Myringotomy and insertion of grommets as day surgery: a case study
This evidence-based case study follows a child from a nursing assessment on the day of his elective surgery at a children's hospital for myringotomy and insertion of grommets under general anaesthesia through to his arrival at the operating room. Potential pre-operative problems are identified and two problems that arose are discussed in detail. The main care provider in this case was a student nurse referred to as ‘the nurse’, supported by a qualified nurse, referred to as the ‘registered nurse’, who performed some assessments.
Jack, a 2-year-old boy, was seen by his family GP because of recurrent middle ear infections that had led to an ear condition called otitis media with effusion (OME). His GP had carried out a general assessment, including otoscopy, tympanometry and developmental status. Jack was subsequently referred for a hearing test and monitored for a period of 3 months. Following this, due to continued OME, notable hearing loss and developmental delays, it was decided that Jack would benefit from a referral to an ENT consultant with a view to the elective procedure of myringotomy and insertion of grommets (National Institute for Health and Care Excellence (NICE), 2008).
A secondary assessment is typically carried out before admission for grommet insertion (Easto et al, 2016). The secondary assessment is to confirm the diagnosis of OME, it involves clinical review by a GP or in a specialist clinic where otoscopy and tympanometry can be carried out (Rosenfeld et al, 2016). In recurrent OME with hearing loss, children are often referred to an otolaryngologist for an audiological assessment (Easto et al, 2016). Generally, two audiograms are required 3 months apart and within 3 months of surgery (Health Information and Quality Authority (HIQA), 2013; Easto et al, 2016).
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