Management of Otitis Media with Effusion: Nursing Assignment

This nursing assignment discusses the management process of Otitis Media with Effusion (OME), including surgical and non-surgical interventions, interdisciplinary team duties, and prolonged care education.

Running head: NURSING ASSIGNMENT 1
Nursing Assignment
Name
Institution

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NURSING ASSIGNMENT
Introduction
This paper discusses the issues that relate to the disease known as the Otitis media, it
can also be called an ear infection. Otitis Media with Effusion (OME) is the accumulation of
non-infected liquid in the ear space (Babu, Prabakaran & Radhakrishnan, 2016). The disease
is common to most of the children under the age of 7 months up to 15 years. This type of the
disease is characterized by an inflammation of the ear, as well as subcategorized into either
chronic otitis media or acute otitis. The disease begins with viral infection or a bacterial from
the throat then it spread into the ear, initiating the formation of fluids in the middle area of the
ear (Walker et.al, 2017). The paper is divided into parts. The first part covers the background
information of the infection and that of the patient. The second part discusses the
management process of the infection (Babu et.al, 2016). The third part explains the duties of
the interdisciplinary team that are involved in the care of the patient. The last part is the
prolonged care education and possible co-morbid complications (Williamson et.al, 2015)
Background
OME is the accumulation of the fluid in the middle ear with no symptoms and sign of
the ear infection (Bruce, 2015). Approximately 2/3 of the children are being affected by the
disease at the age of 3year. The incidence of the disease varies depending on the race and
geographical variation (Rosenfeld, 2016). The prevalence of the infection is higher in the
Native American because of the differences in the Eustachian tube and Skull base, and the
differences in the socioeconomically status. The loss in hearing is mostly temporary
(Williamson, 2015).
Management

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The management of the otitis media with effusion is divided into two parts: surgical
and non-surgical intervention. The non-surgical intervention is made up of medical therapy,
active observation hearing aids, and auto-inflation. The non-surgical intervention process is
usually helpful if it could increase the resolution to the patient (Belkadi, Messaadia, Bernard
& Baudry, 2017).
Active observation is that duration in which the patient diagnosed with the OME is
being taken through observation for a period of 3 months after diagnosis earlier to surgical
intervention. It refers to behavioral and educational strategies that can help reduce the loss in
hearing before the consideration of the surgical intervention (Maio, Borges, Abreu &
Queirós, 2016). All process will include facing Kevin who is a patient when speaking, using
visual signals (for example pictures and hands), giving Kevin more attention before the start
of the talk, lowering the noise from the background, talking openly with normal volume and
rhythm. Other active observation which should be done to Kevin includes the following:
Besides to speech, Kevin should be given the explanation on the pictures as well as asking
questions, repeating phrases, words, as well as asking questions in case of misunderstanding,
and placing Kevin close to them in the classroom. Specific advice should be given to Kevin
with the intention of improving communication (Maatouk et.al, 2016).
The decision must be reached between the medical department and Kevin family on
whether to perform the surgical intervention. The ventilation tubes should be inserted into the
ear before the start of the surgery (Silva et.al, 2016).
The reason for the performance of the surgery in OME is when the disease is
persistence and the patient continues to experience a hearing problem. It must be performed
to the patient in order to minimize the risk of the disease occurrence and improve the hearing.
Kevin should be given a bleeding disorder before the surgery (Hwang & Chia, 2016).

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The surgical intervention must be done after 3 months when the disease persists. The
use of VT insertion is the required procedure to be followed because it’s the safe procedure.
Kevin should be also be subjected to the adenoidectomy if the disease continues to affect the
Patient (Akazawa, 2018).
The disease is recurrent and therefore Kevin should be given advice on the post VT
insertion which includes: to keep the ear dry, to avoid inserting the object into the ear and to
use earplug when bathing and swimming.
Information for Kevin, parents, and Carers
Carers/Parents and Kevin will be informed of the effect and nature of the OME, as
well as its natural resolution
Carers/ parents and Kevin will be given an opportunity of discussing the different
options for treating OME, including their risks and benefits.
Verbal information on OME should then be offered to both Kevin and his family.
Assessment strategies- the basement ear assessment should be performed to the
patient (Kevin), the assessment on the hearing process should be done to the patient this will
help in knowing the intensity of the disease, Assessment should be done on the wound to
reduce the pain associated with the surgery. The team should also monitor the healing process
of the patient by examining the intensity of the pain. In case there is wound after the surgery,
I will advise the care team to seek the help of the interdisciplinary team to help in the caring
of the wound (Blioskas et.al, 2018).
Nursing diagnosis
Diagnosis can be made by the use of the otoscopic examination, taking history and
audiological evaluation. The loss in hearing is the most common symptom (Atkinson, Wallis
& Coatesworth, 2015).

