UNIVERSITY OF

PERPETUAL HELP
SYSTEM DALTA

Grand Case Presentation

Second Semester S.Y. 2021-2022

Nursing Care Management for a Patient

with Auditory Disorder

In Partial Fulfillment of the Requirements in the Course

NCM 116L

Prepared by:
Kagaya, Ronnarin Z.
Landrito, Jasstine Erika O.
Lipata, Sheikainah Mae T.
Medina, Louie Nicoll A.
Moldez, Denise Allyson M.
Navidad, Glee Ann C.
Oyson, Joshua T.
Paulin, Ivygail Karen K.
Payanay, Fatima May E.
Pepito, Chrismonte Kyle

BSN 3A – Group 4

Presented to:
UPHSD Nursing Faculty

June 2022
 TABLE OF CONTENTS
Introduction ......................................................................................................................... 1
Chief Complaint .................................................................................................................. 3
Patient’s Profile................................................................................................................... 3
Nursing History ................................................................................................................... 3
History of Present Illness .................................................................................................... 3
Past Medical History ........................................................................................................... 3
Family History .................................................................................................................... 4
Physical Assessment ........................................................................................................... 6
Vital Signs........................................................................................................................... 6
Additional Measurement ..................................................................................................... 7
Primary Assessment ............................................................................................................ 7
Anatomy and Physiology .................................................................................................... 9
Pathophysiology of Otitis Externa .................................................................................... 12
Pathophysiology of Acute Otitis Media............................................................................ 13
Diagnostic and Laboratory Examinations ......................................................................... 15
Clinical Findings and Significant Signs and Symptoms ................................................... 16
Nursing Care Plan (1st Actual) .......................................................................................... 18
Nursing Care Plan (2nd Actual) ......................................................................................... 21
Nursing Care Plan (3rd Actual) ......................................................................................... 25
Nursing Care Plan (1st Potential) ...................................................................................... 28
Nursing Care Plan (2nd Potential) ..................................................................................... 31
Drug Study ........................................................................................................................ 35
Discharge Planning (M.E.T.H.O.D.S) .............................................................................. 37
References ......................................................................................................................... 38
 INTRODUCTION
Otitis externa is an inflammation of the skin and soft tissue surrounding the ear canal.
It is sometimes referred to as “swimmer’s ear” because it is common in children who frequently
swim, particularly in hot and humid weather. Cotton-tipped applicators and foreign objects can
also cause damage to the ear canal. Any canal irritation can become infected with bacteria,
viruses, or fungi; it can also be an allergic reaction. The child usually complains of pain and
itching and may have intense pain when the examiner presses on the tragus or skin tab in front
of the ear. On otoscopic examination, the ear may appear swollen, with redness or drainage of
the canal.
A malfunction of the eustachian tube usually causes middle ear infections. This canal
connects the middle ear to the throat. The eustachian tube aids in equalizing pressure between
the outer and middle ear. When this tube malfunctions, it prevents normal drainage of fluid
from the middle ear, resulting in a buildup of fluid behind the eardrum. When this fluid cannot
drain, bacteria and viruses can grow in the ear, leading to acute otitis media.
Otitis media is inflammation located in the middle ear. It can result from a cold, sore
throat, or respiratory infection. According to Stanford Children’s Health (2019), more than 80
percent of children have at least one episode of otitis media by the time they are three years of
age. In addition, it occurs most often in children 6 to 36 months of age and again at 4 to 6 years
(Silbert-Flagg & Pillitteri, 2018). Otitis media can also affect adults, although it is primarily a
condition that occurs in children.
Different types of otitis media include the following:
• Acute otitis media (AOM) – is an acute middle ear infection that causes swelling and
redness. Fluid and mucus become trapped inside the ear, causing fever, ear pain, and
hearing loss in the child.
• Otitis media with effusion (OME) – fluid effusion and mucus continue to accumulate
in the middle ear after the initial infection. The child may have a feeling of fullness in
the ear, which may affect his or her hearing, or it can be asymptomatic.
• Chronic otitis media with effusion (COME), the fluid remains in the middle ear for
a prolonged period or returns again and again, even though there is no infection. This
may result in difficulty fighting new infection and hearing loss.
The following are the most common symptoms of otitis media. However, each child
may experience symptoms differently. Symptoms may include:
• unusual irritability • fluid draining from ear(s)
• difficulty sleeping or staying asleep • loss of balance
• tugging or pulling at one or both ears • hearing difficulties
• fever • ear pain
During the admission, the physician will perform a complete medical history and
physical examination, and an otoscope is used to inspect the outer ear and eardrum. To test
the eardrum movement, a pneumatic otoscope will be used to blow a puff of air into the ear.

1
Tympanometry tests can be done in most physicians’ offices to determine how well the middle
ear works. It does not tell whether the child is hearing, but it can detect changes in pressure in
the middle ear. It is difficult to perform this test on younger children because they must remain
still and not cry, talk, or move.
Specific treatment for otitis media is determined by the child’s physician based on the
following: child’s age, overall health and medical history, the extent of the condition, child’s
tolerance for specific medications, procedures, or therapies, expectations for the course of the
condition, and parent’s opinion or preference. Treatment may include antibiotic medication by
mouth or ear drops and medication for pain. If fluid remains in the ears for longer than three
months, the physician may suggest that small tubes be placed in the ears. This surgical
procedure, called a myringotomy, involves making a small opening in the eardrum to drain the
fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the
eardrum to ventilate the middle ear and prevent fluid from accumulating. The child’s hearing
is restored after the fluid is drained. The tubes usually fall out on their own after six to 12
months. Moreover, the surgeon may also recommend the removal of the adenoids if they are
infected. Removal of the adenoids has been shown to help some children with otitis media.
Otitis media (OM) is the most common illness in childhood, and its management is a
controversial topic. Serious complications of acute otitis media (AOM) include:
• Meningitis • Mastoiditis
• Brain abscesses • Permanent sensorineural hearing loss
• Epidural abscesses • Death

Perforation of the eardrum is common: progression to chronic suppurative otitis media

may occur. Labyrinthitis, meningitis, intracranial sepsis, or facial nerve palsy are rare and occur
in fewer than 1 in 1,000. In addition, in a child with a high temperature, there is a risk of febrile
convulsions. Rare complications include:
• Petrositis • Subarachnoid abscess
• Acute necrotic otitis • Subdural abscess
• Otitis hydrocephalus • Sigmoid sinus thrombosis

Rarely, systemic complications can occur, including:

• Bacteremia
• Septic arthritis
• Bacterial endocarditis
This study presents the case of a 9-year-old patient with acute otitis media with externa.
The patient experienced pain in the right ear a day after their family outing at Pansol, Laguna.
The mother inspected the affected ear and found that it was inflamed inside. He was advised
to be admitted to Asian Medical Center but refused and was prescribed by antibiotic. Due to
the patient’s noncompliance in taking medication, symptoms persisted and made them seek
consultation at Perpetual Help Medical Center.

