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MS1 Comprehensive Final Study Guide Latest Exam 2023-24
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MS1 Comprehensive Final Study Guide Latest Exam 2023-24MS1 Comprehensive Final Study Guide Latest Exam 2023-24
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MS1 Comprehensive Final Study Guide Latest Exam 2023-241. 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
P a g e 1 | 78
, 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
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
P a g e 2 | 78
,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. The patient may need to undergo frequent
evacuation of drainage and debris in an outpatient setting. Often chronic
TM perforations do not heal with conservative treatment, and surgery is
necessary. Tympanoplasty (myringoplasty) involves reconstruction of
the TM and/or the ossicles. A mastoidectomy is often performed with a
P a g e 3 | 78
, tympanoplasty to remove infected portions of the mastoid bone.
Removal of tissue stops at the middle ear structures that appear
capable of conducting sound. Sudden pressure changes in the ear and
postoperative infections can disrupt the surgical repair during the
healing phase or cause facial nerve paralysis.
Table 22-9 COLLABORATIVE CARE
CHRONIC OTITIS MEDIA
DIAGNOSTIC COLLABORATIVE THERAPY
• History and physical • Ear Irrigations
examination
• Otic, oral, or
• Otoscopic examination parental
• Culture and sensitivity of antibiotics
middle ear drainage • Analgesics
• Antiemetics
• Surgery
• Tympanoplasty
(see eTable 22-2)
• Mastoidectomy
• F.Y.I Postoperative INFO: Impaired hearing is expected during the
postoperative period if there is packing in the ear. A cotton ball dressing
is used for the incision made through the external auditory canal
(endaural). Instruct the patient to change the cotton packing as needed.
If a postauricle (behind the ear) incision is used and a drain is in place,
place a dressing over the mastoid area (sits behind the ear). A small
gauze pad is cut to fit behind the ear, and soft dressing material is
applied over the ear to prevent the outer circular head dressing from
placing pressure on the auricle. Monitor the tightness of the dressing to
prevent tissue necrosis and assess the amount and type of drainage.
Keep the suture line dry. Also from Saunders pg. 899: Keep dressing
clean and dry. Keep client flat as prescribed, with the operative ear up
for at least 12 hours. Administer antibiotics as prescribed.
Mastoid disease?
• Saunders ch. 64 pg. 899 (this book had more about this than our text
book): Mastoid disease (Mastoiditis) may be acute or chronic and results
from untreated or inadequately treated chronic or acute otitis media. The
pain is not relieved by myringotomy.
• Assessment: swelling behind the ear and pain with minimal
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