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Pre-operative represent the period between the performance of the surgery and the
shift of Kevin to the operating table
Nursing duties include:
Assessment of the patient (Kevin), plan of care which will be based on the need of
Kevin, identification of the Kevin health problems (both potential and actual), the preparation
of the patient to surgery (psychological, social and physical)
Post-operative it represents the duration of admissions of Kevin to the care
management room till the completion of the healing process. The nursing activities in this
stage include planning process for Kevin home care, care to stimulate healing process,
performing activities that could prevent complication and assessment of the Client’s (Kevin)
reactions after the surgery.
Diagnosis-related to preoperative client
Fear that is linked to the risk of death, fear linked to the effect of surgery, Anxiety
related to inadequate knowledge about post-operative and pre-operative care, the disturbance
on the pattern of sleep, fear linked to control loss during anaesthesia and fear linked to past
experience surgery.
Nursing diagnoses that will be performed for the post-operative stage include:
The risk for damage associated to post- anaesthetic status, pain related to reflex
muscle spasm, altered nutrition, inadequate for the total requirements for the normal function
of the body, Risk for changed body hypothermia and temperature, pain in the eardrum and
high risk of other infection due to surgery.
The patient ear will be examined by the use of Otoscope, this is an instrument used
for examining the ear of the patients.
Formal assessment of Kevin who is the patient, in this case, should begin with:
1) Looking for the clinical history, focusing on:

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Hearing fluctuation, poor educational progress, poor listening, and indistinct speech
2) Clinical examination, concentrating on:
Otoscopy, the health of the upper respiratory, general development of Kevin status
3) Hearing testing- they should be performed by the professional nurse using the test
which can help in the development of the patient (Cevizci, Dilci, Celenk, Karamert &
Bayazit, 2018).
The diagnosis process that takes place in both the pre/post-operative was to help
Kevin to have a control of the strong pain that Kevin may experience before and after the
surgery process. It also helps the Client of which in this case is Kevin to prevent the anxiety
associated with the performance of the surgery. It also hastened Kevin healing process
(Ghedia, Ahmed, Navaratnam & Harcourt, 2018).
Planning
Pain reduction and treatment of the disease is the specific goal that the care team will
try to work towards. These specific goals will enable Kevin to solve the cases that relate to
the OME. The satisfaction of the goal will enable both the family and the well wiser reduce
the number of resources being spent on Kevin treatment. The evaluation of the progress will
take place and it will be measured by examining the healing process of the Client who is
Kevin. The resources which will be used in the fulfillment of the set goal will include the
medical instruments and the human resources such as the use of the interdisciplinary team in
the achievement of the set goal. The goal which was set is realistic because the all the team
that is involved in the care management of will work smart to hastened the treatment process
of the disease (Yoo et.al, 2018).
Implementation

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In order to achieve the SMART goals of treating Kevin back to his normal condition,
the following intervention will be taken into consideration.
Preparing Kevin physically for the surgery- Kevin will be prepared both physically
and emotionally. This will enable the smooth flow of the treatment process. The help of the
professional Doctors will assist in the provision of necessary skills and knowledge on how
the patient who is Kevin will be prepared for the surgery. The Kevin family will also be
informed of the importance of all the treatment process that Kevin will be undergoing.
Offering emotional support to Kevin and his family- Emotional support will help the
recovery process of the client who in this case is Kevin. The emotional support is provided
for both the patients and his family. This will motivate Kevin and his family thereby
increasing the healing process of the patient.
Adhere to the legal matters- the family should be advice on the importance of signing
the legal content before the surgery as these will help in case of the complication during the
surgery process (Cai, McPherson, Li & Yang, 2018).
Referral to the interdisciplinary team will be considered in a situation where there are
no changes in the health of the patient (Kevin). The referral will take place when Kevin still
experiences difficulties in hearing, specifically when there are social, developments or
educational difficulties. The referral will also take place if there is pre-existing impairment in
hearing.
If Kevin’s adenoids are affected, then it should be removed with the help of the
Physician. The removal of the adenoids will hasten the fulfilment of the treatment goal.
Evaluation

