otitis media_cs

8/14/2019 otitis media_CS

1/14

II. HEALTH HISTORY

A. PROFILE OF THE PATIENT

Name:

Age: Address: ?

Sex: Female

Birthday: ?

Placed of Birth: ?

Civil Status: Single

Religion: R. Catholic

Occupation: Housekeeper

Nationality: Filipino

Date Admission:June 30 2009

Time: 7:30 pm

Attending Physician: ?, MD

Admitting Diagnosis: Chronic Otitis Media, bilateral, brain abscess facial nerve

palsy,

S/P Mastoidectomy Right

Fathers name: ?

Mothers name: ?

Height: 52

Weight: 38 kgs

Blood pressure: 100/70 mmHg

Pulse rate: 82 bpm

Respiratory Rate: 18 cpm

Temperature: 37.2 C.


2/14

B. FAMILY and PERSONAL HEALTH HISTORY

? had undergone surgery in the past, went do German doctors for ear problem on

both sides. She also has asthma. Her father is not known to have a genetic diease and

so with her mother. She doesnt seem to have food and drug allergies. She had been

taking mefenamic acid for the management of pain she experience whenever her ears

ar again infected. She doesnt smoke but drink liquor occasionaly

C. HISTORY OF THE PRESENT ILLNESS

8 years PTA patient had undergone Mastoidectomy on her Left side. 3 years PTA

patient had asthma but did not seek for medical assistant, instead, stayed at home and

went on self medication. 6 months PTA patient was admitted at the german Hospital for

her recurring Otitis media.

D. CHIEF COMPLAINT

The patient was admitted due to the Chief Complaint pain on both ears. Also,

patient is suffering from hearing loss and also from facial never palsy which is the factor

for making her depressed


3/14

Anatomy and Physiology

Ear

The ear is divided into 3 main regions: the external ear, which collects sound

waves and channels them inward; the middle ear, which convey sound

vibration to the oval window; and the internal ear, which houses the

receptors for hearing and equilibrium

External ( Outer) ear

The external or outer ear consist of the auricle, external auditory canal, and

eardrum. The auricle (pinna) is a flap of elastic cartilage shape like the flared

and of a trumpet and covered by skin. The rim of the auricle is the helix; the

inferior portion of the lobule. Ligaments and muscles attach the auricle to

the head. The external auditory canal (audit=hearing) is a curved tube about

2.5 cm long that lies in the temporal bone and leads from the auricle to the

eardrum. The eardrum or tympanic membrane (tympan= a drum) is a thin,

semitransparent partition between the external auditory canal and middle

ear. The eardrum is covered by epidermis and lined by simple cuboidal

epithelium. Between the epithelial layers is connective tissue composed of

collagen, elastic fibers, and fibroblasts. Near the exterior, the external

auditory canal contains a few hairs and specialized sebaceous glands called

ceruminous glands that secret earwax or cerumen. The combination of hairs

and cerumen prevent dust and foreign objectives from entering the ear.

Cerumen usually dries up and falls out of the ear canal. Some people,

however, produce a large amount of cerumen, which can become impacted

and can muffle incoming sounds.

Middle ear

The middle is a small, air-filled cavity in the temporal bone that is lined by

epithelium. It is separated from the external ear by the eardrum and from

the internal ear by a thin bony partition that contains 2 small membrane-

covered opening: the oval window and the round window. Extending across


4/14

the middle ear and attached to it by ligament are the 3 smallest bone in the

body, the auditory ossicles, which are connected by synovial joints. The

bones, named for their shapes, are the malleus, incus, and stapes-commonly

called the hammer, anvil and stirrup, respectively. The handle of the

malleus attaches to the internal surface of the eardrum. The head of the

malleus articulates with the body of the incus. The incus, the middle bone in

the series, articulates with the head of the stapes. The base or footplate of

the stapes fits into the oval window. Directly below the oval window is

another opening, the round window, which is enclosed by a membrane,

called the secondary tympanic membrane. Besides the ligaments, 2 tiny

skeletal muscles also attach to the ossicles. The tensor tympanimuscle,

which is innervated by the mandibular branch of the trigeminal nerve or

cranial nerve number 5, limits movement and increases tension on the

eardrum to prevent damage to the inner ear from loud noises.

