NURS 4385 PEDS EXAM 2 GUIDE The Child With
A Respiratory Alteration 2023 A+
Module 6 – The child with a Respiratory Alteration
1. Otitis Media
Common illness in infancy and childhood
The term otitis media refers to effusion (fluid) and infection or blockage of the
middle ear.
Acute otitis media (AOM) is effusion and inflammation of the middle ear that
occurs suddenly, and it is associated w/ other signs of illness.
Otitis media w/ effusion (OME) is the presence of fluid behind the tympanic
membrane w/o signs of infections.
• It often follows an episode of AOM
• Resolves in 1 to 3 months.
Etiology:
o Otitis media is triggered by a bacterial infection (S.
pneumoniae, H. Influenzae, and M. catarrhalis)
o Viral infection (Respiratory syncytial virus or influenza)
o Allergies or enlarged adenoids
Risk factors:
• Infants younger than 1 year who attend daycare have a
significant risk for acquiring AOM
• Age (6 to 20 months old)
• Ethnicity (higher in Native Americans, Alaskan and Canadian
Inuit, and Indigenous people of Australia)
• Exposure to household cigarette smoke or secondhand smoke
• Poverty
• Bottle feeding (b/c of the position of the infant during feeding, reflux
of formula into the eustachian tube from the nasopharynx occurs when
the infant swallows while supine.)
• Cleft lip and/ or cleft palate
,NURS 4385 PEDS EXAM 2 GUIDE The Child With
A Respiratory Alteration 2023 A+
• Noncompliance w/ childhood immunizations
• Down syndrome
There is a lower incidence of otitis media in infants who are breastfed due to the
presence of immunoglobulin A (IgA) in breast and the semi-vertical position of the
breastfed babies
Breastfeeding offers protection from ear infection by providing maternal
antibodies.
The more upright position of the infant while nursing or bottle feeding there will
be some form of protection against ear infection.
Incidence:
• Boys have a higher incidences of otitis media than girls
• Incidence of otitis media is higher in the winter and spring and lowest in the
summer.
• Early onset of AOM (during infancy) increases the risk of recurrent episodes
• Most initial episodes occur approximately 6 months of age, when
maternal antibody levels decline.
Manifestations:
AOM is characterized by the following:
• Otalgia (earache) – infants may pull on their ears or roll their heads
• A bulging, opaque tympanic membrane that looks red w/
decreased mobility; diffuse light reflex; and obscured landmarks
• Drainage – yellowish green, purulent, and foul smelling
(indicates perforation of the tympanic membrane)
• These signs and symptoms might also be accompanied by
irritability, sleep disturbances, persistent crying in infants, fever,
vomiting, anorexia, or diarrhea (especially in infants).
OME differs from AOM b/c there is no sign of acute infections.
• The tympanic membrane appears retracted and either dull gray or yellow
and an air-fluid level or air bubbles are visible
• The mobility of the tympanic membrane is decreased, and landmarks
are distorted.
• Associated signs and symptoms are subtle and include the following:
o Tinnitus, popping sounds
, NURS 4385 PEDS EXAM 2 GUIDE The Child With
A Respiratory Alteration 2023 A+
o Hearing loss (usually conductive) below 35 decibels
o In older children hearing loss manifest as:
▪ Behavior problems,
▪ Poor school performance,
▪ Disturbed sleep,
▪ Irritability, and
▪ Decreased responsiveness.
o Mild balance disturbances result in delays in motor skills
o A flattened tracing and negative pressure on the tympanogram
• AOM is considered persistent if the child experiences symptoms while
being treated or within 1 month after treatment is completed.
• AOM is viewed as recurrent if the child experiences more than
three episodes over a 6-month period or four episodes in a year
Diagnostic Evaluation:
• Pneumatic otoscopy – a small puff of air is blown into the ear canal
through the otoscope; helps the examiner to discern the appearance and
mobility of the tympanic membrane
• Tympanometry
• Tympanography
Therapeutic Management:
• Accurate diagnosis of AOM before treatment decision are made
• Optimal pain relief w/ an appropriate analgesic for children w/ AOM
• Symptomatic treatment and observation for 48 to 72 hours after
diagnoses as an alternative to imitating antibiotic therapy for
selected
children’
• Reassessment and treatment initiation for children w/ positive AOM
after the 48-to-72-hour observation period
• Use of Amoxicillin at a dose of 80 – 90 mg/kg/day for 5 to 10 days
when treatment is indicated, or
• Cephalosporin for children allergic to penicillin
• Encouraging reduction of risk factors as a method of preventing
AOM episodes.
