Ears and Throats!

  1. Hello everyone!
    Newbie school nurse here and I'm curious as to:

    1. Do you look into ears and into "sore" throats?

    2. What do you do with your findings?

    coming from the hospital environment (and mostly teaching environments), I honestly never used an otoscope for an ear but kept it charged for the docs and residents. As for throats, if I had a post T&A I would definitely look for bleeding if I had concerns but not when a patient had a non-surgical sore throats.

    I just am not sure what is a reasonable expectation for all the random sore throats and ear aches I get.

    sore throats, I'm generally inquiring about runny nose/sniffles/history of seasonal allergies as a likely culprit as I have yet to have a febrile kid come in with a sore throat. I've looked in them but have yet to see any white patches or angry looking red throats.

    ears: I was super excited to actually see an eardrum the other day when I was presented with an ear not full of wax, but it looked ok to me based on images I looked up online But what if it hadn't?

    I guess I'm struggling with where nursing assessment ends and medical diagnosing is beginning. Regardless of what I find, I can't do anything about it other than send a note home or call the family if I want the parents to know.

    Would appreciate other comments on how you handle sore throats and ear aches as I think I've gotten my stomach ache and headache interventions down and those are the majority of "illness" complaints I've been seeing so far.
    Last edit by River Song, RN on Sep 10 : Reason: Punctuation - it matters!
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  2. 21 Comments

  3. by   moreoreo
    We don't have otoscopes in our offices. For sore throats, maybe I should be more consistent but I tend only to take a peek with my penlight if they have a cough, hoarse voice, or complain that it is really bothersome. I let a parent know if it looks inflamed, or if I do see white spots (in which I do send home), and in one case a girl's tonsils were very enlarged and I called home to find that it had been a chronic concern for her. (Still sent her home.) I guess where I draw the line is I never refute a student's complaint simply for a throat looking normal, and any time I inform a parent of an abnormal finding I encourage follow up with PCP rather than claiming a diagnosis.
  4. by   dakotadenise
    I look in every sore throat and every earache. If I didn't, I can just hear it now - "I sent a kid to the nurse with a sore throat/sore ear and she didn't even look at it! Why is she here??" No thanks. I have a basic otoscope that I can see if there is massive wax, really red canals and the like. I use the otoscope light to look in throats. If Idon't see anything major, I do comfort measures - salt water gargle, cotton ball in ear, etc. If I see anything that i would take my kid to the dr for, I give parents a call and let them know.
  5. by   aprilmoss
    I look primarily when the student complains about a sore throat or an ear ache. Note my findings. As mentioned if it looks like something that merits attention (excessive ear wax, etc...), I contact the parent. Yeah, more often than not you're just going through the motions but you do catch things.
  6. by   MHDNURSE
    I wish I had an otoscope, but alas, too much $$ for my school. I do always check throats with my iphone light.
  7. by   JenTheSchoolRN
    Quote from MHDNURSE
    I wish I had an otoscope, but alas, too much $$ for my school. I do always check throats with my iphone light.
    I have a super cheap one I got from Amazon for $30. It does the job to see wax vs inflamed canals so I can alert a parent if needed.

    Side story: I had one student throw a lollipop stick at another student (as a joke) and it landed in then bounced out of the student's ear. I was able to use my cheap otoscope to see blood and refer out. (Turns out it was perfect storm of an accident and it caused a thankfully minor injury to the eardrum.).
  8. by   BeckyESRN
    I check throats and ear with my penlight. No otoscope here. I use ear-ease (a container designed to go over the ear, you fill it with warm water) when the kiddo returns it, if the ear issue hasn't resolved, I call home and recommend that they be seen by their PCP or MedExpress. The down side to using the ear-ease container is that it seems to make ear aches more contagious, as in, my friend got attention and now I need attention too
  9. by   Farawyn
    I like looking in the hopes of seeing pus or wax, 'cause I'm disgusting.
  10. by   AdobeRN
    I use a penlight to look at throats just because when I call home to parents that is usually the first question they ask me "how does the throat look?" Honestly I am not good at assessing throats - unless there are obviously enlarged tonsils, pus etc, I can't tell if a throat is red or if its that is just normal for the kid. If the kid has runny nose, cough etc I will call the parent but if they are just complaining of a sore throat without other symptoms I will have them do a salt water gargle and tell them to return in a few hours if pain continues - If I see them again I will contact the parent.

