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Nursing management of patients with Eye, Nose, and Throat( ENT)

Otitis media

 OM Acute inflammation of the middle ear, due to viral or bacterial infection, very
common in children under 3 years, but uncommon in adults.
 The principal causative organisms of bacterial otitis media are Streptococcus
pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and in older children,
Streptococcus pyogenes..
 AOM is a recurrent disease. More than one third of children experience 6 or more
episodes of AOM by age 7 years.
Pathophysiology
Allergy , infection , ear trauma , swelling of the adenoids

Obstruction of Eustachian tube

Prevent drainage of normal secretion from the middle ear

Tube become partially opened

Organism enter middle ear & multiply

Infection process( fever, sever pain , swelling)

Reddening & bulking & depressed tympanic membrane

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Causes

Ear infections happen when the Eustachian tubes are blocked. Blockages can be caused by:

 A respiratory infection, such as cold or flu

 Allergies
 Exposure to cigarette smoke
 Infected or overgrown adenoids (tonsils)
 For infants, being fed lying down (drinking a bottle while lying on the back)

Ear infections happen most often in the winter. They are not contagious, but a cold may spread
among a group of children and cause some of them to get ear infections.

Risk Factors

Age -- children between 6 - 36 months are most likely to get ear infections

 Attending daycare
 Recent illness, such as a cold or sinus infection
 History of allergies, like hay fever, also called allergic rhinitis, or sinusitis
 Exposure to secondhand smoke
 Having family members who are prone to ear infections
 Using a pacifier

Symptoms of acute OM

1-Otalgia(Pain in and about the ear) 2-Fever, hearing loss.

3-Otorrhea(drainage from the ear) 4-Recent onset of anorexia

5-Irritability 6-Vomiting

7-Diarrhea

8-Tympanic membrane is erythematous and often bulging.

9-Conductive hearing loss due to exudate in the middle ear.

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Diagnosis

1. use an otoscope to look inside the ear. If infected, there may be areas of dullness or
redness or there may be air bubbles or fluid behind the eardrum. The fluid may be bloody
or filled with pus.
2. Tympanometry, which uses a small handheld instrument to measure changes in air
pressure in the ear. It can indicate if the eardrum is ruptured.
3. Reflectometry, in which a small instrument is placed near the ear and makes a sound. It
allows to see if fluid is present behind the eardrum.
4. A hearing test may be recommended if your child has had persistent ear infections.
5. Cultures of drainage, Show the type of bacteria
6. Mastoid X rays or CT scan, Show spreading of the bacteria beyond the middle ear.
Treatment

The goals for treating ear infections include:

1. Curing the infection.

2. Relieving pain and other symptoms, and ,
3. Preventing future ear infections.
4. If a bacterial infection is present, your doctor may prescribe antibiotics.

Medications

 Antibiotics -- If antibiotics use , be sure to give the child all the doses. The antibiotic
most often prescribed for an ear infection is amoxicillin, Children who are treated with
antibiotics are more likely to develop vomiting, diarrhea, or a rash.
 Ear drops -- If the child has recurring ear infections, a perforated eardrum, or develops
infection after ear tubes have been placed (see Surgery and Other Procedures), it may
prescribe antibiotic ear drops instead of oral antibiotics, to be used over a period of time
such as a few months.
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Ibuprofen, acetaminophen -- for pain or fever, such as ibuprofen (Advil, Motrin) or

acetaminophen (Tylenol). Children under 19 should not take aspirin, due to the risk of
developing a rare but serious illness called Reye's syndrome

Surgical management

1. Tympanoplasty: it is designed to close a perforation in the tympanic membrane)

2. Ossiculoplasty: Surgical reconstruction of the middle ear bones to restore hearing)

3. Mastoidectomy: surgery to remove cholesteatoma .

Complications

1. Temporary hearing loss during and right after an ear infection. Permanent hearing
loss is very rare, but the risk increases if the child has a lot of ear infections.
2. Other potential complications include:
 Ruptured or perforated eardrum, which usually heals on its own.
 Chronic, recurrent ear infections.
 Enlarged adenoids or tonsils.
 Mastoiditis, an infection of the bones around the skull.
 Speech or language delay in a child who suffers lasting hearing loss from
multiple, recurrent ear infections; very rare.
3. Cholesteatoma ( middle ear cyst)
4. Epidural abscess ( inflammation around the brain).
5. Facial paralysis.
Nursing care plan
A: Assessment
1. Assess the presence of pain behaviors: verbal and non-verbal.
2. Assess the increase in temperature (an indication of the infection process).
3. Assess the presence of enlarged lymph nodes in the neck area.
4. Assess nutritional status and adequacy of fluid intake of calories.
5. Assess the possibility of deafness.
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B: Nursing Diagnosis
 Anxiety R/T surgical procedure, potential loss of hearing.
 Disturbance auditory sensory perception R/T ear disorder , surgery, or packing.
 High Risk for infection R/T mastoidectomy, placement of grafts.