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The planned outcome and goal of reducing the pain and treating the disease (OME)
were met this is due to the assessment of the client health which reveals that there is a
reduction in pain. Based on the check-up performed to Kevin, the outcome is that the hearing
level of the patient greatly improved because Kevin can now recognize the speech after two
to three weeks of follow-up. There is the reduction of the pain. After the surgery procedure,
the pain that Kevin was undergoing greatly reduced. The tool used in the performance of the
analysis is the fixed-effect model. Though the evidence was bias because the tool provided
the evidence that is of low quality but the team upgraded the evidence to higher quality.
Interdisciplinary team
The first member is the team of the physicians- Neuropsychologists, psychologists,
internists, physiatrists- who administer the care plan for the patients and also oversee the
medical need of the patients (Simon et.al, 2018).
Rehabilitation nurses- they incorporate evidence-based care into bedside care
Physical, speech and Occupational therapists- who develop and assess individualized
programs that are useful for the need of the patient.
Case managers - who administer the plan to the patients from the admission up to
when the patients are being discharged from the hospital care.
Social workers- they provide counseling and support to the families of the Patients
and to the patients.
Registered dieticians- they solve the need for the nutritional needs of the patients.
Interdisciplinary team members involved in the treatment of Kevin (Patient)
Specialist physician-they help in the provision of medication and drugs.
Speech-language pathologists- They assess, prevent, treat language, speech, and
swallowing disorders in the patients.

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Rehabilitation nurses- They will assist the Patient (Kevin) to reach their full potential.
The nurse will work with the Kevin family to ensure that he regained his normal status.
Pediatrician- they have special skills and training in the illness and disease that affect
the development and health of the children.
Extended care education and Potential co-morbid complications
Outline the pre-discharge education that would need to be provided to your patient
and family, in order to promote a successful recovery. Identify and address your
considerations for the child’s return to the remote community.
In order to promote successful recovery for the patient, the following education
program should be performed: Kevin should be advice on how to keep the wound clean to
prevent infections of the wound. The family should also be advised by the dietician on the
diet that Kevin should take to help in the recovery of the disease. It is advisable for the
patient to take specific diets that could control and hasten the recovery process. Any person
who has undergone surgery should take the diet rich in minerals and vitamins (Ghedia,
Ahmed, Navaratnam & Harcourt, 2018).
The OEM initiated another disease because of the wound which causes other illness to
the patient. Strong pain also causes another disease like malaria to the patient. The research
states that these comorbidities may prevent the recovery process of the OEM.
Conclusion
The OME is mostly prevalence to children under the age of 12-48 months. The
significant risk factor for the infection is the adenoid obstruction which affects children.
Symptoms duration, gender, and symptomatology are not an essential risk factor for the
infection in children with OAD. The care plan was established following the framework of
the CFCC, it allows the patients to be involved in the decision-making process pertaining to

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their treatment as well as improving the well-being of the patient families. The symptom of
the disease involves loss of hearing which can be detected by the use of the audiogram.
Recommendation
1) This information should be given to the public care unit to assist them preventing
the infection.
2) Children who experience obstructive adenoid infection should be examined keenly
to avoid early infection of the disease.

