What effect does the elevated temperature have on the other vital signs?

Real-Life Challenge: Otitis Media

An 18-month-old male child has been brought to the physician’s office by his parents who say that he has been fussy and crying for the last 10 hours. The mother says she is having difficulty getting him to eat, and she has noticed that he sits with his head held to the right side. He has a history of a cold in the past few days with a runny nose and watering eyes. Examination reveals a temperature of 103° F, pulse of 116, and respirations of 32. The otoscopic examination was used to evaluate the condition of the tympanic membranes. The physician examined the left ear first, a method employed to see what the asymptomatic ear looked like. It revealed a normal translucent pearl-gray tympanic membrane. Examination of the right or symptomatic ear disclosed a red, bulging eardrum. The mucous membrane of the nasal passages appeared inflamed, as did the back of the throat. An antibiotic (amoxicillin trihydrate [Amoxil] 125 mg q.i.d. × 10 days) was prescribed. The parents were instructed to give acetaminophen or ibuprofen (Motrin) for a temperature greater than 101° F and to call if the fever and pain persisted beyond 24 hours. The child was scheduled for a follow-up visit in 1 week.


1. Why is it important to note that the child sits with his head held to the side?

2. What effect does the elevated temperature have on the other vital signs?

3. Why did the physician examine the left eardrum first?

4. What patient teaching would you offer the parents about the medication suggested for the elevated temperature?

5. What patient teaching would you offer the parents about the antibiotics?

6. Why are treatment and follow-up important?

7. Which surgical procedure may be indicated?

8. What long-term effects may the child experience if the otitis does not respond to treatment?

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