2
 CHIEF COMPLAINT
Right ear pain

PATIENT’S PROFILE
Client’s Initials Y. G. D.
Age 9 years old
Sex Male
Birthday April 17, 2013
Religion Catholic
Civil Status Child
Nationality Filipino
Address Bacoor, Cavite
Occupation Student
Room Number 303
Admitting Date May 6, 2022
Chief Complaint Right ear pain
Admitting Diagnosis Acute Otitis Media w/ Externa; COVID suspect
Final Diagnosis Acute Otitis Media w/ Externa
Attending Physician Dr. E. B.

NURSING HISTORY
History of Present Illness
Three days PTC, the patient had a family outing at Pansol, Laguna. Two days PTC,
pain was noted in his right ear. It was tolerable with no other associated symptoms.
However, the mother noted upon inspection of the client’s right ear that the inside was
inflamed. One day PTC, the client noted increased severity of ear pain associated with (+)
headache. This prompted the mother to seek consultation at Asian Hospital last May 2,
2022. Fever was also noted with a temperature of 39.0°C. CBC was done, segmenters were
noted to be high, advised admission but opted not to. The client was prescribed antibiotics.
The client also does not want to take oral medications, and the persistence of symptoms
prompted the client to seek consult.

Past Medical History

The patient was hospitalized with gastritis last 2019. It was the only medical
condition experienced by the client that needed hospitalization aside from his present
infection.

3
Personal History
The patient lives with his mother, father, and maid. He is currently a grade 3 with
consistent grades and no reported problems with friends or school. He has a regular diet
and was noted to have gained some weight since 2020. He likes playing virtual games and
watching television at home since the start of the pandemic.

Family History
The patient had a family history of asthma from his paternal side. Hypertension and
breast cancer from the maternal side.

GORDON’S FUNCTIONAL HEALTH PATTERN

Functional Health
Before Hospitalization
Pattern
The patient does not take
any vitamins.
Health Perception
Management The child said that orals
medications are hard to
swallow.
During Hospitalization
Takes chewable Vitamin C
during hospital admission.
Hates taking oral
medications because they
are “bitter.”

Follows no regular meal Incorporated fruits and

plan consisting of meat vegetables into his diet.
products and fewer
vegetables.
Nutritional Metabolic
The client gained weight
during the lockdown.
Drinks more than 8 glasses
Drinks 6-8 glasses of water of water per day.
a day.
Eliminates once a day. Eliminates every other day.
Elimination Pattern
Urinates 7 - 8 times a day. Urinates 5-6 times a day.

Patient does not like Patient does not like

performing physical performing physical
exercises. exercises.
Activity-Exercise
The client spends most of The client spends most of
his time playing online his time playing online
games. games.
Normal cognitive and Attentive during the
Cognitive-Perceptual
perceptual pattern. interview.

4
 Decreased hearing but talks
clearly.

Completes the 8 hours of Completes 8 hours of sleep

sleep per day. daily with distractions due
to medication
administration and doctor’s
Sleep-Rest visits.
The client verbalized that The client verbalized that
he usually sleeps at around he usually sleeps at around
10 pm and wakes up at 12 am and wakes up at
around 9 am. around 6 am

Patient had poor eye Patient had poor eye

contact and communicated contact and communicated
Self-Perception calmly. calmly.
Relies primarily on his Relies primarily on his
mother and “yaya”. mother.

Only child. Evidently, the mother took

Does not help with
household chores because
Role-Relationship
he has a yaya.
Verbalized to have a small
circle of friends.
care of the patient during
his hospital admission.
Verbalized to have a small
circle of friends, and they
play with each other from
time to time.

No sexual and romantic No sexual and romantic

Sexuality-Relationship
relationship. relationship.

Relies primarily on his Relies primarily on his

mother. mother.
Coping/Stress Tolerance
Plays virtual games when Plays virtual games when
feeling stressed. feeling stressed.

Attends online mass every Attends online mass every

Value-Belief Sunday and prays before Sunday and prays before
and after every meal. and after every meal.

5
 PHYSICAL ASSESSMENT
VITAL SIGNS
May 11, 2022
VITAL SIGNS NORMAL ACTUAL
ANALYSIS
(8:00am) FINDINGS FINDINGS
36.5 - 37.5 ℃
Temperature 36.2°C Normal
(axillary)
Pulse Rate 75 - 120 bpm 90 bpm Normal
Respiratory Rate 15-25 cpm 23 cpm Normal
Oxygen Saturation 95 – 100% 98% Normal

VITAL SIGNS NORMAL ACTUAL

ANALYSIS
(9:00am) FINDINGS FINDINGS
36.5 - 37.5 ℃
Temperature 36.4°C Normal
(axillary)
Pulse Rate 75 - 120 bpm 88 bpm Normal
Respiratory Rate 15-25 cpm 26 cpm Normal
Oxygen Saturation 95 – 100% 96% Normal

VITAL SIGNS NORMAL ACTUAL

ANALYSIS
(12:00am) FINDINGS FINDINGS
36.5 - 37.5 ℃
Temperature 36.1°C Normal
(axillary)
Pulse Rate 75 - 120 bpm 95 bpm Normal
Respiratory Rate 15-25 cpm 24 cpm Normal
Oxygen Saturation 95 – 100% 98% Normal

May 12, 2022

VITAL SIGNS NORMAL ACTUAL
ANALYSIS
(8:00am) FINDINGS FINDINGS
36.5 - 37.5 ℃
Temperature 35. 3℃ Normal
(axillary)
Pulse Rate 75 - 120 bpm 93 bpm Normal
Respiratory Rate 15-25 cpm 22 cpm Normal
Oxygen Saturation 95 – 100% 99% Normal

6
 VITAL SIGNS NORMAL ACTUAL
ANALYSIS
(12:00am) FINDINGS FINDINGS
36.5 - 37.5 ℃
Temperature 35.6°C Normal
(axillary)
Pulse Rate 75 - 120 bpm 91 bpm Normal
Respiratory Rate 18 - 30 cpm 25 cpm Normal
Oxygen Saturation 95 – 100% 97% Normal

ADDITIONAL MEASUREMENT
Weight 34kgs / 74.8lbs
Height 123 cm / 4ft
BMI 22.5

PRIMARY ASSESSMENT

NORMAL FINDINGS ACTUAL FINDINGS

Alert, oriented to time, place, person,
and situation, Recent and remote
Patient is awake, alert,
memory intact, No aphasia, dysarthia
conscious, (-) in
General or hoarseness, gait and station normal,
cardiorespiratory distress, (-
Skin warm, dry with good turgor, no
) weak looking
abnormal pigmentation, bleeding,
rash, or other lesions
Varies from light to deep brown; Patient’s skin is fair in color,
from ruddy pink to light pink; from warm to touch, good skin
Skin yellow overtones to olive turgor, (-) cyanosis, (-)
No edema, Freckles, Moisture in pallor, (-) flushed skin, (-)
skinfolds and the axillae petechia, (-) rash
HEENT:
Head Symmetric, no edema, rounded (-) mass, (-) tenderness
Transparent; sclera appears white,
illuminated pupil constricts, Anicteric sclerae, pink
nonilluminated pupil constricts, palpebral conjunctiva, (-)
Eyes
Response is brisk, both eyes discharge, (-) cloudiness,
coordinated, move in unison, with (-) periorbital edema
parallel alignment
Pearly gray color, semitransparent, Symmetric, (-) swelling, (-)
Ears
Normal voice tones audible discharge
Symmetric and straight no discharge (-) nasal flaring, (-)
or flaring uniform color, no tender; no congestion
Nose lesions, mucosa pink, watery
discharge, nasal septum intact and in
midline

