Lippincott Certification Review Medical-Surgical Nursing


Otitis Externa

●● Postoperative nursing interventions ●● Keep the patient’s head elevated 30 degrees to promote drainage, reduce edema, and maintain a patent airway. ●● Check the patient’s vital signs and airway frequently to ensure that the packing hasn’t slipped posteriorly, which could block the oral airway; take rectal, ear, or axillary temperatures while the packing is in place because the patient’s only airway is his oral airway. ●● Watch for nasal bleeding and frequent swallowing; inspect the pharynx with a penlight if bleeding is suspected; keep emergency suction equipment near patient in recovery. ●● Encourage the patient to expectorate oral secretions; record the amount and describe the secretions. ●● Change the 2″ × 3″ gauze dressing or drip pad, as needed, and record the frequency and amount of drainage. ●● Urge the patient to avoid swallowing blood, which can lead to nausea and vomiting. ●● Provide comfort measures, and administer analgesics, as needed, to decrease pain and promote participation in care. ●● Use a face tent to provide humidified air, and frequently perform oral hygiene measures; because air breathed in through the mouth isn’t humidified like air breathed in through the nose, the oral mucous membranes can become dry. ●● Inform the patient of limitations and safety measures, such as not blowing their nose to prevent injury to the surgical site; if sneezing is necessary, the patient should open the mouth to release the pressure of the sneeze. ●● Tell the patient to notify the practitioner if signs or symptoms of infection, hemorrhage, or hematoma occur, including bleeding, pain, swelling, redness, fever, headache, or foul-smelling drainage. ●● Educate patient to keep head elevated, not to blow nose for several weeks, to only wear clothing that does not get pulled over the head, and to avoid aerobic exercise for at least 5 weeks. Otitis Externa ●● Description ●● Otitis externa is an acute or chronic inflammation of the external auditory canal. The pinna or tympanic membrane may also be involved. ●● Risk factors include water in the ear canal (swimmer’s ear), trauma to the skin of the ear (such as cotton swab, fingers, piercing site), use of objects in the canal that impact wax (earplugs, hearing aids), and endocrine disorders (such as diabetes mellitus) that can predispose a patient to infections. ●● Staphylococcus aureus and Pseudomonas are the most common types of bacteria that cause otitis externa. Acute otitis externa (AOE) is caused by a bacteria in 80% to 95% of cases. Fungus Aspergillus fumigatus is more likely in chronic otitis externa than AOE. ●● Signs and symptoms ●● AOE is a cellulitis of the ear skin and subdermis. A diagnosis requires evidence of diffuse inflammation of a rapid onset within 48 hours, occurring in the last 3 weeks. ●● Symptoms of ear canal inflammation include one or more of the following: otalgia, ear itching, or fullness. Ear canal pain and temporal mandibular joint pain may be increased with jaw motion.

●● Signs of ear canal inflammation include one or more of the following: tenderness of the tragus and/ or pinna, diffuse erythema, and/or edema of the canal. Otorrhea, regional lymphadenopathy, tympanic membrane erythema, or cellulitis of the pinna and adjacent skin may also be seen. ●● Fungal otitis externa may not produce any symptoms. ●● Diagnosis and treatment ●● Microscopic examination, if performed, reveals the causative organism. ●● Otoscopy shows a swollen external ear canal, debris, and erythema. Occasionally, regional cellulitis and periauricular lymphadenopathy are noted. ●● Treatment includes cleaning debris from the ear canal under direct visualization. ●● With mild, chronic otitis externa, the patient may need specially fitted earplugs for showering or swimming. ●● Oral analgesics help control pain; topical anesthetics are not recommended. Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

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