 Acute Pain related to inflammation of the middle ear tissue.

C: Planning and goals

 Reduce the pain.
 Reduce the anxiety .
 Improving hearing & communication.
 Prevent infection.

D: Nursing Intervention

1. Assess the level of intensity of the client and client's coping mechanisms.

2. Give analgesics as indicated.

3. Distract the patient by using relaxation techniques: distraction, guided imagination, touching,
etc.

4.Reduce noise in the client environment.

5. Using the signs of non-verbal (e.g facial expressions, pointing, or body movement) and other
communications.
6. If the client wants, the client can use hearing aids.

E: Evaluation

 Patient verbalizes acceptance of the results of surgery & exhibits less stress, tension
&irritability.
 The patient free from signs of infections.
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Tonsillitis

Tonsillitis is an inflammation of the glands of the throat, which results in a sore throat.
Tonsillitis can be caused by either viruses or bacteria. Most cases of tonsillitis resolve in a few
days without antibiotic medication.

Causes

1. Whether viral or bacterial, tonsillitis is transmitted most commonly from one person to
another by social contact such as droplets in the air from sneezing.
2. Most of the time, tonsillitis is caused by a viral infection.
3. Bacterial tonsillitis can be caused by Streptococcus pyogenes, the organism that causes strep
throat.
4. Only about 30% of tonsillitis in children is caused by strep throat.
5. Only 10% of tonsillitis in adults is caused by strep throat.
Symptoms

1-Sore throat .

2-Difficulty feeding (in babies) .

3-Pain with swallowing .

4-Fever, Headache.

5-Abdominal pain, Nausea and vomiting.

6-Cough, Hoarseness.

7-Runny nose .

8-Redness of the tonsils and throat , White patches on the tonsils

9-Tenderness in the glands of the neck (swollen lymph glands) .

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10-Ear pain (caused by nerves that go to the back of the throat also go to the ear)

Tonsillitis Contagious

Tonsillitis is contagious. Tonsillitis is spread mainly by droplets from direct contact (kissing) or
airborne droplets (cough).

Viral caused tonsillitis is often contagious for about 7–10 days while untreated bacterial caused
disease may be contagious for about 2 weeks.

However, bacterial caused tonsillitis can be treated with antibiotics and the patient usually is not
contagious 24–48 hours after starting antibiotics.

Diagnosis

 1. Physical examination .
 2. a swab specimen from the back of the throat.

Treatment

 1. Throat pain and fever may be improved with over-the-counter pain relievers such as
ibuprofen (Advil, for example) or acetaminophen (Tylenol).
 2. Ease sore throat pain by gargling frequently with warm salt water (8 ounces of warm water
mixed with 1 teaspoon salt).
 3. Drink plenty of clear liquids to avoid dehydration.

4. Because most sore throats are caused by viruses, antibiotics are not routinely needed.
However, penicillin is the most commonly prescribed class of antibiotics.

 5.People who are allergic to penicillin may be treated with erythromycin. Treatment with oral
antibiotics may be provided for 10-14 days.
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Nursing Diagnosis for Tonsillitis

 Ineffective Airway Clearance related to obstruction of breath due to foreign bodies;

excess production secret.
 Acute Pain related to swelling of tissues; surgical incision.
 Imbalanced Nutrition Less Than Body Requirements related to the anorexia; difficulty
swallowing.
 Knowledge deficit related to lack of understanding.
 Risk for Fluid Volume Deficit related to the risk of bleeding due to operative action.
Nursing Interventions

1-Exempt a patent airway (keep your head in a state parallel to the spine / as indicated(

2 -Perform suctioning if necessary.

3-Assess the respiratory system function.

4- Assess the patient's ability to do cough / business release secretions.
• Observation of vital signs before and after taking action.
• Observation for signs of respiratory distress (the skin becomes
pale/cyanosis.(
• Collaboration with the therapists in the provision of
Physiotherapy.
5-Assess the level or degree of pain felt by patients in using the scale ,help the patients in
finding the factors the precipitation on pain in feel.
6-Create a peaceful environment.