Chapter 43: Caring for Clients w/ Ear Disorders Flashcards

1

Nursing interventions for clients w/ ear disorders?

speak clearly in a low tone of normal volume during frequent reorientations and teaching related to assistive hearing devices
soft consonant sounds such as beginning and ending consonants should be clearly articulated
the nurse should face the client if possible

2

occurs from obstructions of the outer or middle ear, such as an accumulation of cerumen in the external acoustic meatus, or a disease such as a failure of the tiny ear bones to vibrate

Conductive hearing loss

3

involves damage to the inner ear from conditions that affect the sensory hair cells or the nerves

ex. atherosclerosis, tumors of the vestibulocochlear nerve, infections and drug toxicity

Sensorineural hearing loss

4

involves both conductive and sensorineural problems, involving damage within the outer or middle hear and in the inner ear or auditory nerve

Mixed hearing loss

5

involves injury or damage to the nerves or the nuclei of the CNS

Central hearing loss

6

hearing impairment that is associated w/ old age

Presbycusis

7

Possible reasons for hearing loss?

presbycusis
excessive noise
loud environment from work
fhx of sensorineural impairment
congenital malformations
ototoxic medications (ex. gentamycin, loop diuretics)
bacterial meningitis
perforation of the tympanic membrane

8

This client reports:

words and other sounds that are muffled
difficulty understanding conversations, esp. if there is other noise
inability to hear complete words, esp. consonants
request for frequent repetition during a convo
increased volume on tvs, radios, and other devices
sense that hearing problems are interfering w/ normal activities
friends/family report client's speech has deteriorated and client is less understandable

Hearing loss

9

Examinations used to detect hearing loss?

otoscopic exam: detects cerumen impaction or injury to tympanic membrane
audiometry
tuning fork
client's hx for exposure to occupational or other noise
fhx

10

Medical management for clients w/ hearing loss?

recommendation for hearing aid
American sign language
Speech reading/lip reading
light-activated alarms
hearing dogs

11

Functions of a hearing aid?

fits behind ear, in ear, or in the ear canal and amplifies sound
amplifies sound but doesn't improve a client's ability to distinguish words or speech
all sounds are amplified, including background noise
clients must seek assistance when they having hearing aid problems

12

REVIEW CLIENT AND FAMILY TEACHING 43-1: TIPS FOR HEARING AID CARE AND MAINTENANCE

13

Is sensorineural hearing loss reversible or irreversible?

Irreversible

14

Surgical management for clients w/ hearing loss?

cochlear implant

15

What is a cochlear implant?

an external microphone captures incoming sounds as wells as an external sound processor implanted behind the ear that captures sound, converts it to digital sounds and sends them to an internal plant

doesn't restore normal hearing
provides a means for clients to learn or relearn sounds in the environment and to understand speech

16

Nursing management for clients w/ hearing loss?

observe for signs such as leaning forward and cupping the ear to hear better, asking that words be repeated
determine the clarity of the client's speech and may recommend a referral for the dx and subsequent tx of a hearing impairment as well as speech therapy
stress the importance of avoiding the purchas e of a hearing aid from a mail-order catalog or company salesperson
obtain information about its severity and the methods used to understand the speech of others
used illustrations, pamphlets, and written directions to aid teaching and include a family member
ask the client to repeat info and demonstrate skills

17

accumulated earwax that obstructs the external acoustic meatus

clients have excessive thick, dry cerumen

Impacted cerumen

18

this client presents w/:

otalgia: fullness/pain in the ears
diminished hearing
asks for words to be repeated, misinterprets questions, raises tv or radio volume
visual exam w/ otoscope shows orange-brown accumulation of cerumen in distal end of the external acoustic meatus

Impacted cerumen

19

Medical management for clients w/ impacted cerumen?

instilling one or two drops of half-strength hydrogen peroxide, warm glycerin
carbamide peroxide (debrox)
triethanolamine (cerumenex)
removed mechanically by irrigating the ear using a cerumen spoon or curette

20

Nursing management for clients w/ impacted cerumen?

inspect ear and implement measures to remove excessive cerumen
eardrops can be warmed by holding the container in the hand for a few moments or placing it in warm water
be sure to warm ear drops to body temp b/c hot/cold liquids cause dizziness
avoid inserting irrigation too deeply; direct the flow toward the roof of the canal rather the tympanic membrane
teach clients to not clean the external auditory canal w/ cotton swabs or tooth picks

21

Medical management for clients w/ foreign objects in the ear?

This client may present w/:

diminished hearing
feels movement or a hears a buzzing sound
discomfort

mineral oil is instilled into the ear to smother an insect
solid object
the nurse instructs client to clean ears w/ a face cloth rather than inserting objects into the ears

22

inflammation of the tissue in the external auditory canal

can be caused by:

psoriasis
eczema
seborrheic dermatitis
allergies to hair products

Otitis externa

23

This client reports:

external ear looks red
swelling; can't see tympanic membrane
discomfort increases w/ manipulation
fever
lymph nodes behind ear enlarge
pus

Otitis externa

24

Medical management for clients w/ otitis externa?

warm soaks
analgesics
antibiotic ear medication
corticosteroid meds: (neomycin/polymyxin/hydrocortisone solution)

25

Nursing management for clients w/ otitis externa?

provide teaching to prevent recurrence
advise swimmers to wear soft plastic earplugs to prevent trapping of water in ear
encourage client to eat soft foods or consume nourishing liquids to prevent discomfort
advised client to avoid the use of non prescription remedies unless they have been approved by the PCP

26

REVIEW BOX 43-3: PREVENTING RECURRENT OTITIS EXTERNA

27

Acute inflammation or infection of the middle ear

Otitis media

28

if otitis media is left untreated, it can lead to infection of the mastoid process ?

or travel deeper to the inner ear?