7
 Moist, soft, glistening, elastic texture, (-) cleft lip/palate, moist oral
shiny smooth enamel, Pink gums, no mucosa, (-)
Mouth retraction of gums, no tenderness, tonsillopharyngeal
light pink soft palate and lighter pink congestion, (-) exudates, (-)
for hard palate vesicular lesions
Muscles equal in size, no discomfort,
Trachea in the midline, (-)
Coordinated, Lymph nodes are not
Neck palpable mass, (-) cervical
palpable, thyroid gland ascends
lymph adenopathy
during swallowing but is not visible
Anteroposterior to transverse
Patient has symmetrical
diameter in ratio of 1:2, thorax
chest expansion, no
symmetric, Spine vertically aligned,
retractions and use of
Spinal column is straight, chest wall
Chest/Lungs accessory muscles. Also has
intact, no masses, no tenderness,
(-) grunting, (-) dullness, (-)
Bilateral symmetry of vocal fremitus,
crackles, (-) wheezes, (-)
percussion notes resonate, except
rhonchi
over scapula
No lift or heave, symmetric pulse
No precordial bulge, (-)
volumes, elastic arterial wall, full
Heart tachycardia, regular rhythm,
pulsations of carotid arteries, Jugular
(-) PM, (-) ICS, (-) murmur
veins not visible
Flat, rounded, No evidence of
enlargement of liver or spleen,
symmetric contour, symmetric Patient has no palpable mass,
movements caused by respiration, direct and rebound
Abdomen
visible peristalsis, No visible vascular
pattern, audible bowel sounds, tenderness.
absence of arterial bruits, absence of
friction rub, no tenderness
Patient has full and equal
No asymmetry or muscle atrophy,
pulses, < 2 secs capillary
Extremities normal skin temperature, No edema,
refill, and no presence of
All distal pulses intact
clubbing

NEUROLOGICAL
Cranial Nerves Examination GCS
I: not assessed Eye opening = 4/4
II: intact pupillary reflex, brisk & reactive Verbal response = 5/5
III, IV, VI: EOM’s intact Motor response = 6/6
VII: no facial symmetry
VIII: intact hearing and balance Total = 15/15
IX, X: uvula midline when saying “aahh”
XI: good, symmetrical shoulder shrug,
able to turn head against resistance
XII: tongue midline

8
 ANATOMY AND PHYSIOLOGY
The ear is divided into three parts: external, middle, and inner ear.
The external ear includes the
auricle and external auditory canal,
ending until the tympanic membrane
or eardrum. The middle ear is an air-
filled space within the petrous
portion of the temporal bone that
contains the auditory ossicles. The
inner ear houses the sensory organs
for both hearing and balance. It
consists of interconnecting, fluid-
filled tunnels and chambers within
the petrous portion of the temporal
bone. (Vanputte et al., 2014)

EXTERNAL EAR
The auricle, or pinna, is the fleshy part of the external ear found outside of the head
and primarily consists of elastic cartilage covered with skin. It is responsible for collecting
and directing sound waves to the external auditory canal. Hairs and ceruminous glands,
which produce cerumen or earwax, line the external auditory canal. These two keep
foreign objects from reaching the sensitive tympanic membrane. Cerumen overproduction
could also cause canal blockage.

MIDDLE EAR
The tympanic
membrane, or eardrum,
usually is pearly gray and
translucent, measuring
about 1 cm in diameter and
very thin. It separates the
external ear from the middle
ear. Sound waves that travel
through the external
auditory canal cause the
eardrum to vibrate. The
middle ear has three

9
auditory ossicles: malleus, incus, and stapes, which are held in place by joints, muscles,
and ligaments and help transmit vibrations from the eardrum to the oval window. The
middle and inner ear are separated by two small fenestrae (oval and round window) in
the medial wall of the middle ear. The ossicles, particularly the stapes, amplify sound and
transmit it through the oval window to the inner ear and the fluid-filled hearing organ
known as the cochlea. A thin membrane covers the round window, allowing sound
vibrations to adjust or control the pressure inside the cochlea.

INNER EAR
The inner ear is
divided into three
sections. The hearing portion
is the cochlea and vestibule,
while the semicircular canals
are responsible for balancing.
A piston action of the ossicles
creates a wave in the fluid in
the inner ear. The fluid in the
chambers activates the hair
cells in the cochlea, and an
electrical impulse is sent to
the brain via the eighth cranial nerve.
The semi-circular canals, also known as the labyrinth, are aligned at right angles
(90°). This allows the brain to determine which way the head is moving. This, in turn, alters
the electrical impulses to the brain and uses this information to make any necessary
adjustments to the body’s balance. These semi-circular canals are filled with fluid and have
tiny calcium crystals embedded in the lining.
The auditory nerve, the eighth cranial nerve, runs from the inner ear to the brain.
This nerve transmits balance information and sounds to the brain. Along with the eighth
cranial nerve runs the seventh cranial nerve. The seventh cranial nerve is also known as the
facial nerve because it supplies nerve impulses to the muscles of the face.

10
EUSTACHIAN TUBE

The pharyngotympanic tube (eustachian tube) connects the middle ear cavity to the
nasopharynx. It is responsible for equalizing atmospheric pressure in the middle ear;
closing the eustachian tube protects the middle ear from unwanted pressure fluctuations
and loud sounds. Mucociliary clearance removes mucus from the middle ear and drains it
into the nasopharynx, preventing infection from ascending to the middle ear.
Pathological changes in the middle ear can be caused by eustachian tube
dysfunction (e.g., impaired opening or closing, defective mucociliary clearance). This
results in hearing loss and other otitis media complications. Recurrent acute otitis media
and otitis media with effusion are pathological changes. Chronic tympanic membrane
retraction can cause middle ear atelectasis and subsequent adhesive otitis media. A
tympanic membrane retraction pocket caused by chronic eustachian tube dysfunction may
progress to cholesteatoma and potentially severe complications. (Tewfik, 2022)

11
 PATHOPHYSIOLOGY OF OTITIS EXTERNA

PREDISPOSING FACTOR
Age (9 years old) PRECIPITATING FACTOR
Moisture trapped in the ear
Swimming

CAUSES: pH alteration in the ear RISK FACTORS:

Bacterial infection Swimming

Fungal infection Warm weather
Seborrheic infection Ear injury/damage
Inflammation
Irritation or allergic Skin conditions
reaction Excessive earwax
Trapped moisture in Loss of earwax
Epithelial damage Weakened immune
the ear
system

Reduction in
cerumen/earwax

Increased moisture

Increased
microorganism growth

Otitis Externa

Itchiness
Abscesses
Redness of inside ear
Narrowing of the ear
Some drainage of clear,
canal
odorless fluid
Inflamed or perforated er
Ear pain
drum
Decreased/muffled
Cellulitis
hearing
Necrotizing otitis externa
Fever

