In reviewing a 50-year-old client's medical record, which clinical manifestation should the nurse plan to assess for?

Rationale

• B. Sudden pain relief: The intense pain associated with otitis media is caused by the accumulation of fluid and pressure against the tympanic membrane. When the membrane ruptures, that pressure is instantaneously released, resulting in a sudden and dramatic decrease in pain. This is often followed by purulent (pus-filled) or serosanguineous (bloody) drainage in the external ear canal.

Why the others are incorrect

• A. Increased temperature: While a fever is a common sign of an acute infection (Acute Otitis Media), it is not a specific indicator that the eardrum has ruptured. In fact, systemic symptoms like fever may actually decrease once the pressure and infection are vented through a rupture.

• C. Popping sensation when swallowing: This sensation is typically associated with the opening and closing of the Eustachian tube as it attempts to equalize pressure in the middle ear. It is a common symptom of Eustachian tube dysfunction or fluid in the ear, but it indicates an intact eardrum rather than a ruptured one.

• D. Green-blue discharge in the ear canal: While drainage (otorrhea) occurs after a rupture, the color is typically clear, bloody, or yellowish-white (purulent). Green-blue discharge is more characteristic of Pseudomonas infections, often seen in otitis externa (swimmer's ear), rather than a standard tympanic membrane rupture from middle ear effusion.

Choice A reason: A low fiber diet with decreased intake of nuts is not specifically indicated for managing Meniere's disease. Meniere's disease management focuses on fluid balance rather than dietary fiber.

Choice B reason: A low fat diet with a restriction of citrus fruits is not relevant to Meniere's disease. Fat intake and citrus fruits do not directly affect the symptoms or management of this condition.

Choice C reason: A low carbohydrate diet and the elimination of red meats are not standard dietary recommendations for Meniere's disease. The focus is on reducing sodium intake to manage fluid retention and balance.

Choice D reason: A low sodium diet and fluid restriction are key dietary measures for managing Meniere's disease. Reducing sodium intake helps to decrease fluid retention, which can alleviate symptoms such as vertigo and tinnitus associated with this condition.