infection related to opening in both tympanic membranes. Risk for altered sensory perception: auditory related to effusion/disease process. Knowledge deficit related to lack of experience with pressure -equalizer tubes.

49. Nursing Diagnosis: Risk for infection related to opening in both tympanic membranes. Goal: The patient will experience no infection as evidenced by, 1. Normal range of temperature. 2. WBC count remaining within normal limits. 3. No purulent drainage from ears. 4. Denial of head or ear pain 50. Nursing Interventions: 1. Clean any exudate present from myringotomy every hour. 2. Keep water from entering auditory canals. 3. Assess for signs and symptoms of infection every 4 hours. 4. Administer antibiotic ear drops as ordered.