12
 PATHOPHYSIOLOGY OF ACUTE OTITIS MEDIA

PREDISPOSING FACTOR PRECIPITATING FACTOR

Age (9 years old)
Otitis Externa
Gender (Male)

RISK FACTORS:
Inflammation
• Age
CAUSES: • Gender
• Allergies • Using a pacifier
• Common cold • Being exposed to
• Flu cigarette smoke
Congestion or edema
• A sinus infection • Being exposed to
of the eustachian tube
• Infected or high levels of air
enlarged
pollution
adenoids
• Experiencing
• Cigarette smoke
changes in altitude
Resolved or Issues
• Experiencing
with the fluid drainage
changes in climate
in the middle ear
• Being in a cold
climate
Decreased • Ear infection
Hearing • URTI
Accumulation of
Red and Bulging
middle ear secretions
Eardrum
Pain

Release of systemic Proliferation of

inflammatory
infective organisms
cytokines

Fever Increased negative

Acute Otitis Media
pressure in the ear

13
 Spread of Increased negative
Acute Otitis Media
infection pressure in the ear

Mastoiditis Residual fluid in the Perforation of the

Intracranial abscess Tympanic
middle ear
Subperiosteal Membrane
abscess
Facial Nerve Palsy
Labyrinthitis Otitis Media with
Suppurative Otitis
Effusion
Media

Recurrent
Resolved
Acute Otorrhea
or Healed
Otitis
Media

LEGENDS:

Disease Process Additional Information Diagnosis

Related Signs and

Complications
Symptoms

14
 DIAGNOSTIC AND LABORATORY EXAMINATIONS
Complete Blood Count
Date: May 06, 2022
Specimen: Blood

Normal
Examination Results Interpretation
Values
Red Blood 4.50 – 6.0
5.24 Within normal range.
Cell x1012/L
Hematocrit 0.41 0.40 – 0.54 L Within normal range.

Hemoglobin 137 120 – 160 g/l Within normal range.

White Blood 4.50 – 10.00
9.46 Within normal range.
Cell x109/L
Segmenters 0.68 0.50 – 0.70 Within normal range.

Eosinophils 0.01 0.00 – 0.05 Within normal range.

Lymphocytes 0.20 0.20 – 0.40 Within normal range.

Higher than the normal range.

An increase in circulating monocytes
(monocytosis) often indicates an
infection or disease the body is
0.00 – 0.07 fighting. An increase in monocytes
Monocytes 0.11
(H) can be caused by infections, cancer,
autoimmune illnesses, and other
causes. The monocyte count can be
high when the body is healing from an
infection.

Higher than normal range.

Infections are the most common
reason for a high platelet count for
150 – 400 adults and children. Platelet count is
Platelet Count 408 likely to remain increase until the
x109/L (H)
infections or inflammatory condition
is controlled if present. The platelet
count will return to normal once the
problem has been resolved.

15
 Below normal range.
Low mean corpuscular volume
(MCV) means red blood cells are
80 – 100 fl small (RBC). When infection or
MCV 78.20
(L) illness develops that produces
swelling or inflammation, immune
response affects the body's functions,
resulting in inflammatory anemia.

MCH 26.20 26 – 34 pg Within normal range.

MCHC 334 320 – 360 g/L Within normal range.

RDW 14.60 12 – 16 % Within normal range.

Diagnostic Tests
1. Chest APL (Pedia) Portable X-Ray
a. Impression: Normal Chest at this time of study

CLINICAL FINDINGS AND SIGNIFICANT SIGNS AND SYMPTOMS

The client manifested the following significant signs and symptoms:
• Fever (T = 38.0°C).
• Increased pain in the right ear.

The client had the following significant laboratory and diagnostic findings:
• CBC results revealed that monocytes are higher than the normal range.
• CBC results revealed that platelets are higher than the normal range.
• CBC results revealed that Mean Corpuscular Volume (MCV) is below the normal
range.

16
 PROBLEM LIST (PRIORITIZATION OF PROBLEMS)
PROBLEM PRIORITIZATION
Acute pain related to
inflammation and
increased pressure in the
middle ear
Deficient knowledge
related to lack of
information
Disturbed sensory
perception (auditory)
Risk for infection related
to knowledge deficit
about infection in children
Risk for delayed
development related to
hearing loss
JUSTIFICATION
The patient experience increased
1 pain in the right ear a day before
the admission
Knowledge deficit was considered
when the patient verbalized that
the cause of his otitis media was
2
when they had their family outing.
He also has a history of
noncompliance with medication.
Fluid accumulation in otitis media
prevents the eardrum from
3 vibrating efficiently, resulting in
sound waves not being transmitted
appropriately.
After initial infection and
treatment of otitis media, residual
4
fluid could be a factor in the
growth of bacteria.
Cognitive development may be
5 affected by the hearing loss
associated with otitis media.
17
 NURSING CARE PLAN (1st Actual)
Nursing
Assessment Planning Implementation Rationale Evaluation
Diagnosis
Subjective: Acute pain Short-term Goals Independent Independent Short-term Goals
“sobrang sakit
related to
After 1 to 2 hours • Establish rapport • Good rapport creates
inflammation of with patient and a close and Goal met.
po talaga ng of nursing
external ear as his family harmonious
tenga ko” as intervention, the After 30 minutes to
evidence by relationship with
verbalized by the patient will be 1 hour of nursing
report and facial patients and family
patient able to: intervention, the
expression of
• Maintain patient was able to:
pain. • Monitor and • A normal response to
Pain scale of 7/10 normal vital • The client’s
signs (T- record vital signs pain is an increase in vital signs
Inflammation of closely respiration rate, heart remained
36.2℃;
the ear as rate and blood stable (T-
PR- 90; pressure; fever may
observed by the RR-23; O2 36.4℃; PR-
mother cause discomfort
Sat- 98%) 88; RR-26;
• Verbalize • Position patient • Lying flat on the side O2 Sat- 96%)
decrease in for comfort; of affected side of the • Verbalized
pain scale sitting up or affected ear can cause decrease level
Objective: score from lying on side of more swelling and of pain and
7 to 4-5 unaffected ear fluid accumulation in was able to
Facial grimace
• Demonstrat the eustachian tube, take a rest.
Irritable e relief resulting in increased “Medyo hindi
pain; sitting up na po masakit
Ear tugging
promotes drainage ang tenga
Ear swelling and and reduces pressure ko.”
tenderness from fluid. • Pain scale of
(+) slight 5/10
erythematous of • Instruct in and • To distract attention
right ear encourage use of and reduce tension
relaxation
techniques, such
as focused
breathing,

18
 imaging,
CDs/tapes

• Use warm • Heat promotes

heating pad or vasodilation thus
ice pack reduces discomfort;
application Cold compress may
decrease pain.

