Definitions
Otitis media is an infection or inflation (inflation: Inflammation) the middle ear. The middle ear is the area bounded by the outside world by the ear drum. This area connects the sound with a hearing in the inner ear. Also in this area there is a line "eustachian" that connects the middle ear to the back of the nasal cavity and upper throat.
Use of this channel are:
1. Maintain the balance of air pressure in the ear and adjust air pressure in the outside world
2. Drain the mucus produced fewer cells lining the middle ear to the back of the nose.
Cause
The cause of acute otitis media may be a virus or bacteri1. In 25% of cases and sometimes infect the middle ear with the bacteri1. Virus / bacteria that commonly cause otitis media are Streptococcus pneumoniae. Followed by Haemophilus influenzae and Moraxella caltarhalis. To remember the otits media, although most cases are caused by bacteria, only a few cases requiring antibiotics. This is possible because no antibiotic was eustachius channel will be open again so that the bacteria will be eliminated with the flow of mucus.
Why are children more susceptible to otitis media?
Children more susceptible to otitis media as compared to adults:
1. Child's immune system is still in development
2. Eustachius tract in children is more straight and shorter horizontally so that the ARI is more easily spread ketelinga middle.
3. Adenoids (adenoids salahs atu ditenggorokkan upper organ that plays a role in the immune system) is relatively larger in children than adults. Adenoid position adjacent to the mouth of the eustachian channel. In addition adenoid itself can be infected when the infection then spreads to the middle ear through the channel uestachius.
Diagnosis
OMA diagnosis must meet three of the following:
1. Disease appear suddenly (acute)
2. The discovery marks lefusi elasi: sector in body cavity fluid collection) the middle ear. Effusion demonstrated the presence of either one of the following signs:
- Mengembungkan eardrum
- Limited / absence of movement of the eardrum
- The shadow of fluid behind the eardrum
- Fluid out of the ear.
3. Signs / symptoms of middle ear inflammation, as evidenced by the presence of either one of the following signs:
- Redness of the eardrum
- Ear pain that interferes with sleep and normal activity
Symptoms and signs of Otitis media
1. Ear pain, fever, irritability
2. Middle ear effusion
3. Eardrum bleak
4. Mengembung eardrum
5. Reduced drum movement
6. Decreased hearing
Symptoms and signs of otitis media with effusion:
1. Middle ear effusion
2. Eardrum bleak
3. Reduced drum movement
4. Decreased hearing
Handling
1. Antibiotics
OMA is a disease that will usually heal by itself. Approximately 80% of OMA cured in 3 days without antibiotics. The use of antibiotics does not reduce the complications that can occur, including decreased hearing.
Observations can be done in most cases. If symptoms do not improve within 48-72 hours or no change in symptoms, antibiotics are given
The definition of mild symptoms are mild ear pain and fever <39oC in 24 hours. While the symptoms are severe ear pain is severe or fever-39 oC.
Antibiotics on the OMA will result in improvement of symptoms within 48-72 hours. In the first 24 hours occurred within 24 hours of stabilization are both taking place improvements. If the patient does not improve within 48-72 hours, there may be other diseases or treatment provided is not adequate.
In this case such as this, antibiotics are considered:
- In patients with severe symptoms or OMA is probably caused by Haemophilus influenzae in moraxalle catarrhalis, which are then selected antibiotic is amecixillin clavumate. Another source states granting clavulanate amoxixillin do if symptoms do not improve in 7 days re-emerged in 14 days.
- If the patient's allergies can be mild to amocixillin caphalosphorin such as cefdinir, loracarbef, or cefuroxime.
- In the severe allergy to amocixillin, the money given is azithormycin or clarithornycin.
2. Analgesia / pain reliever
Besides antibiotics, treatment should be accompanied OMA pain (analgesia). Analgesia is generally used on simple analgesia such as paracetamol or ibuprofen can aggravate the digestive tract irritation.
