Development of Otitis Media Protocol-Algorithm in Children Aged 6-12 - Essay Example

An Analysis of the development of Otitis Media Protocol/Algorithm in children aged 6 to 12 years old. s Class Date In the development of the complete nurse protocol for Otitis media in children of between 6 and 12 years, one should have some key elements. The protocol should clearly define the Otitis media for clinicians, identify its natural history without antibacterial treatment, give a guide for appropriate diagnoses of the disease, guide on the steps to be followed for the initial treatment of the child, propose the appropriate antibacterial regimen for the disease, measure the relative effectiveness of the recommended antibacterial regimen in prevention of Otitis media and give recommendations for reducing its recurrence in children (Gulani, Sachdev & Qazi 2010; Forgie, Zhanel & Robinson 2009). The following chart summerises the above protocol elements to be analysed in this paper. Fig 1: Outline of the algorithm for Otitis Media in children aged 6 to 12 years old. Developing evidence-based clinical guidelines and recommendations to clinicians who offer primary care for the management of children aged between 6 and 12 years with complicated Otitis media is significant (Forgie, Zhanel and Robinson 2009; Shekelle et al. 2010). This paper is an analysis of the development of the Otitis media protocol/algorithm in children aged 6 to 12 years old. The algorithms starting date was December 12, 2012 and the review date was March 29, 2014. For clinicians and other people who work with them such as social care practitioners, defining AOM is very important (Laine et al. 2010). This is because AOM is prevalent in general medical practice and failure to have it clearly defined may lead to a lot of cost in terms of time and resources and even health for the sick child (Shekelle et al. 2010). Otitis media is a term used for two diseases. These are acute Otitis media (AOM) and Otitis media with effusion (OME) (Cherpillod 2011). The AOM and OME are prevalent in children between 6 and 12 years. It is also important to differentiate that AOM can be cause by viral or bacterial (Venekamp 2013). A guideline protocol that does not explicitly put these differences may mislead the nurses. Knowing the differences is important for the initial treatment because their approach is different and the treatment regimen administered is also different (Venekamp 2013). Moreover, the seriousness of AOM is highly determined by the causal factor, which could either be viral or bacterial. Having this information included in the protocol will guide nursing practitioners to be aware of the disease, the cause, and the type of medication required at every stage (Laine et al. 2010). The protocol should also guide on Otitis media with effusion (OME) which is a stage of Otitis media called. Otitis media with effusion (OME) is also referred to as serous or secratory Otitis media (SOM) (“Glue ear” 2014). Glue ear is a collection of fluid in the middle of the ear space as a result of a negative pressure from a malfunction of the Eustachian tube. This may occur as a result of viral infection in which it will not present any pain or a bacterial infection that presents painful experiences (Venekamp 2013). Clinical practitioners are supposed to be made aware that this fluid can also occur as a result of acute Otitis media infection and so they should make a follow up after treatment (Gulani, Sachdev & Qazi 2010). A so important point to note in this case and which should be included in the protocol is that the OME begins as a result of feeding while lying down, parental smoking, inadequate breast feeding and child overspending in group child care (Rovers et al. 2008). Most children present a self limiting illness which in most cases they do not need a doctor (Thompson et al. 2013). It is only a few who will require a medical attention as a result of recurrence (Thompson et al. 2013). Another significant point to be included in the guide for every person involved knowing is that as children grow bigger, there is an increase of the angle between the Eustachian tube as the pharynx more acute thus coughing and sneezing will tend to push the Eustachian tube shut (Rosenfeld et al. 2013). In small children, the infected materials are directed down to the middle ear by the acute angle (Rosenfeld et al. 2013). In defining AOM, it is also important to know the epidemiology of