• Advise the • Chewing causes

parent to provide movement of the
and offer liquid eustachian tube that
or soft diet may further aggravate
the pain

• Continuously • To assess
assess pain level effectiveness of the
through pain treatment
scale

Dependent Dependent
• Administer • To relieve pain
analgesics/pain
medications as
prescribed by the
physician

• Administer • To treat inflammation

clindamycin as that causes pain
ordered

Collaborative Collaborative
• Refer to • To assure patient is
nutritionist given food that is
tolerable and won’t
initiate more pain

19
Long term goals Independent Independent Long term
After 2-3 days of Continuous nursing Goal met.
nursing management:
• To promote drainage After 2 days of
intervention, the • Proper nursing
patient will be and reduce ear pain
positioning intervention, the
able to: (Sitting up or patient was able to:
• Verbalize lying on the
• The client
absence of unaffected side)
verbalized
pain in • Monitor vital • To assess treatment total absence
right ear signs and pain progress of pain “hindi
• Exhibit level na po masakit
decrease/ • Monitor correct • To completely ang tenga ko”
absence of schedule in eradicate infection • No signs of
ear swelling taking and prevent antibiotic swelling from
and medications resistance ear
tenderness
• The patient
• Be
was
discharged Dependent Dependent
discharged.
• Administer • To relieve pain
analgesics/ pain
medications as
prescribed by the
doctor

• Administer • To treat inflammation

clindamycin as that causes pain
ordered

20
 NURSING CARE PLAN (2nd Actual)

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective: Deficient Short-term Independent: Independent: Short term goals

“Nagswimming knowledge Goals • Assess parent’s • Provides baseline
current knowledge information about Goal met.
lang ako tapos related to lack After 6 hours of on the condition, the parent’s
naging ganito na of information After 6 hours of
nursing the risks of awareness.
ako” as as evidenced nursing
intervention, the exposing the child
verbalized by the by intervention, the
patient and to passive
patient when inappropriate patient and parent
parents will be smoking, feeding
asked what does behavior were able to:
able to: activities with the
he think the towards child, and exposure • Verbalize the
• Identify
cause of his ear treatment to illness. cause of his
factors that
infection regimen disease
may
• Provide privacy for • Shows respect for “nakuha ko
contribute
discussion, the patient and po yung
Objective: to the promote trust, opens infection
susceptibili remain communication.
History of not nung
ty of the nonjudgmental,
taking nagswimming
disease and support
medications po ako at
• Verbalize patient. dahil sa
Resist to understandi bacteria.”
instructions ng of the • Explain possible • Provides
causes of otitis information about • “Papaliguin
cause of the
Uninterested media: exposure to health promotion. ko siya sa
disease
behavior during illness of others, shower next
health teaching irritation from time after
environmental mag-
smoke. swimming”
• Provides
• Teach parent and information by
child about OM auditory and
using an ear model visual means and
for demonstration.

21
 Ask to verbalize assesses
their understanding understanding.
of teaching.

• Encourage • To facilitate open

questions communication
and allow
verification of
understanding of
given
information.

• Use the teach-back • Teach-back

technique to technique is use
determine the to evaluate the
patient’s patient’s
understanding of understanding of
what was taught the topic
discussed.

• Render positive, • A positive

constructive approach by the
reinforcement of patient will help
learning him feel good
about learning
accomplishments,
gain confidence
and maintain self-
esteem.

Collaborative: Collaborative:
• Refer parents to • Encourages
specialized class follow-up and
such as caregiving, gaining additional
smoking cessation, knowledge and
skills.

22
 or parenting skills
as needed. • Allow parents to
make good
• Assist parents to parenting
plan measures to decisions for their
decrease the child to help
chances of prevent otitis
recurrent otitis media.
media such as
completing the
course of
antibiotic, avoiding
exposure to
persons with
infection and
maintaining a
smoke-free
environment.

Long-term Independent Independent Long term goal

Goals • Explain the • It is important for
importance of the the patient to Goal met.
After 7 days of medication to the know the purpose After 7 days of
nursing patient using of his medication nursing
intervention, the simple words that to prevent further intervention, the
client will be they can complications. patient was able to:
able to: understand
• Prevent
• Prevent
• Monitor the patient • To ensure that the complications
complicatio
when during time patient is taking of further
ns of
of medication his medication. infection as
infection
administration his ears are
• Demonstrat almost
e full • Educate client • For early healed.
compliance about the disease treatment of
in taking complications and complications

23
 prescribed their signs and • Comply with
medication notify the the prescribed
• Be physician if medications
complication
discharge • Get
occurs
discharged
Dependent Dependent from the
• Administer • Strict hospital.
Clindamycin as monitoring on
per doctor’s taking
order antibiotics
should observe
to guarantee
that bacteria
are totally
eradicated and
to prevent
antibiotic
resistance

Collaborative Collaborative
• Refer patient and • For further
parents to ENT disease process
and
management
discussion

24
 NURSING CARE PLAN (3rd ACTUAL)

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective: Disturbed Short-term Goals Independent: Independent: Short-Term Goal

sensory • Assess client’s
“Medyo After 6 hours of • Provides baseline Goal met.
perception hearing ability.
nahihirapan po nursing evaluation
(auditory) Ask the child to After 6 hours of
akong intervention the regarding the
related to describe hearing nursing intervention
makarinig client will be: degree of hearing
loss (e.g., Is the the client was able
inflammation loss.
ngayon.” as • Able to hearing muffled to:
and edema of
verbalized by participate in one ear? or is
middle ear as - Participate in
the patient in there an absence
evidenced by of sound in the health
intervention interventions
child reports affected ear?).
to improve
Objective: of hearing • The client was
and regain
difficulties • Position the client • Elevation able to recall
Swelling of the hearing
on comfortable promotes drainage all of the
right ear • Able to position, elevate and reduces interventions
recall the head and lie pressure from the made during
(+) slight appropriate down on the middle ear which his care.
erythematous of interventions unaffected ear can worsen the
the tympanic to improve hearing loss
membrane health.
Confused • Minimize noise • To ensure that the
while giving patient
Irritable information comprehends to
the nurse health
teaching

• Involve the • The patient must

patient in participate in
planning the correct treatment
proper treatment in order to treat
(such as the effect of otitis
complying to media.

25
 medical regimen,
avoiding lying
down on the
affected ear)

• Encourage the • To monitor if the

child to inform otitis media is
his parents if worsening and if
there is any there is a need for
worsening of further
symptoms such investigation and
as ear pain, treatment
discharge or
worsening of
hearing ability

• Reassure parents • Decreases anxiety

and child that over a sensory
hearing loss is not loss.
permanent and
will resolve with
treatment.

• Encourage patient • To help identify,

to have a routine assess and manage
examination by problems of
an audiologist. hearing and
balance

Dependent: Dependent:
• Administered • Clindamycin is an
medication antibiotic that
(Clindamycin) works by stopping
orally as ordered the growth of
by the physician. bacteria.

