Med_Surg_Final_Comprehensive study Guide.

Med_Surg_Final_Comprehensive study Guide. 1. What is a myringotomy? Why is one done? Ch. 22 Pg. 404- Lewis  Myringotomy is an incision in the tympanum to release the increased pressure and exudate (fluid) from the middle ear. A tympanostomy tube may be placed for short- or long- term use. Prompt treatment of an episode of acute otitis media generally prevents spontaneous perforation of the TM (Tympanic membrane). If allergies are a causative factor, antihistamines may also be prescribed.  This is a surgical intervention for acute otitis media, (which is an infection of the tympanum, ossicles, and space of the middle ear infection. Pressure from the inflammation pushes on the TM, causing it to become red, bulging, and painful. Acute otitis media is usually a childhood disease because, in children, the auditory tube that normally drains fluid and mucus from the middle ear is shorter and narrower and its position is flatter than adults. Infection can be due to viruses or bacteria. Pain fever, malaise, and reduced hearing are signs and symptoms of infection. Referred pain from the temporomandibular joint, teeth, gums, sinuses, or throat may also cause ear pain). Surgical intervention is generally reserved for the patient who does not respond to medical treatment.  Saunders Ch. 41 Pg. 469: Myringotomy is a surgical incision into the tympanic membrane to provide drainage of the purulent middle ear fluid; may be done by a laser assisted procedure. Tympanoplasty tubes may be inserted into the middle ear to allow continued drainage and to equalize pressure and allow ventilation of the middle ear.  F.Y.I. Saunders Ch. 41 Pg. 469 Postoperative interventions: A. Instruct the parents and child to keep the ears dry. B. The client should wear earplugs while bathing, shampoo, and swimming (diving and submerging under water are not allowed). C. Parents can administer an analgesic such as acetaminophen (Tylenol) or ibuprofen (Motrin IB) to relieve discomfort after insertion of tympanoplasty tubes. D. Parents should be taught that the child should not blow his or her nose for 7 to 10 days after surgery. E. Instruct the parents that if the tubes fall out, it is not an emergency, but the health care provider (HCP) should be notified; inform the parents of the appearance of the tubes (tiny, white, spool-shaped tubes).  F.Y.I Saunders Ch. 64 pg. 898 BOX Client education following Myringotomy: Avoid strenuous activities, Avoid rapid head movements, bouncing, or bending, Avoid straining on bowel movements. Avoid drinking through a straw. Avoid MS1 Comprehensive Final Study Guide traveling by air. Avoid traveling by air. Avoid forceful coughing. Avoid contact with persons with colds. Avoid washing hair, showering, or getting the head wet for 1 week as prescribed. Instruct the client that if he or she needs to blow the nose to blow one side at a time with the mouth open. Instruct the client to keep ears dry by keeping a ball of cotton coated with petroleum jelly in the ear and to change the cotton ball daily. Instruct the client to report excessive ear drainage to the HCP. 2. What is chronic otitis media?  Lewis Ch. 22 Pg. 404: characterized by purulent exudate and inflammation that can involve the ossicles (three bones in either middle ear that are among the smallest bones in the human body; malleus, incus, staples), the auditory tube and the mastoid bone. It is often painless. Hearing loss, nausea, and episodes of dizziness can occur. Hearing loss is a complication from inflammatory destruction of the ossicles, a TM (Tympanic membrane) perforation, or accumulation of fluid in the middle ear space. A mass of epithelial cells and cholesterol in the middle ear (cholesteatoma) may also develop. The cholesteatoma enlarges and can destroy the adjacent bones. Unless removed surgically, it can cause extensive damage to the ossicles and impair hearing. Otoscopic examination of the TM may reveal changes in color and mobility or a perforation. Culture and sensitivity tests of the drainage are necessary to identify the organisms involved so that appropriate antibiotic therapy can be prescribed. The audiogram may demonstrate a hearing loss as great as 50 to 60 dB if the ossicles have been damage or separated. Sinus x-rays, MRI, or a computed tomography (CT) scan of the temporal bone is done to assess for bone destruction and the presence of a mass.  Nursing care: The aims of treatment are to clear the middle ear of infection, repair any perforations and preserve hearing. Otic and systemic (oral and IV) antibiotic therapy is started based on the culture and sensitivity results. In many cases of chronic otitis media, antibiotic resistance is present.