the Otitis media (Coker et al. 2010). Research shows that over two thirds of children are prone to one or more AOM attacks by the time they reach 3 years while a half experience more than three episodes (Taylor et al. 2012). It has been established that the recurrence and incidence of the Otitis media occurs between one and two years and the incidence is not common in school children (Cherpillod 2011). Another important point that every nurse should know is that AOM is prevalent during winter than summer months because AOM is associated with cold weather (Zemek, Szyszkowicz & Rowe 2010). Although some studies have established that AOM can occur in adults, this has been said to be rare and unusual (Zemek, Szyszkowicz & Rowe 2010; Rovers et al. 2008). It will therefore be important to define AOM as elaborately as possible. This will enable the clinicians and other medical practitioners to have a clear knowledge of the disease for quick and accurate diagnosis and treatment (Damoiseaux 2005). This will ensure the recurrence of the disease is curbed and children are given a chance to live healthy lives and safe the government and the parent’s resources (Damoiseaux 2005). The understanding of every disease and the natural history without antibacterial treatment is important for any clinician (Gulani, Sachdev & Qazi 2010). Otitis media is among the diseases which require objective approach to diagnose and treat (Lieberthal et al. 2013). Therefore, for a clinician to be accurate and efficient in diagnoses, understanding the history of the disease will help in dealing with it even when the antibacterial medication is not available (Lieberthal et al. 2013). The algorithm below illustrates the Protocol and algorithm followed when diagnosing and treating Otitis Media in children (Adopted from Shaikh et al. 2012). In developing a protocol for Otitis media, it is critical to consider the appropriate diagnosis of the disease so that nursing practitioners and clinicians are aware of them and apply them for accurate diagnosis (Lieberthal et al. 2013). This is because AOT has been found to have typical symptoms that overlap with other diseases and therefore, clinical history alone is not enough to make an accurate prediction of AOM (Shaikh et al. 2012). In diagnosing AOT, clinical history of a patient must be complemented with an observation of the tympanic membrane (Laine et al. 2010). Lieberthal et al. (2013) have analysed that diagnosis of AOM is confirmed once the middle ear effusion and inflammation of the eardrum are similarly full, bulgy, cloudy and red. Another fact of the AOM that the protocol will help nursing practitioners to know is that the viral Otitis media presents with blisters on the outer section of the tympanic membrane (Stenstrom et al. 2005). The protocol should also include the risk factors for the diagnosis of AOT in order to help nursing practitioners and other medical personnel (Rosenfeld et al. 2013). The AOM risk factors information which can assist clinicians and nursing practitioners in the effective diagnosis is as follows according to Rosenfeld et al. (2013): 1. That girls stand a higher risk of developing AOM than boys 2. That children whose siblings are at school are at a high risk of contracting the disease because they are exposed to infection from school 3. That the risk of developing AOM is high to children who are exposed to dummy sucking because the activity of sucking and swallowing expands the Eustachian tube hence putting the middle ear at a risk 4. That children who experience repeated cold and respiratory infections are likely to develop AOM 5. That parents who smoke puts their children at a high risk of developing acute Otitis media This information may seem straightforward and simple but it enables nursing practitioners and clinicians to advice parents on the best ways to avoid putting their children at risk of developing AOM (Rovers et al. 2008). The protocol should also include the symptoms of AOM for the clinicians and nurses and this will help them during diagnosis (Lieberthal et al. 2013). Some symptoms of AOT, which are marked by an inflammation of the middle ear, include pain, malaise, irritability, fever and vomiting (Laine et al. 2010). The signs that the patient presents include very high fever, which may include convulsion, read and bulging eardrum, redness of the outer ear, and hearing impairment (Laine et al. 2010). There are also diagnostic investigations that