26
Long-term Goals Independent: Independent: Long-term Goal
• Continuous • To ensure
After 7 days of Goal met.
nursing effective patient
nursing interventions treatment After 7 days of
intervention the (proper nursing intervention
client will be positioning, the patient was able
• Able to have monitoring of to:
an improved vital signs, • Have an
hearing. medication improved
administration) hearing after
following to
Dependent: Dependent: nursing
• Administered • Clindamycin is an intervention
medication antibiotic that such as
(Clindamycin) works by stopping complying to
orally as ordered the growth of medication, and
by the physician bacteria. participating to
intervention.
Collaborative: Collaborative: • Verbalized that
• Refer the patient • Otolaryngology is he hears well
to ENT a medical and equally on
(Otolaryngology) specialty which is both ears.
focused on the
ears, nose, and
throat

27
 NURSING CARE PLAN (1st Potential)

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Objective: Risk for After 6 hours of Independent: Short-term Goal

• Proper hygiene
infection nursing • Advice family
Swelling of right members on
prevents spread Goal Partially
related to intervention, the of pathogens.
external auditory handwashing Met
patient will be
canal knowledge techniques and the
able to: After 6 hours of
deficit about importance of nursing
Tenderness in • Verbalize covering their
infection in understandin intervention, the
right ear is mouths and noses
children g of client was able to:
when sneezing or
present individual • Verbalize
coughing.
risk factors “mag-iingat
Presence of • Identify • Encourage increased • Decreases na po ako
residual fluid in interventions fluid intake, good susceptibility to mag-
the ear to prevent or nutrition, and infection.
adequate rest. swimming at
reduce risk
mag-shower
of infection
History of not • Limit visitors and • Other people pagkatapos”
compliance to avoid exposure to can spread • Verbalize
medication people with existing infections or
upper respiratory colds to a the
infections. susceptible importance
patient through of proper
direct contact, hygiene by
contaminated
objects, or stating “lagi
through air na po ako
currents. maghuhugas
ng kamay at
Dependent: Dependent:
• Administer • For continuous magsshower
clindamycin as compliance of pagkatapos
ordered

28
 infection magswimmi
treatment ng”
Collaborative:
• Refer the patient to • Otolaryngology
ENT is a medical
(Otolaryngology) specialty which
focuses on the
ears, nose, and
throat
After 7 days of Independent: Long-term Goal
nursing • Assist parents to • Allow parents to
plan measures to make good Goal Partially
intervention, the
decrease the parenting Met.
client will be able
to: chances of recurrent decisions for After 7 days of
OM such as their child to nursing
• Demonstrate completing the help prevent
techniques intervention, the
course of antibiotic, OM.
and lifestyle client was able to:
avoiding exposure
changes to to persons with • Comply with
promote safe infection and medications
environment feeding the infant in • Achieved
• Achieve a sitting position. timely
timely wound-
wound- • Advice family • Proper hygiene healing; be
members on proper prevents spread free of
healing; be
hygiene techniques of purulent
free of pathogens.
and the importance drainage or
purulent of covering their
drainage or erythema
mouths and noses
erythema when sneezing or • Verbalize
• Comply coughing. “Naghuhuga
with s po ako ng
medications • Encourage to • To decrease kamay pero
increase fluid intake susceptibility to hindi ko na
infection po nalilinis
ang kwarto

29
 • Provide quiet • To promote ko kasi
environment and nonpharmacolog tinatamad
adequate rest ical pain ako kaya
management puro
makalat din
Dependent: • Clindamycin po ang
• Administer proved to be
paligid ko”
antibiotics as effective therapy
prescribed such as for otitis media
Clindamycin due to
penicillin-
sensitive and
penicillin-
resistant
Staphylococcus
aureus,
epidermidis, and
Diplococcus
pneumoniae.

• Administer • The most

Analgesic as PRN common
such as Biogesic medications
used to treat the
pain caused by
acute otitis
Collaborative: media is
• Refer the patient to paracetamol;
the ENT specialist Paracetamol is
(Pedia usually
otolalaryngologists) preferred, as it is
associated with
fewer side
effects

30
 NURSING CARE PLAN (2nd Potential)

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective: Risk for After 6 hours of Independent: Short-term Goals

• Promoting
delayed nursing • Encourage the
“ha?” and patient to engage in
wellness starts Goal met.
development intervention, the with preventing
“ano po prevention
client will be complication or After 6 hours of
ulit?” as related to strategies (e.g.
• Able to limited the nursing intervention,
verbalized by hearing loss referral for
participate to severity of the client will be
the patient treatment program)
nursing anticipated • Able to
management problems. participate in
to prevent the nursing
Objective:
risk • Participate in • Developmental management to
Swelling of • Able to screening the delay occurs prevent the risk
right external Verbalize and child’s development when a child after providing
auditory demonstrate level by means of fails to achieve health teaching
canal interventions observation and one or more and continuous
to prevent history. developmental administering of
Tenderness in milestone within
right ear is delayed medication
an expected time • Able to
present development period may be in
verbalize and
Presence of one or more
areas. (e.g., demonstrate
residual fluid interventions to
cognitive,
in the ear prevent
speech and
language, social developmental
and emotional, deviations after
encouraging
• Emphasize the • To promote on the patient and
importance of going evaluation, family to
screening management of prevent possible
appointment. situation developmental
delay

31
• Provide information • To educate both
regarding the patient and
development, as parents
appropriate (e.g. regarding
pertinent reference appropriate
materials, reliable development
websites)

• Encourage parents • Hearing

to have their child`s problems are
hearing tested frequently
regularly. associated with
developmental
delay; therefore,
frequent
consultations are
required to
ensure that
appropriate
treatment is
provided and the
underlying cause
is dealt with.

• Assists to treat the • To prevent the

condition (otitis developmental
media) that deviations that is
contribute to cause by the
developmental occurring
deviations disease

• Describe realistic, • This is important

age-appropriate in planning
patterns of intervention in
development to keeping with
parent and patient individual’s

32
 and promote current status
activities and and potential.
interaction that
support
developmental tasks
where client is at
this time

Dependent:
• Administered • Clindamycin is
medication an antibiotic that
(Clindamycin) works by
orally as ordered by stopping the
the physician growth of
bacteria to
prevent the
delayed
development

Collaborative:
• Collaborate with • Multidisciplinary
related professional team care
resources (e.g., increases the
hearing therapists, likelihood of
speech and developing a
language therapy, well-rounded
developmental plan of care that
pediatrician) meets the
client/family’s
specialized and
varied needs,
minimizing
identified risks.

33
Long-term Goals Independent: Long-term Goal
• Continuous nursing • To ensure
After 7 days of interventions: effective patient Goal Met.
nursing medication treatment After 7 days of
intervention, the administration
nursing intervention,
client will be
• Evaluate the • To make referrals
the client will be
• Able to
patient’s progress on in a timely • Able to prevent
prevent
a continual basis. manner and to possible
possible Identify symptoms make ad the developmental
delayed requiring adjustments in delay after
development intervention plan of care continuous
nursing
Dependent:
• Administered • Clindamycin is
intervention
medication an antibiotic that (medication
(Clindamycin) orally works by administration
as ordered by the stopping the
physician growth of
bacteria to
prevent the
delayed
development
Collaborative:
• Collaborate with • Multidisciplinary
related professional team care
resources (e.g., increases the
hearing therapists, likelihood of
speech and language developing a
therapy, well-rounded
developmental plan of care that
pediatrician). meets the
client/family’s
specialized and
varied needs,
minimizing
identified risks.

