Which of the following instructions should Nurse Cheryl include in her teaching plan for the parents of Reggie with otitis media?
A. Placing the child in the supine position to bottle-feed
B. Giving prescribed amoxicillin (Amoxil) on an empty stomach
C. Cleaning the inside of the ear canals with cotton swabs
D. Avoiding contact with people who have upper respiratory tract infections
Correct Answer: D. Avoiding contact with people who have upper respiratory tract infections.
Otitis media is commonly precipitated by an upper respiratory tract infection. Therefore, children prone to otitis should avoid people known to have an upper respiratory tract infection. Acute otitis media is the second most common pediatric diagnosis in the emergency department following upper respiratory infections. Although otitis media can occur at any age, it is most commonly seen between the ages of 6 to 24 months.
Option A: A bottle-fed child should be fed in an upright position because feeding the child in the supine position may actually precipitate otitis by allowing the formula to pool in the pharyngeal cavity. Infants with otitis media should be breastfed whenever possible, as breast milk contains immunoglobulins that protect infants from foreign pathogens in key phases of early extra-uterine life.
Option B: Amoxicillin, when prescribed, should be given with food to prevent stomach upset. If there is clinical evidence of suppurative AOM, however, oral antibiotics are indicated to treat this bacterial infection, and high-dose amoxicillin or a second-generation cephalosporin are first-line agents.
Option C: Cotton swabs can cause injuries such as tympanic perforation. They may be used to clean the outer ear, but they should never be inserted into the ear canal.