should be proposed in the developed protocol such as culturing the discharge from the ear in chronic perforations or if grommets are present, audiometry for children with chronic hearing loss and CT or MRI where complications are suspected (Coker et al. 2010). In most cases majority of AOM patients are cured without treatment. Recent studies have discouraged practitioners from prescribing antibiotics to mild and moderate cases (Antibiotic Guidelines 2012). The guidelines allow practitioners to only consider prescribing analgesia (Sattout & Jenner 2008). Antibiotics should be prescribed to patients with whose symptoms have persisted for 2 to three days, children with otorrhea, those with high risks of health complications born with or acquired in childhood (Antibiotic Guidelines 2012). Where prescription of antibiotics is needed under all circumstances, the Health Protection Agency recommends that a prescription of amoxicillin or erythromycin be given to patients who are allergic to penicillin (Antibiotic Guidelines 2012; Gulani, Sachdev & Qazi 2010). Before using the antibiotics, the clinicians should weigh the benefits of prescribing antibiotics for AOM (Antibiotic Guidelines 2012). Studies have proved that over 80 percent of AOM cases settle without any treatment but 20 out of 100 children with positive diagnosis should be treated to prevent cases of ear pain, perforation and opposite side ear infection (Venekamp 2013; Lieberthal et al. 2013). However, it is highly preferable that antibiotics be deferred for acute Otitis media if the pain can be managed (Damoiseaux 2005; Marchetti et al. 2005). This information is very important for nursing practitioners and should form part of clinical guidelines and the protocol for the treatment of Otitis media (Gulani, Sachdev & Qazi 2010). The most effective antibiotic regimen is amoxicillin (Lieberthal et al. 2013). In cases where use of amoxicillin is noted in the last 30 days, the practitioner should consider prescribing amoxicillin-clavulanate or penicillin derivative combined with beta lactamase inhibitor (Lieberthal et al. 2013). In order for a clinician to determine the appropriate treatment, he or she should consider the presented symptoms, because the effectiveness of the medicine or improvement is based on asymptomatic outcomes (Forgie, Zhanel & Robinson 2009). There should be clear guidelines in the protocol on how the recurrence of the AOM should be reduced or prevented (Gulani, Sachdev & Qazi 2010). Research has shown that giving a prescription of less than seven days has reduced side effects but more days prescription is more effective (Kozyrskyj et al. 2010). Moreover, long-acting azithromycin has been proposed as a short course antibiotic which is successful than other short alternatives and reduces the incidences of recurrence (Gulani, Sachdev & Qazi 2010). The protocol can also recommend the use of topical antibiotics to treat Otitis media with discharge and it has been proved to reduce reccurrence of the AOM (Macfadyen et al. 2006). Although the safety of the antibiotics is not scientifically proven, it has been found by the Cochrane review that topical quinolone antibiotics are more effective on AOM with discharge than oral antibiotics (Macfadyen et al. 2006). There are other ways in which clinicians can reduce recurrence of AOM (Lozano 2012). These are for example, avoiding smoking at home, reducing daycare attendance, avoiding exposure to winter time cold as well as eliminating pacifiers (Rovers et al. 2008; Lozano 2012; Thompson et al. 2013). Moreover, there are the clinicians should be encouraged to prescribe pneumococcal vaccines because they have been found to be beneficial with decreased incidence of recurrent among older children approaching 12 years (Jansen et al. 2009). Reference List Antibiotic Guidelines 2012. Health Protection Agency. Cherpillod, J 2011. Acute Otitis media in children. Int J Gen Med., vol. 4, pp.421-3 Damoiseaux R 2005. "Antibiotic treatment for acute Otitis media: time to think again". CMAJ vol. 172, no. 5, pp.657–8. Coker, T M et al. 2010. Diagnosis, microbial epidemiology, and antimicrobial treatment of acute Otitis media in children. J Am Med Assn, vol.304, pp.2161-2169 Forgie, S; Zhanel, G and Robinson, J 2009. Management of Otitis media. Pediatrics & child health, vol.14, no. 7, pp.457 “Glue ear” 2014. NHS Choices. Department of Health. Gulani A, Sachdev HP, Qazi SA 2010. "Efficacy of short course ( Read More