Other:
1. Provision of other drugs: as anthihistamin (allergy) or dekongestyan not provide benefits for children.
2. Corticosteroids is not recommended
3. Myrongitomy
4. Giving antibiotics as prophylaxis to prevent recurrence of the OMA does not have sufficient evidence
Prevention
Some of this seems to reduce the risk of OMA
1. And prevention of ARI in children bayui
2. Breastfeeding for at least 6 months
3. Prevention of child-feeding while lying down dibotol
4. And avoidance of tobacco smoke exposure
Complications
Chronic otitis media is characterized circuitry in a history of chronic discharge from one or two ears. If the eardrum has been ruptured for more than 2 weeks, the risk of infection has become very common. Generally, the handling is done is wash and dry ears for several weeks until the liquid is no longer out.
Otitis media is not treated it can spread to tissues surrounding the middle ear, including the brain. But these complications are generally rare. One is mastoiditis in 1 in 1000 children who were not treated OMA circuitry.
Diagnosis appears:
1. Acute pain related to the agent bioloti
2. Sleep disorders associated with pain agent
3. Hyperthermia associated with disease or trauma
4. Anxiety related to health status.
NOC (Purpose)
DX :1
1. Lomfosit level (2100)
- Reported physical mell-being (210001)
- Reproted statisfaction with symptom contril (210002)
- Reported psyehclogikal well-beining (210003)
- Expressed contentetement with physical remanding (210004)
- Expressed contentement with social relationship (210005)
2. Pain control (1605)
- Recognize causal factor (160501)
- Recognize pain anset (160502)
- Use preventive inpasures (160503)
- Use non-analgesik reliet measures (160504)
- Use analgesic apporiatelery (160505)
3. Pain level (2102)
- Reported pain (210201)
- Percent of body affectzd (210202)
- Freluency of pain episodes (210204)
- Oral expresnous of pain (210205)
DX : 2
1. Anxiety control (1402)
- Monitors of anxipty (140201)
- Himimales proasure of anxiety (140202)
- Decrease envirotment stimuli when anxious (140203)
- Use effective coping strategis (140206)
- Use relaction techniques toreduce anxiety (140207)
2. Rest (0003)
- Amount of rest (000301)
- Rest pattern (000302)
- Rest quality (000303)
- Physically rested (000304)
- Mentally rested (000305)
3. Sleep (0004)
Hours of sleep (000401)
Sleep pattern (000403)
Sleep quality (000404)
Sleep effiaphcy (000405)
Sleep routnice (000407)
DX : 3
1. Thermoregulation (0800)
- Skin temperature IER (080001)
- Body temperature WNL (080002)
- Headache nol present (080003)
- Respiratory rate IER (080014
- Hydration adecute (080014)
2. Thermoregulation : Neonate (080101)
- Body temperature WNL (080101)
- Respiratory distress not present (080102)
- Restlesrness not present (080103)
- Skin coles change IER (080105)
- Weight gain IER (080106)
DX : 4
1. Anxiety control (1402)
- Monitors intensity of anxiety (140201)
- Elminates precursor of anxiety (140202)
- Decrearsus envirobmental stimulasi when anxioor (140203)
- Plans coping strategis for stesiful situation (140205)
- Use effective coping strategis (140206)
2. Coping (1302)
- Identities effective coping pattern (130201)
- Identities ineffective coping pattern (130202)
- Modities life style as needed (130207)
- Employs behaviors to reduce stress (130211)
- Use effective coping stragnes (130212)
3. Impuls control (1405)
- Identifies harmful implusive behaviors (140501)
- Identities feelings that lead folmpulsive actions (140502)
- Recognizes rinc in environtment (140505)
- Verbaliset control of impulses (14050705)
- Accepts rofernalis for treatment (140510)
INTERVENTION (NIC)
DX: 1
Pain Management
1. The review comprehensively about pain, including the location, characteristics and oaset, duration, frequency, quality, intensity / severity of pain and the participation factors