Infants and young children (6 to 24 months):
• Initiate antibiotics if the child had a positive diagnosis of AOM along w/
pain and fever (>39* C) for 48 hours or bilateral AOM w/ mild
symptoms
A Respiratory Alteration 2023 A+
Module 6 – The child with a Respiratory Alteration
1. Otitis Media
Common illness in infancy and childhood
The term otitis media refers to effusion (fluid) and infection or blockage of the
middle ear.
Acute otitis media (AOM) is effusion and inflammation of the middle ear that
occurs suddenly, and it is associated w/ other signs of illness.
Otitis media w/ effusion (OME) is the presence of fluid behind the tympanic
membrane w/o signs of infections.
• It often follows an episode of AOM
• Resolves in 1 to 3 months.
Etiology:
o Otitis media is triggered by a bacterial infection (S.
pneumoniae, H. Influenzae, and M. catarrhalis)
o Viral infection (Respiratory syncytial virus or influenza)
o Allergies or enlarged adenoids
Risk factors:
• Infants younger than 1 year who attend daycare have a
significant risk for acquiring AOM
• Age (6 to 20 months old)
• Ethnicity (higher in Native Americans, Alaskan and Canadian
Inuit, and Indigenous people of Australia)
• Exposure to household cigarette smoke or secondhand smoke
• Poverty
• Bottle feeding (b/c of the position of the infant during feeding, reflux
of formula into the eustachian tube from the nasopharynx occurs when
the infant swallows while supine.)
• Cleft lip and/ or cleft palate
,NURS 4385 PEDS EXAM 2 GUIDE The Child With
A Respiratory Alteration 2023 A+
• Noncompliance w/ childhood immunizations
• Down syndrome
There is a lower incidence of otitis media in infants who are breastfed due to the
presence of immunoglobulin A (IgA) in breast and the semi-vertical position of the
breastfed babies
Breastfeeding offers protection from ear infection by providing maternal
antibodies.
The more upright position of the infant while nursing or bottle feeding there will
be some form of protection against ear infection.
Incidence:
• Boys have a higher incidences of otitis media than girls
• Incidence of otitis media is higher in the winter and spring and lowest in the
summer.
• Early onset of AOM (during infancy) increases the risk of recurrent episodes
• Most initial episodes occur approximately 6 months of age, when
maternal antibody levels decline.
Manifestations:
AOM is characterized by the following:
• Otalgia (earache) – infants may pull on their ears or roll their heads
• A bulging, opaque tympanic membrane that looks red w/
decreased mobility; diffuse light reflex; and obscured landmarks
• Drainage – yellowish green, purulent, and foul smelling
(indicates perforation of the tympanic membrane)
• These signs and symptoms might also be accompanied by
irritability, sleep disturbances, persistent crying in infants, fever,
vomiting, anorexia, or diarrhea (especially in infants).
OME differs from AOM b/c there is no sign of acute infections.
• The tympanic membrane appears retracted and either dull gray or yellow
and an air-fluid level or air bubbles are visible
• The mobility of the tympanic membrane is decreased, and landmarks
are distorted.
• Associated signs and symptoms are subtle and include the following:
o Tinnitus, popping sounds
, NURS 4385 PEDS EXAM 2 GUIDE The Child With
A Respiratory Alteration 2023 A+
o Hearing loss (usually conductive) below 35 decibels
o In older children hearing loss manifest as:
▪ Behavior problems,
▪ Poor school performance,
▪ Disturbed sleep,
▪ Irritability, and
▪ Decreased responsiveness.
o Mild balance disturbances result in delays in motor skills
o A flattened tracing and negative pressure on the tympanogram
• AOM is considered persistent if the child experiences symptoms while
being treated or within 1 month after treatment is completed.
• AOM is viewed as recurrent if the child experiences more than
three episodes over a 6-month period or four episodes in a year
Diagnostic Evaluation:
• Pneumatic otoscopy – a small puff of air is blown into the ear canal
through the otoscope; helps the examiner to discern the appearance and
mobility of the tympanic membrane
• Tympanometry
• Tympanography
Therapeutic Management:
• Accurate diagnosis of AOM before treatment decision are made
• Optimal pain relief w/ an appropriate analgesic for children w/ AOM
• Symptomatic treatment and observation for 48 to 72 hours after
diagnoses as an alternative to imitating antibiotic therapy for
selected
children’
• Reassessment and treatment initiation for children w/ positive AOM
after the 48-to-72-hour observation period
• Use of Amoxicillin at a dose of 80 – 90 mg/kg/day for 5 to 10 days
when treatment is indicated, or
• Cephalosporin for children allergic to penicillin
• Encouraging reduction of risk factors as a method of preventing
AOM episodes.
Infants and young children (6 to 24 months):
• Initiate antibiotics if the child had a positive diagnosis of AOM along w/
pain and fever (>39* C) for 48 hours or bilateral AOM w/ mild
symptoms