34
 DRUG STUDY

MECHANISM CONTRAIN ADVERSE

DRUG INDICATION NURSING RESPONSIBILITIES
OF ACTION DICATIONS EFFECTS
Generic name It binds to the Used to treat Hypersensitivi Unpleasant/me Assessment:
50S subunit of bacterial ty tallic taste in • Assess for history of asthma or
clindamycin a bacterial infection allergies
mouth
ribosome (Streptococcus Kidney
Brand Name • Weight the patient
leading to a pneumoniae) disease
Pain/swelling • Culture and susceptibility
Cleocin reduced protein causing acute Liver disease at injection site testing should be performed
synthesis. It otitis media. initially and periodically during
Classification exerts its Stomach/bowe
l disease Dark urine therapy.
bacteriostatic • Monitor BP and pulse in
lincomycin Yellowing
effect which
antibiotics eyes/skin patients receiving drug
suppresses the
parenterally.
Dose/Frequen growth of
bacteria. Persistent
cy
nausea/vomitin Patient & Family Education:
g • Report loose stools or diarrhea
340 mg IV, Q6 promptly.
was shifted • Stop drug therapy if significant
Easy
into 150 mg diarrhea develops (more than 5
bruising/bleedi
tab, Q6 loose stools daily) and notify
ng
physician.
• Do not self-medicate with
Pain in several antidiarrheal preparations.
joints
• Take oral drug with a full glass
of water or with food.
Fast/slow/irreg
• Take full prescribed course of
ular heartbeat oral drug.
Fainting

35
 MECHANISM CONTRAINDI ADVERSE
DRUG INDICATION NURSING RESPONSIBILITIES
OF ACTION CATIONS EFFECTS
Generic name It inhibits Used to treat Hypersensitivity Headache Assessment:
prostaglandin fever. • Monitor patient’s body
paracetamol Severe Insomnia
synthesis in the Prescription is temperature every 4 hours.
hypothalamus. taken as hepatocellular (difficulty in
Brand Name • Monitor for signs and
It produces needed if the insufficiency sleeping)
symptoms of hepatoxicity.
Ifimol antipyresis by patient’s body Constipation
acting centrally temperature is Patient & Family Education:
Classification on the greater than or Itching • Do not take other
hypothalamic equal to medications containing
Analgesics/anti Anxiety
heat-regulating 37.8°C. acetaminophen without
pyretics Nausea
center to medical advice.
Dose/Frequenc produce Stomach • Do not self-medicate for pain
y peripheral pain more than 5 days in children
vasodilation without consulting a
300 mg IV q4, Vomiting
resulting in physician.
(PRN)
increased blood • Do not use this medication
flow through without medical direction
the skin, for: fever persisting longer
sweating and than 3 d, fever over 39.5° C
heat loss. (103° F), or recurrent fever.
• Do not give children more
than 5 doses in 24 h unless
prescribed by physician.

36
 DISCHARGE PLANNING (M.E.T.H.O.D.S)

• Instruct the patient’s mother about the home medication.

Clindamycin 150 mg/cap.
• Instruct the patient’s mother that it should be taken by
Medications
his son 4 times a day to complete for 7 days.
• Explain that this medication is used to treat bacterial
infection.

• Encourage the patient to practice neck rotation exercises

to reduce the pressure in the ear canal caused by ear
Exercise/Activity infections.
• Do not have any heavy activity
• Get plenty of rest

• Follow treatment regimen prescribed by his physician

Treatment • If the pain is severe, there may be a need for antibiotic
medication by mouth or ear drops.

• Take medicine that the doctor prescribed.

• Do some gentle exercise
• Get plenty of sleep
• Instruct the child sit, up, put pillows behind the head, or
lie on the unaffected ear.
Health Teaching • Encourage the mother to provide and offer liquid to soft
foods.
• Instruct the use of a warm heating pad or an ice pack
application.
• Encourage family members speak in normal tones and
avoid talking too fast.

• The parent/patient should attend follow-up check-up in

order for the physician to see the progress of the patient.
Outpatient (Follow-up) • Advise the client that as much as possible, an individual
should consult and visit their local physician to get their
ears checked every six (6) months.

• Encourage patient to eat more healthy food.

Diet
• Avoid solid foods.

• Encourage patient to spend time with his family and

friends
Spiritual Counselling
• Encourage to have faith in God and to not give up when
hard times come.

37
REFERENCES
BOOK SOURCES
Ackley, B. J., Ladwig, G. B., & Makic, M. B. F. (2017). Nursing Diagnosis Handbook: An
Evidence-Based Guide to Planning Care (11th ed.). Elsevier.
American Nurses Association. (2022). Nursing Informatics: Scope and Standards of
Practice (2nd ed.). American Nurses Association.
Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb’s Fundamentals of Nursing:
Concepts, Practice, and Process (10th ed.). Pearson.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s Pocket Guide:
Diagnoses, Prioritized Interventions, and Rationales (14th ed.). F.A. Davis
Company.
London, M. L., Ladewig, P. W., Davidson, M. R., Ball, J., Ruth Mcgillis Bindler, &
Cowen, K. J. (2017). Maternal & Child Nursing Care (5th ed.). Pearson Education,
Inc.
Silbert-Flagg, J., & Pillitteri, A. (2018). Maternal & child health nursing: Care of the
childbearing & childrearing family (8th ed.). Wolters Kluwer.
Vanputte, C. L., Regan, J., & Russo, A. (2014). Seeley’s Anatomy & Physiology. (10th ed.).
McGraw-Hill.

ONLINE REFERENCES
4 Otitis Media Nursing Care Plans. (n.d.). Nurseslabs. https://nurseslabs.com/otitis-media-
nursing-care-plans/2
Acute otitis media in children (Causes, symptoms and treatment). (2021, December 23). Symptom
Checker, Health Information and Medicines Guide | Patient. https://patient.info/doctor/acute-
otitis-media-in-children
ADA. (2022, February 15). Otitis Externa «Ada. Ada; Ada.
https://ada.com/conditions/otitis-externa/#causes-risk-factors
Alila Medical Media. (2020). Otitis Media: Anatomy, Pathophysiology, Risk Factors,
Types of OM, Symptoms and Treatment, Animation [YouTube Video]. In
YouTube.
https://www.youtube.com/watch?v=rPGUFaKqL4Y&t=14s&ab_channel=Osmosi
s
Availability. ACETAMINOPHEN, PARACETAMOL. (n.d.). Retrieved June 11, 2022,
from
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/A006.htm
l

