MASTOIDITIS
Definition
is the infection and inflammation of the mastoid air cells as a result of recurrent chronic otitis media.
Pathophysiology
the mastoid air cells have a rich supply of blood. mastoiditis is a result of chronic otitis media, where there is damage to the tympanic membrane. The infection then drains into the mastoid cavity where infecting organisms thrive and multiply, resulting in increased exudates. Excessive drainage from the mastoid cavity traverses through the middle ear and out of the perforated tympanic membrane through into the external auditory canal. the inflammatory process in the mastoid cells results in oedema and more exudate, thus increasing the pressure in the bony cavity.
Clinical Manifestations
on palpation, there's swelling and tenderness over the mastoid process
the swelling results in the pinna being pushed out, causing it to protrude from the side of the head.
pain in the ear is severe and purulent ear discharge may be profuse
Assessment and common findngs
subjective data
there is a history of recurrent otitis media with or without cholesteatoma.
there is otalgia, otorrhoea and impaired hearing
Objective data
The pinna protrudes indicating oedema and the mastoid process is tender on palpation.
Otoscopic examination reveals perforation of the tympanic membrane.
Nursing Management
Matoidectomy is an advanced stage of infection and requires urgent intervention. Recommended treatment includes;
- parenteral antibiotics and analgesics to combat infection and relieve pain
- Surgery, mastoidectomy and possibly tympanoplasty
NURSING CARE PLAN
PAIN
Nursing diagnosis: Altered comfort and sleep due to pain
Expected outcome: no pain
Nursing interventions: assess pain accurately, give analgesics as prescribed, cold compresses may be applied, monitor vital signs 4-hourly to assess progress.
Evaluation: Vital signs gradually return to normal and no fever reported, patient expresses decreasing pain, patient sleeping comfortably.
RISK OF HAEMORRHAGE
Nursing diagnosis: Risk of fluid volume deficit related to haemorrhage as a result of incision made
Expected outcome: No bleeding
Nursing interventions: observe the dressing for bleeding, prepare for possible packing of the wound, monitor vital signs to detect signs of concealed bleeding and hypovolaemic shock.
Evaluation: No bleeding from the mastoid prominence on dressings observed.
RISK OF INFECTION
Nursing diagnosis: Risk pf secondary infection following mastoidectomy.
Expected Outcome: No infection.
Nursing interventions: Observe aseptic technique while attending to the operated area. Administer prescribed antibiotics. Give nourishing diet to enhance healing. Give plenty of fluids if allowed.
Evaluation: Vital signs normal. the patient reports no bleeding and pain from the operated site.