Discussion response #1 Ear Pain ( No app style needed, half a page responding to Rosie) Need it for Friday (tomorrow)
What other associated symptoms should you ask about?
Description, characteristics, if the pain is intermittent or constant, and rate the pain on the numerical scale from 1-10.
Inquire if there is any type of drainage (bloody, pus, clear, yellow) and if there is an odor
If any swelling was noticed, trouble hearing, trouble hearing, or spinning sensation
If there is pain with chewing, sinusitis, GERD, talking or jaw clicking
If there is neck, thyroid or throat tenderness or pain radiating to the ear
Even the patient complaint is related to the right ear, and I would also inquire about the left ear (Earwood, Rogers, & Rathjen, 2018).
How does the time course help to distinguish among different causes of ear pain?
To determine the cause of the ear, pain the practitioner will need to know when the pain started and how long. This information is valuable when determining if the pain is primary or secondary otalgia, the type of treatment required, and to determine the differential diagnosis.
How does the age of the patient help with narrowing the diagnostic possibilities?
Otalgia is a primary in most children who complain about earaches and secondary otalgia is assessed in adults (Dunphy, Winland-Brown, Porter, & Thomas, 2015).
What diagnostic tests do you want to include to help you with your diagnosis?
If drainage is present, culture can be ordered to assess for antibiotic sensitivity.
CT or MRI scan can be ordered to evaluate the condition of the temporal bone
CBC to asses for infection
Audiometry or simple testing to assess for hearing loss
Otoscopic examination
Nasolaryngoscopy and MRI of the head and neck and/or a CT with contrast (Dunphy, Winland-Brown, Porter, & Thomas, 2015).
Create a differential diagnosis flowsheet for this patient and include the diagnostics as well as the pharmacological management and rationale related to the differentials.
Bacteria otitis externa- (swimmer’s ear)—otoscopic examination (check for edema, redness) heat/icepack to the outer ear, no swimming or ear submersion for 4-6 weeks—
OTC pain medication (Tylenol 650 mg PO every 4 hours PRN, max daily dose 4000mg/day; NSAID 400-600 mg PO every 6 hours PRN, max dose 1200 mg daily. For severe pain Tylenol #3 or hydrocodone 5 mg PO every 8 hours for the first 24-48 hours.
Antibiotics and steroids—first-generation cephalosporins or penicillin and/or second- generations cephalosporins or beta-lactamase resistant penicillin, Fluoroquinolones
Surgery- for severe cases (Dunphy, Winland-Brown, Porter, & Thomas, 2015).
Children- Tympanometry (helps diagnose hearing loss)
Barotrauma-otoscopic (ear)examination (blockage, fluid inflammation, injury, or infection), hearing test (rubbing fingers together or whispered voice test (hearing loss) physical examination (r/o other causes), and balance test (assess for vertigo) office visit treatments (chew gum or yawn) to equalize the pressure r/t airplane or swimming.
OTC pain medication (Tylenol 650 mg PO every 4 hours PRN, max daily dose 4000mg/day; NSAID 400-600 mg PO every 6 hours PRN, max dose 1200 mg daily. For severe pain Tylenol #3 or hydrocodone 5 mg PO every 8 hours for the first 24-48 hours.
Antibiotics and steroids—first-generation cephalosporins or penicillin and/or second- generations cephalosporins or beta-lactamase resistant penicillin, Fluoroquinolones (Dunphy, Winland-Brown, Porter, & Thomas, 2015; Earwood, Rogers, & Rathjen, 2018).
Rosie
References
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., Thomas, D. J. (2015). Primary Care The Art and Science of Advanced Practice Nursing. [VitalSource Bookshelf]. Retrieved from https://bookshelf.vitalsource.com/#/books/9780803655621/
Earwood, J. S., Rogers, T. S., & Rathjen, N. A. (2018). Ear Pain: Diagnosing Common and Uncommon Causes. American Family Physician, 97(1), 20–27. Retrieved from https://search-ebscohost-com.libauth.purdueglobal.edu/login.aspx?direct=true&db=mdc&AN=29365233&site=eds-live