2. OPbservasi non-verbal terms of inconvenience, especially in the inability to communicate effectively
3. Use therapeutic communication so that patients can express pain
4. Evaluation of the effectiveness of the actions that have been used to control pain
5. Control factor-environmental factor that can affect the patient's response to discomfort
6. Provide information about the pain such as: causes, some of the old place and precautions
7. Give analgesics according to the recommended circuitry
8. Increase / adequate rest
9. Monitor patient comfort for pain management
10. Perform technical variations to reduce the pain
DX : 2 Sleep Enhancement
1. Determine patients sleep /activity pattern
2. Approximate patient regular sleep/make cycle in planning care
3. Explain the importance of educate sleep
4. Determine the effect of the patients mediation on sleep pattern
5. Monitor/recorded patients sleep pattern and number of sleep hours
6. Instruct comfort measure of message, positioning and affective touch
7. Implement comfort measure of message, posiolioning in effective touch
8. Promot an increase in number of hours of sleep if needed
9. Provide for naps during the day, if in diated to meet sleep requirement.
DX: 3
Fever treatment
1. Monitor the temperature as often as possible
2. Monitor skin color and temperature
3. Monitor blood pressure, pulse, and RR
4. Monitor intake and output
5. Give antipelink
6. Monitor decreased level of consciousness
7. Provide treatment to have the cause of fever
8. selimuti patients
9. Provide treatment to prevent shivering.
DX: 4 Anxiety Reducation
1. Reassure the client
2. Provide information about diagnosis, prognosis and action
3. Assess the level of anxiety and physical reactions at the level of anxiety (toachycardia, tachppnea, non-verbal expression of dismay)
4. Accompany the patient to support the safety and reduce fear
5. Provide activities to reduce tension
6. Bantul patients to identify situations that create anxiety
7. Support the use of defensive mechanisms in the right way
8. Instruct patient to use relaxation techniques
9. Give medication to reduce anxiety in a proper way trying to understand the state of the client.
PHYSICAL EXAMINATION EAR
a. Assist the patient in a sitting position of patients who were children can be arranged to sit on the lap of others
b. Adjust your sitting position facing the patient's ear to be reviewed.
c. For lighting, use auroskop, past the head or other light source so that your hands will be free to work
d. Begin to observe external ear, check the state of the pinna of the size, shape, color, and the presence of mass lesions on the pinna
e. Continue assessment of palpation by holding the ear with the thumb and finger tenunjuk
f. Palpation of the outer ear cartilage, namely the systematic network of luna, then the hard tissue and note if there is pain
g. Press the tragus to the ear bones and the press are below the ear leaf. When there is inflammation amka patient will feel pain
h. Compare the left ear and right ear
i. If necessary, continue the assessment of the inner ear
j. Grasp the edge of the auricle / helix and slowly pull the ear upward and backward so that the ear canal becomes straight and easily observable. In children, the ear is pulled down.
k. Observe the entrance hole of the ear and note the presence or absence of inflammation, bleeding or dirt
l. Carefully insert the lit otoskop into the ear hole
m. If the location is right otoskop, put your eyes on eye-piece
n. Observe the presence of dirt, wax, inflammation or foreign bodies in the ear hole.
o. Observe the shape, color, transparency, luster, or perforation of a blood / fluid
EXAMINATION HEARING
Way of hearing a whisper
1. Adjust your back to the patient standing at a distance of about 4.5 to 6 meters
2. Instruct the patient to cover one ear that does not dipemeriksaan
3. Whisper of a number (eg seven six).
4. Tell the patient to repeat numbers at the hearing
5. Examination of the other ear the same way
6. Compare the ability to hear the right ear and left the patient
Ways to watch hearing
1. Hold a watch on the patient's ear
2. Have the patient states whether to hear the watch ticking
3. Move slowly watch the position of the ear and send the patient away from the states if they are not able to hear again. Normally the clock rate can still be heard at distances up to about 30 cm
4. Compare the right and left ear
Way of hearing with tuning fork
1. The first examination (Rinne)
a. Vibrasikan garputala
b. Put a fork in the left mastoid patients
c. Instruct patient to tell when no longer feel the vibrations
d. Lift and hold the tuning fork in front of the patient's left ear with a tuning fork position parallel to the external ear canal of patients.
e. Instruct patient to tell whether still hear the sound vibration or not.
2. Second examination (Weber)
a. Fibrasikan garputala
b. Put a fork in the middle of the forehead of patients
c. Ask the patient about the ears hear the sound balanced, so that the vibrations felt in the middle of the head.
d. Record the results of the hearing.
3. Determinasikan whether the patients had impaired bone conduction, air or both
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