Mastoiditis
labyrinthitis

29

This client presents w/:

hx of having a recent upper respiratory infection or seasonal allergies
fever
tinnitus
malaise
severe earache
diminished hearing
tenderness behind the ear=mastoiditis
tympanic membrane looks red and bulging
pressure of middle ear causes n/v and dizziness
increased WBC

Otitis media

30

Medical/surgical management for clients w/ otitis media?

prompt tx prevents rupture of the tympanic membrane
fluid aspiration by needle
antibiotics
myringotomy/tympanotomy: facilitates drainage of purulent material, eases pressure, and relieves throbbing pain
myringoplasty
mastoidectomy (removes diseased tissue; mastoiditis is rare)

31

Nursing management for clients w/ otitis media?

after a myringotomy, the discharge from the ear is bloody and then purulent
to remove the drainage, the nurse wipes the external ear repeatedly w/ a dry sterile cotton applicator
insert a loose (not tightly packed) cotton pledget in the external ear to collect drainage.
change pledget when it becomes moist

32

result of a bony overgrowth of the stapes and a common cause of hearing impairment among adults

interferes w/ the vibration of the stapes and the transmission of sound to the inner ear

Otosclerosis

33

This client reports:

progressive, b/l loss of hearing
tympanic membrane appears pinkish-orange from structural changes in the middle ear
interference with the ability to follow conversation
difficulty hearing others

Otosclerosis

34

When the rinne test is performed where is the best sound heart when the tuning fork is applied?

the sound is best heart when tuning fork is applied behind the ear

35

Medical/surgical management for clients w/ otosclerosis?

otosclerosis has no cure
hearing aid may help
surgical option: stapedectomy is performed on ear most affected

36

Complications associated w/ a stapedectomy?

continued hearing loss
infection
dizziness
facial nerve damage

37

Nursing management for clients w/ otosclerosis?

give pre-op client an explanation of what to expect in post-op period
client activity is restricted for 24 hours or more post-surgery
hearing may be temporarily or the same as or worse than before surgery
post-op, position client on non-operative side
prevent dislodgment of the prosthesis as a result of coughing, sneezing, or vomiting
nausea and dizziness are common problems
assess facial nerve function by checking symmetry when the client smiles or frowns

38

REVIEW NURSING PROCESS FOR CLIENT RECOVERING FROM STAPEDECTOMY

39

sensation of movement when there is none, or a sense of exaggerated motion when movement

two types:

objective: person is stationary and the environment is moving
subjective: a person feels motion but the surrounding environment is stationary (spinning sensation)

Vertigo

40

Nursing care for clients w/ vertigo focuses on what?

tx of symptoms
maintenance of the client's safety

41

Medications used to tx Vertigo?

Meclizine
Dimenhydrinate
Benzos (end in -pam)
Antidepressants

42

form of physiologic vertigo
repeated and constant motion causes this
clients experience this while in a car or plane, on a boat, or on carnival rides

s/s:

nausea and vomiting
pallor
diaphoresis

treatment:

dimenhydrinate
meclizine
scopolamine patches

Motion sickness

43

involves brief periods of severe vertigo when clients move their heads, particularly if they move their head back and toward the affect ear

many clients experience it when they roll over in bed onto their side

treatment:

meclizine
vestibular rehab therapy (VRT)

Benign paroxysmal positional vertigo

44

disorder is characterized by fluctuations in the fluid volume and pressure in the endolymphatic sac of the inner ear

causes distention of the endolymphatic compartment, leading to hearing loss, tinnitus, and vertigo
generally affects one ear, but can affect both
idiopathic

Meniere disease

45

This client presents w/:

s/s that are sudden, occur daily or infrequently
vertigo is the most incapacitating symptom
whirling dizziness and need to lie dow
nausea/vomiting/abdominal discomfort
tinnitus
hearing loss
headaches
nystagmus
hearing returns b/t attacks but gradually becomes worse w/ repeated attacks

Meniere disease

46

Medical/surgical management for clients w/ Meniere disease?

tx aims at reducing fluid production of inner ear, facilitating drainage, and tx'ing symptoms that accompany attack
low-sodium diet
no smoking
tx of allergy and avoidance of allergen is recommended
bed rest
meclizine
diazepam
promethazine
hydrochlorothiazide (watch potassium level)
avoid monosodium glutamate
avoid aspirin and aspirin products

47

Medical/surgical management for clients w/ Meniere disease?

assess gross hearing and perform Rinne test and Weber tests
determine extent and effect of the client's disability
provide emotional support
be available, empathic, and responsive
low-sodium diet to decrease edema
advise clients that have allergies to avoid allergens and take antihistamines

48

detrimental effect of certain medications on the 8th cranial nerve or hearing structures

drugs associated: salicylates, loop diuretics, quinidine, quinine, aminoglycosides

s/s:

tinnitus
sensorineural hearing loss
lightheadness
vertigo
n/v

nurses must be knowledge about the ototoxic effects of certain medications

nurses must carefully monitor the dosage and frequency of administration as well as asses the client for changes in hearing

Ototoxicity

49

benign Schwann cell tumor that progressively enlarges and adversely affects cranial nerve 8

acoustic neuroma

Timby's Introductory Medical-Surgical Nursing: Chapter 43: Caring for Clients w/ Ear Disorders Flashcards