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Health Get research paper samples and course-specific study resources under   homework for you course hero writing service – Manage ment Guidelines for Treatment of AOM Essay

Health Get research paper samples and course-specific study resources under   homework for you course hero writing service – Manage ment Guidelines for Treatment of
AOM

Paper type: Essay
Categories: Health And Hygiene For Children, Health Get research paper samples and course-specific study resources under   homework for you course hero writing service – Manage ment, Nursing, Recent Advances In
Medical Treatment
This article establishes diagnosis and management guidelines for the treatment of AOM.
Additionally, the authors make recommendations regarding treatment options for the
symptoms of AOM and address the concept of watchful waiting as opposed to immediate
antibiotic therapy. Recommendations are provided for clinical practice and were created
using a systematic review of clinical research, making it an appropriate source for nursing
practice.
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(Block, 1997)
Appropriate: This article contains up to date research obtained by the authors in a primary
research study so it is an appropriate source for nursing practice.
Primary research evidence
(Kelley, Friedman, & Johnson, 2007)
Appropriate: This article (chapter of a textbook) provides generalized information and
descriptions the mechanisms of AOM, along with a host of information about other
conditions that are not pertinent to this inquiry. It does appear to provide supporting
research to aid in diagnosis and treatment of AOM and mentions the objective of watchful
waiting as a possible option in the text and within the treatment matrices and simply states
what current treatment guidelines are in place.
The age group classications for treatment do not align with those in the suggested policy
guidelines for the nursing group’s recommendation however it could be appropriate for
nursing practice.
(McCracken, 1998)
Appropriate: This article supports current guidelines and discusses potential issues
associated with continued antibiotic use, making it an appropriate source for nursing
practice.
Evidence based summary
Interviews
Inappropriate: These interviews give rst-hand accounts of parental experience noting signs
and symptoms in cases of AOM and subsequent treatment. Because the information is
anecdotal in nature and not evidence-based it would not be appropriate evidence for
changing nursing practice
Watchful Waiting
According to an AAP/AAFP clinical guideline published in the May 2004 edition of Pediatrics,
“Acute otitis media (AOM) is the most common infection for which antibacterial agents are
prescribed for children in the United States”. Direct and indirect costs of providing care,
treatment and medications for AOM is well over $3 billion yearly. Although AOM is the most
commonly treated infection in the United States, test ndings and recent studies have found
that most cases of AOM are viral in nature. Because viral infections do not respond to
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8/10/2020 Health Get research paper samples and course-specific study resources under   homework for you course hero writing service – Manage ment Guidelines for Treatment of AOM Free Essay Example