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References
Akazawa, K., Doi, H., Ohta, S., Terada, T., Fujiwara, M., Uwa, N., ... & Sakagami, M.
(2018). Relationship between Eustachian tube dysfunction and otitis media with
effusion in radiotherapy patients. The Journal of Laryngology & Otology, 132(2),
111-116.
Atkinson, H., Wallis, S., & Coatesworth, A. P. (2015). Otitis media with
effusion. Postgraduate medicine, 127(4), 381-385.
Babu, S., Prabakaran, J., & Radhakrishnan, S. (2016). Prevalence and Management of Otitis
Media with Effusion Amongst the School Going Children of a Rural Area in
Puducherry. Bengal Journal of Otolaryngology and Head Neck Surgery, 24(1), 21-28.
Belkadi, F., Messaadia, M., Bernard, A., & Baudry, D. (2017). Collaboration management
framework for OEM–suppliers relationships: a trust-based conceptual
approach. Enterprise Information Systems, 11(7), 1018-1042.
Blioskas, S., Karkos, P., Psillas, G., Dova, S., Stavrakas, M., & Markou, K. (2018). Factors
affecting the outcome of adenoidectomy in children treated for chronic otitis media
with effusion. Auris Nasus Larynx.
Bruce, I., Harman, N., Williamson, P., Tierney, S., Callery, P., Mohiuddin, S., ... & O'Brien,
K. (2015). The management of Otitis Media with Effusion in children with cleft
palate (mOMEnt): a feasibility study and economic evaluation. Health technology
assessment (Winchester, England), 19(68), 1.
Cai, T., McPherson, B., Li, C., & Yang, F. (2018). Pure tone hearing profiles in children with
otitis media with effusion. Disability and rehabilitation, 40(10), 1166-1175.

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Cevizci, R., Dilci, A., Celenk, F., Karamert, R., & Bayazit, Y. (2018). Surgical considerations
and safety of cochlear implantation in otitis media with effusion. Auris Nasus
Larynx, 45(3), 417-420.
Ghedia, R., Ahmed, J., Navaratnam, A., & Harcourt, J. (2018). No evidence of cholesteatoma
in untreated otitis media with effusion in children with primary ciliary
dyskinesia. International Journal of Pediatric Otorhinolaryngology, 105, 176-180.
Hwang, J. Y. F., & Chia, S. E. (2016). P183 Planning and evaluation of a medical
surveillance programme for healthcare workers in a singapore hospital.
Maatouk, I., Mueller, A., Schmook, R., Angerer, P., Herbst, K., Cranz, A., ... & Gündel, H.
(2016). Healthy aging at work–Development of a preventive group intervention to
promote quality of life of nursing staff aged 45 years and older. Mental Health &
Prevention, 4(1), 42-48.
Maio, T., Borges, E., Abreu, M., & Queirós, C. (2016). P235 Bullying and engagement in
nursing workplace.
Rosenfeld, R. M., Shin, J. J., Schwartz, S. R., Coggins, R., Gagnon, L., Hackell, J. M., ... &
Poe, D. S. (2016). Clinical practice guideline: otitis media with effusion
(update). Otolaryngology–Head and Neck Surgery, 154(1_suppl), S1-S41.
Silva, F. J., Felli, V. E., Martinez, M. C., Silva, S. M., Baptista, P. C., Borges, E. M., &
Queirós, C. M. (2016). P142 Presenteeism in brazilian care nursing workers.
Simon, F., Haggard, M., Rosenfeld, R. M., Jia, H., Peer, S., Calmels, M. N., ... & Teissier, N.
(2018). International consensus (ICON) on management of otitis media with effusion
in children. European annals of otorhinolaryngology, head and neck diseases, 135(1),
S33-S39.

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Walker, R. E., Bartley, J., Camargo, C. A., Flint, D., Thompson, J., & Mitchell, E. A. (2017).
Higher Serum 25 (OH) D Concentration is Associated with Lower Risk of Chronic
Otitis Media with Effusion: A Case‐Control Study. Acta Paediatrica.
Williamson, I. (2015). Otitis media with effusion in children. BMJ clinical evidence, 2015.
Williamson, I., Vennik, J., Harnden, A., Voysey, M., Perera, R., Breen, M., ... & Mant, D.
(2015). An open randomised study of autoinflation in 4-to 11-year-old school children
with otitis media with effusion in primary care.
Yoo, M. H., Cho, Y. S., Choi, J., Choung, Y. H., Chung, J. H., Chung, J. W., ... & Kim, K. S.
(2018). Microbiological Results From Middle Ear Effusion in Pediatric Patients
Receiving Ventilation Tube Insertion: Multicenter Registry Study on the
Effectiveness of Ventilation Tube Insertion in Pediatric Patients With Chronic Otitis
Media With Effusion: Part I. Clinical and experimental otorhinolaryngology.