    I do have an otoscope - I had a NP friend of mine show me how to use it and coach me on what to look for with an ear infection. I always call parents when kids complain of earaches and let them know what I see even if the ear looks normal to me.

    As far as diagnosing...I tell them what I am seeing/what their kid is telling me and that they should consider making an appointment with their doctor if symptoms continue. So I don't feel as if I am diagnosing anything - just informing the parent.
  11. by   kidzcare
    Quote from Farawyn
    I like looking in the hopes of seeing pus or wax, 'cause I'm disgusting.
    Gross.

    I would always look and then tell the student what I saw. "Your throat looks fine- no swelling or red/white spots. Make sure you are drinking enough water and keep mom and dad updated if it continues or gets worse."

    When I worked in a building with an otoscope, I would look but I was not confident in my ear assessment skills. I would always call parents and tell them that their kid had a complaint and to have it checked out if the pain continued.
  12. by   kidzcare
    Fun story... I took a bug out of a kid's ear at camp over the summer. Camper came in saying they'd had a dream that a spider crawled in her ear and now she felt something. I looked with an otoscope and just saw black. Assumed it was old wax. She returned 45 minutes later (with friends) and asked me to look again... I decided to humor her and there is was- ready to crawl out. I grabbed some tweezers, pulled it out, and tried to keep her and her friends from freaking out (didn't work). Every time she saw me around camp for the rest of the summer, she would smile sheepishly at me and wave.
  13. by   WineRN
    I have an otoscope I use but 8/10 times there is so much wax I can't see the ear drum. The other times, the little one is so freaked out by me saying I'm going to look in their ear, they squirm and I can't see anything.

    In an ideal world, I want a nice, non bulging, no red, no random object, minimal wax present canal. I also check for fever with every ear ache, sometimes that goes hand and hand with an ear infection. I can usually get the little ones to tell me how painful it is and if it's not tear inducing they go back to class and I call home to give the parents a heads up.

    Sore throats, we have strep going around so I recently sent out a little chart to my parents with the different between a viral sore throat and possible strep. Some of the little ones aren't good at opening their mouth, so if they have a low fever, problems with swallowing and no cough, I call home for them to get a rapid strep test done even if I don't see the white plaques. (I'm 3/3 positives currently)
    All others, we do a salt water rinse/gargle and back to class they go.

    And with both of these, if they are sent back to me a second time (and they aren't on my FF list) I call home and tell the parents that their symptoms aren't improving and are having trouble focusing in class. This will usually end with the parent talking to the little one and either they talk them back into class or they come and get them.
  14. by   OyWithThePoodles
    Haven't read previous posts so sorry if duplicated.
    I used to use my pen light to look at throats, but one day by battery was out and used the otoscope without the specula and liked it much better.

    Throats: I look for redness, and whether it is just on the tonsils (maybe strep, let parent know but don't mention the word strep) or if it is also red at the back of the throat, which is likely drainage. If there are white patches I will definitely call home and report my findings.

    Ears: I attempt to visualize the ear drum, sometimes with the wax it just isn't possible. If the ear drum is inflamed I call home and let them know, or if there is fluid. I used to work at my kiddos pediatrician so if one of my own has an ear infection/swimmers ear/fluid, they will let me look to while we are there so I can see what they look like. Which is nice If there is a foreign object that isn't sticking out of the ear, I call home and have them pick their kiddo up.

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