antibiotics, there is subsequently no benet shown by use of antibiotics in reducing the
intensity of the symptoms or the duration of infection. Conversely, prescribing antibiotics for
AOM caused by viral infection can have a negative impact on the current and future health
of the children treated, and increase the cost of providing care.
For many years, physicians would simply prescribe antibiotics immediately when the signs
and symptoms of an ear infection were present. However recent evidence shows that over
several decades the frequent use of antibacterial agents has caused various bacteria to
mutate and become resistant to certain antibiotics necessitating exploration of alternative
treatments. Overuse or misuse of antibiotics such as prescribing for viral illnesses and/or
not completing the full course prescribed when bacterial infection is actually present have
led to the development of antibiotic resistant strains of bacteria. As a result, researchers,
physicians, and other medical personnel have looked for methods of treatment that are
eective for illnesses caused by viral agents, such as AOM. AAP/AAFP (2004) now
recommend “watchful waiting” for a period of 48-72 hours in cases of uncomplicated AOM
that are caused by other illnesses such as an upper respiratory virus. If a child presents with
acute symptoms of AOM and has no other underlying illness or complicating factors, then it
is appropriate to use watchful waiting as a “no-treatment” treatment for that child.
This avoids unnecessary exposure to antibiotics and reduces the likelihood of antibiotic
resistance in the future. Research cited in the article showed that in placebo trials, the
children who did not receive an antibacterial agent had favorable outcomes and recovered
as well as those in the treatment group. Additionally, this allowed for signicant reduction in
the amounts of money spent on medication, and ultimately for health care overall. The
guidelines clearly outline that watchful waiting is only appropriate for those with
uncomplicated AOM and that parents and caregivers should be educated on required follow
up if symptoms have not improved within the 48-72 hour time period. If signicant
improvement of symptoms is not seen during watchful waiting, then antibiotic therapy may
be appropriate. “Given the sum of the available evidence, clinicians may consider
observation with symptomatic treatment as an option for initial management of selected
children with AOM”. (American Academy of Pediatrics;
American Academy of Family Physicians, 2004, p. 1456)
Application of Findings to Improve Nursing
Practice
The guidelines listed in the article could be applied to the nursing practice in a clinical setting
using several dierent approaches simultaneously. The article lays out guidelines for
recognizing the most common signs and symptoms of AOM and steps to conrming a
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https://monkessays.com/nursing-writing-services//health-management-guidelines-for-treatment-of-aom-essay 4/8
denitive diagnosis. Clinical providers at all levels would need education in developing a
diagnosis using the guidelines outlined. Once a proper diagnosis has been determined, a
complementary treatment plan can be determined, allowing for more rapid relief of pain
and reduction in other symptoms. The article outlines the criteria that are associated and
present for a conrmatory diagnosis of AOM. If those criteria are not met, then other
illnesses such as viral infection or URI should be considered. The guidelines emphasize an
“accurate diagnosis and adherence to a consistent denition of AOM”. (American Academy
of Pediatrics; American Academy of Family Physicians, 2004, p. 1462) The algorithm included
in the article is an eective tool that providers could use to aid in establishment of the
correct plan of treatment. Treatment options are listed in a ow-chart style that is easy to
follow and gives various treatment options as you progress through the steps.
Options range from watchful waiting to initiation of antibiotic therapy, along with
suggestions for which antibacterial agent would be most eective for dierent scenarios.
The guideline of 48-72 hour window of observation is reinforced in the algorithm. When
implementing a change in clinical practice that involves medications, pharmacy sta should
be included in training to be available to answer provider questions regarding medications,
side eects, and ecacy. They should also to receive education themselves about practice
changes being implemented, as they will likely be approached by clients with questions once
those changes have been initiated. A combined eort among sta will help to improve
nursing practice in the clinical setting through the use of evidence based guidelines and a
willingness to be open to change when it is in the best interest of the patient. It is essential
that those involved also understand that, in certain instances, watchful waiting is not an
appropriate intervention. Those situations are clearly outlined in the guidelines.
The information from this article can be useful for nurses in that it can help to determine
which patients will likely be candidates for watchful waiting and which are likely to need
antibiotic therapy as a rst line of treatment. Nursing sta can reinforce education of
patients and parents regarding treatment, reducing incidence of recurrence, and insuring
that the plan of care is clearly communicated and understood prior to discharging patients
from care. Nursing sta should also make certain that the timeframe for observation is
understood and that education is given regarding where and when follow up will be
necessary if symptoms do not improve.
Ethical Issues
Whenever humans, research, and medical science are present, there is always a chance for
ethical issues to arise. To avoid conict of interest, those involved in the research must
remain neutral and must strive to be certain that personal bias does not enter the arena.
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Participants in any clinical study for research and change of practice need to give informed
consent freely, and any questions they have regarding diagnosis, treatment, or procedure
should be answered prior to their participation. Participants should be encouraged to ask
questions prior to implementation of changes, and also during their participation. Benets
vs risks associated with research and practice changes must be disclosed. Assurance of
condentiality must be given by those administering the research, and any privacy concerns
should be addressed. Full disclosure of any possible detrimental eects from participation
must be understood fully by each participant and entry into research must be completely
voluntary. Parents must ultimately give informed consent for minor children, however if the
child is of school age or above their thoughts and feelings should be taken into
consideration as well. In research, those considered to be vulnerable include children, low
income families, prisoners and those with diminished mental capacity and reasoning.
The use of members of vulnerable populations in research presents the potential for
coercion so care must be taken to clearly explain the benets and the risks with any
guardian or caregiver for those vulnerable children and adults. Care should be taken to
make sure that vulnerable subjects, especially children, are not subjected to unnecessary
additional testing or interventions. Researchers must take care to insure that parents and
guardians fully understand all aspects of care associated with the study and how it
compares to the current standard of care. It is generally acceptable to include pediatric
subjects if the potential for benet is high and the risk for harm is low.
References
Best paper writer websites, Custom term paper writing service and Research papers owl essays – Professional help in research projects for students – Cite this essay
American Academy of Pediatrics; American Academy of Family Physicians. (2004,
May).
1.
Clinical Practice Guideline: Diagnosis and Get research paper samples and course-specific study resources under   homework for you course hero writing service – Manage ment of Acute Otitis Media.
Pediatrics, 113(5), 1451-1465. Block, S. L. (1997, April).
2.
Causative pathogens, antibiotic resistance, and therapeutic considerations in acute
otitis media. The Pediatric Infectious Disease Journal, 16(4), 449-456.
3.
Kelley, P. E., Friedman, N., & Johnson, C. (2007). Ear, Nose, and Throat. In W. W. Hay,
M. J. Levin, J. N. Sondheimer, & R. R. Deterding (Eds.), Current Pediatric Diagnosis and
Treatment (18 ed., pp. 459-492). New York: Lange Medical Books/McGraw Hill.
4.
McCracken, G. H. (1998, June). Treatment of acute otitis media in an era of increa

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