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Discussion Question 1

SJ is a sixteen-month-old boy who is brought to the clinic with a one-day history of tugging at his right ear and crying and a two-day history of decreased appetite, decreased playfulness, and difficulty sleeping. His mother has documented a fever, so she has been giving him 5 mL of ibuprofen every twelve hours. He was diagnosed with acute otitis media (AOM) at the age of four months; he has had the same diagnosis three times since. On physical exam, his vital signs are normal with the exception of a temperature of 102°F. His weight is 10 kg. Both tympanic membranes (TMs) are erythematous, with the right one more than the left one. The right TM is bulging with limited mobility, copious cerumen, and purulent fluid behind the TM. The left TM appears normal. The right TM landmarks are difficult to visualize. Answer the following questions:

• Of the information provided, what data support the diagnosis of AOM and what would be inconclusive?
• How would you distinguish AOM and otitis media with effusion (OME)?
• What treatment would you suggest?
• What types of cautions or instructions would you provide to his mother?

Discussion Question 2

Administration of ophthalmological medications requires some explanation. What are the important points that you would review with a patient when teaching how to instill ophthalmic drops and when teaching how to instill ointment? What are the differences you would need to consider if the patient was a child or if the patient is a geriatric patient? Search the literature to see whether you are able to locate any guidelines to support this teaching.