38
Availability. CLINDAMYCIN HYDROCHLORIDE. (n.d.). Retrieved June 11, 2022, from
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/C090.htm
l
BELLEZA, MARIANNE. “Otitis Media Nursing Care Planning and Management: Study
Guide.” Nurseslabs, 12 Feb. 2018, nurseslabs.com/otitis-media/#nursing_diagnoses.
Cleveland Clinic. (2019). Swimmer’s Ear (Otitis Externa): Causes, Symptoms &
Treatments. Cleveland Clinic.
https://my.clevelandclinic.org/health/diseases/8381-swimmers-ear-otitis-
externa#symptoms-and-causes
Cleveland Clinic. “Ear Infection (Otitis Media): Symptoms, Causes, Prevention &
Treatment.” Cleveland Clinic, 16 Apr. 2020,
my.clevelandclinic.org/health/diseases/8613-ear-infection-otitis-media.
Clindamycin Nursing Considerations &amp; Management. RNpedia. (2019, February 11).
Retrieved June 11, 2022, from https://www.rnpedia.com/nursing-
notes/pharmacology-drug-study-notes/clindamycin/
Complete blood count (CBC). Testing.com. (2021, December 2). Retrieved June 11, 2022,
from https://www.testing.com/tests/complete-blood-count-cbc/
Curtis, L. (2022, March 7). Eosinophil count: Why it’s done and what it means. Verywell
Health. Retrieved June 11, 2022, from https://www.verywellhealth.com/eosinophil-
count-blood-test-5216993
Default. (n.d.). Stanford Children’s Health - Lucile Packard Children’s Hospital Stanford.
https://www.stanfordchildrens.org/en/topic/default?id=otitis-media-middle-ear-infection-
90-P02057
DerSakissian, C. (2002, November). What Is Swimmer’s Ear? WebMD; WebMD.
https://www.webmd.com/cold-and-flu/ear-infection/understanding-swimmer-ear-
basics
Ear Infection (Otitis Media). (2022, April 12). Hopkinsmedicine.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/otitis-
media#:%7E:text=Otitis%20media%20is%20inflammation%20or,sore%20throat%
2C%20or%20respiratory%20infection.
Hasudungan, A. (2015). Anatomy - Ear Overview [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=qYv9V2qna6I&ab_channel=ArmandoHasud
ungan
Hasudungan, A. (2019). Acute Otitis Media (Causes, Pathophysiology, signs and
symptoms, treatment and complications) [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=TiSpjfuQxXM&t=449s&ab_channel=Arman
doHasudungan

39
Hematocrit. Testing.com. (2021, November 9). Retrieved June 11, 2022, from
https://www.testing.com/tests/hematocrit/
Hemoglobin. Testing.com. (2021, November 9). Retrieved June 11, 2022, from
https://www.testing.com/tests/hemoglobin/
IFIMOL injection: View uses, side effects, price and substitutes. 1mg. (n.d.). Retrieved
June 11, 2022, from https://www.1mg.com/drugs/ifimol-injection-340291
JJ Medicine. (2021a). Swimmer’s Ear (Otitis Externa) | Risk Factors, Causes, Signs &
Symptoms, Diagnosis, Treatment [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=hTXhe5BlNhc&ab_channel=JJMedicine
JJ Medicine. (2021b). Middle Ear Infection (Acute Otitis Media) | Causes, Symptoms,
Diagnosis, Treatment [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=Q21klJFDkI4&ab_channel=JJMedicine
Johns Hopkins Medicine. (2022, April 12). Ear Infection (Otitis Media).
Hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-
diseases/otitis-media
Mayo Clinic. “Ear Infection (Middle Ear) - Symptoms and Causes.” Mayo Clinic, 2019,
www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-
20351616.
Mayo Foundation for Medical Education and Research. (2022, April 19). Pediatric white
blood cell disorders. Mayo Clinic. Retrieved June 11, 2022, from
https://www.mayoclinic.org/diseases-conditions/pediatric-white-blood-cell-
disorders/symptoms-causes/syc-
20352674#:~:text=Infections%2C%20cancer%2C%20autoimmune%20diseases%2
0and,toxins%2C%20chemotherapy%20and%20other%20causes.
McGovern Medical School. (2017). Ear Anatomy - Inner Ear - Otorhinolaryngology -
Head & Neck Surgery. Otorhinolaryngology - Head & Neck Surgery.
https://med.uth.edu/orl/online-ear-disease-photo-book/chapter-3-ear-anatomy/ear-
anatomy-inner-
ear/#:~:text=Next%20to%20the%20middle%20ear,canals%20is%20the%20balan
ce%20portion.
MediLexicon International. (n.d.). RDW blood test: What is it, preparation, and results.
Medical News Today. Retrieved June 11, 2022, from
https://www.medicalnewstoday.com/articles/321568
Miyamoto, R. T. (2020, June 1). Otitis media (Acute) - Ear, nose, and throat disorders - MSD
manual professional edition. MSD Manual Professional Edition.
https://www.msdmanuals.com/professional/ear,-nose,-and-throat-disorders/middle-ear-and-
tympanic-membrane-disorders/otitis-media-acute

40
NHS Inform. (2020a). Otitis externa symptoms and treatments. Nhsinform.scot.
https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/otitis-
externa#causes-of-otitis-externa
Pietrangelo, A. (2022, March 25). Monocytes high (monocytosis): Causes, symptoms,
treatment. Healthline. Retrieved June 11, 2022, from
https://www.healthline.com/health/monocytes-high#what-are-monocytes
Red Blood Cell count. Testing.com. (2021, November 9). Retrieved June 11, 2022, from
https://www.testing.com/tests/red-blood-cell-count-rbc/
Ruptured eardrum (perforated eardrum) - Diagnosis and treatment - Mayo Clinic. (2022,
January 18). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ruptured-
eardrum/diagnosis-treatment/drc-20351884#:%7E:text=Tympanoplasty-
,Tympanoplasty,treatment%20within%20a%20few%20weeks.
rxwiki. (2014, April 22). Segmented neutrophils (segs). rxwiki. Retrieved June 11, 2022,
from https://www.rxwiki.com/lab/segmented-neutrophils-
segs#:~:text=Segmented%20neutrophils%20(segs)%20Overview&text=Neutrophils
%20are%20the%20most%20abundant,are%20measured%20as%20a%20percentage
.
Team, C. by M. I. M. S. O. (n.d.). Ifimol. Ifimol Full Prescribing Information, Dosage &
Side Effects | MIMS Malaysia. Retrieved June 11, 2022, from
https://www.mims.com/malaysia/drug/info/ifimol?type=full#:~:text=Paracetamol%
20probably%20produces%20antipyresis%20by,prostaglandin%20synthesis%20in%
20the%20hypothalamus.
Tewfik, T. L. (2022, May). Eustachian Tube Function: Overview, Embryology of the
Eustachian Tube, Anatomy of the Eustachian Tube. Medscape.com; Medscape.
https://emedicine.medscape.com/article/874348-overview
University of Rochester Medical Center. (2022). Anatomy and Physiology of the Ear -
Health Encyclopedia - University of Rochester Medical Center. Rochester.edu.
https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&
ContentID=P02025
WebMD. (n.d.). Clindamycin intravenous: Uses, side effects, interactions, pictures,
warnings & dosing. WebMD. Retrieved June 11, 2022, from
https://www.webmd.com/drugs/2/drug-18657/clindamycin-
intravenous/details#:~:text=Tell%20your%20doctor%20right%20away%20if%20y
ou%20have%20any%20serious,slow%2Firregular%20heartbeat%2C%20fainting.
White Blood Cell Count (WBC). Testing.com. (2022, April 12). Retrieved June 11, 2022,
from https://www.testing.com/tests/white-blood-cell-count-wbc/

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