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Chapter 43: Caring for Clients w/ Ear Disorders

front 1 Nursing interventions for clients w/ ear disorders?	back 1 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
front 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	back 2 Conductive hearing loss
front 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	back 3 Sensorineural hearing loss
front 4 involves both conductive and sensorineural problems, involving damage within the outer or middle hear and in the inner ear or auditory nerve	back 4 Mixed hearing loss

front 5 involves injury or damage to the nerves or the nuclei of the CNS	back 5 Central hearing loss
front 6 hearing impairment that is associated w/ old age	back 6 Presbycusis
front 7 Possible reasons for hearing loss?	back 7 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
front 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	back 8 Hearing loss

front 9 Examinations used to detect hearing loss?	back 9 otoscopic exam: detects cerumen impaction or injury to tympanic membrane audiometry tuning fork client's hx for exposure to occupational or other noise fhx
front 10 Medical management for clients w/ hearing loss?	back 10 recommendation for hearing aid American sign language Speech reading/lip reading light-activated alarms hearing dogs
front 11 Functions of a hearing aid?	back 11 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
front 12 REVIEW CLIENT AND FAMILY TEACHING 43-1: TIPS FOR HEARING AID CARE AND MAINTENANCE	back 12 REVIEW CLIENT AND FAMILY TEACHING 43-1: TIPS FOR HEARING AID CARE AND MAINTENANCE

front 13 Is sensorineural hearing loss reversible or irreversible?	back 13 Irreversible
front 14 Surgical management for clients w/ hearing loss?	back 14 cochlear implant
front 15 What is a cochlear implant?	back 15 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
front 16 Nursing management for clients w/ hearing loss?	back 16 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

front 17 accumulated earwax that obstructs the external acoustic meatus clients have excessive thick, dry cerumen	back 17 Impacted cerumen
front 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	back 18 Impacted cerumen
front 19 Medical management for clients w/ impacted cerumen?	back 19 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
front 20 Nursing management for clients w/ impacted cerumen?	back 20 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

front 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	back 21 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
front 22 inflammation of the tissue in the external auditory canal can be caused by: psoriasis eczema seborrheic dermatitis allergies to hair products	back 22 Otitis externa
front 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	back 23 Otitis externa
front 24 Medical management for clients w/ otitis externa?	back 24 warm soaks analgesics antibiotic ear medication corticosteroid meds: (neomycin/polymyxin/hydrocortisone solution)

front 25 Nursing management for clients w/ otitis externa?	back 25 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
front 26 REVIEW BOX 43-3: PREVENTING RECURRENT OTITIS EXTERNA	back 26 REVIEW BOX 43-3: PREVENTING RECURRENT OTITIS EXTERNA
front 27 Acute inflammation or infection of the middle ear	back 27 Otitis media
front 28 if otitis media is left untreated, it can lead to infection of the mastoid process ? or travel deeper to the inner ear?	back 28 Mastoiditis labyrinthitis

front 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	back 29 Otitis media
front 30 Medical/surgical management for clients w/ otitis media?	back 30 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)
front 31 Nursing management for clients w/ otitis media?	back 31 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
front 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	back 32 Otosclerosis

front 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	back 33 Otosclerosis
front 34 When the rinne test is performed where is the best sound heart when the tuning fork is applied?	back 34 the sound is best heart when tuning fork is applied behind the ear
front 35 Medical/surgical management for clients w/ otosclerosis?	back 35 otosclerosis has no cure hearing aid may help surgical option: stapedectomy is performed on ear most affected
front 36 Complications associated w/ a stapedectomy?	back 36 continued hearing loss infection dizziness facial nerve damage

front 37 Nursing management for clients w/ otosclerosis?	back 37 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
front 38 REVIEW NURSING PROCESS FOR CLIENT RECOVERING FROM STAPEDECTOMY	back 38 REVIEW NURSING PROCESS FOR CLIENT RECOVERING FROM STAPEDECTOMY
front 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)	back 39 Vertigo
front 40 Nursing care for clients w/ vertigo focuses on what?	back 40 tx of symptoms maintenance of the client's safety

front 41 Medications used to tx Vertigo?	back 41 Meclizine Dimenhydrinate Benzos (end in -pam) Antidepressants
front 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	back 42 Motion sickness
front 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)	back 43 Benign paroxysmal positional vertigo
front 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	back 44 Meniere disease

front 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	back 45 Meniere disease
front 46 Medical/surgical management for clients w/ Meniere disease?	back 46 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
front 47 Medical/surgical management for clients w/ Meniere disease?	back 47 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
front 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	back 48 Ototoxicity

front 49

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

back 49

acoustic neuroma