The stapedious muscle, which is innervated by the facial nerve (cranial nerve

VII), is the smallest of all skeletal muscle. By dampening large vibrations if

the stapes due to loud noises, it protect s the oval window but it also

decrease the sensitivity of hearing. For this reasons, paralysis of the

stapedious muscle is associated with the hyperacusia (abnormally sensitive

hearing). Because it takes a fraction of a second for the tensor tympanic and

stapedious muscles to contract, they can protect the inner from prolonged

loud noises, but not from brief ones such as a gun shot. The anterior wall of

the middle ear contains an opening that leads directly into the auditory

(pharyngotympanic) tube, commonly known as the Eustachian tube. The

auditory tubes, which consist of both bone and hyaline cartilage, connect the

middle ear with the nasopharynx (upper portion of the throat). It is normally

closed at its medial (pharyngeal) end. During swallowing and yawning, it

opens, allowing air to enter or leave the middle ear until the pressure in the

middle equals the atmospheric pressure. When the pressures are balanced,

the eardrum vibrates freely as sound waves strike it. If the pressure is not

equalized, intense pain, hearing impairment, ringing in the ears, and vertigo


5/14

could develop. The auditory also is route whereby pathogens may travel from

the nose and throat to the middle ear.

Internal (inner) ear

The internal ear is also called the labyrinth because of its complicate d series

of canals. Structurally, it consists of 2 main divisions; an outer bony labyrinth

that encloses an inner membranous labyrinth. The only labyrinth is a series

of cavities in the temporal bone divided into 3 areas: 1. the semi circular

canals, 2. the vestibule, both if which contain receptors for equilibrium, and

3. The choclea, which contains receptors for hearing. The bony labyrinth is

lined with periosteum and contains perilymph. This fluid, which is chemically

similar to cerebrospinal fluids, sorrounds the membranous labyrinth, a series

of sacs and tubes inside the bony labyrinth and having the same general

form. The membranous labyrinth is lined by epithelium and contains


6/14

endolymph. The level of potassium ions in endolymph is unusually high for

an extracellular fluid, and potassium ions play a role in the generation of

auditory signals. The vestibule is the oval central portion of the bony

labyrinth. The membranous labyrinth in the vitibule consists if 2 sacs called

the utricle (little bag) and the saccule (little sac), which are connected by a

small duct. Projecting superiorly and posteriorly from the vestibule is the 3

bony semicircular canals, each of which lies at approximately right angles to

the other 2. Based on their positions, they are named the anterior, posterior,

and lateral semi circular canals. The anterior and posterior semi circular

canals are vertically oriented; the lateral one is horizontally oriented. At one

end of each canal is a swollen enlargement called the ampulla (saclike duct).

The portions of the membranous labyrinth that lie inside the bony semi

circular canals are called the semi circular ducts. These structures

communicate with the utricle of the vestibule. The vestibular branch of the

vestibulochoclear nerve (cranial nerve VIII) consists of ampullary, utricular,

and saccular nervers. These nerves contain both first order sensory neurons


7/14

and motor neurons that synapse with receptors for equilibrium. The first

order sensory neurons carry sensory information from the receptors, and the

motor neurons carry feedback signals to the receptors, apparently to modify

their sensitivity. Cell bodies Of the sensory neurons are located in the

vestibular ganglia. Anterior to the vestibule is the choclea (snail shape) a

bony spiral canal that resembles a snails shell and makes almost 3 turns

around a central bony core called the modiolus.


8/14


9/14


10/14

Sections through the choclea reveal that it is divided into 3 channels.

Together, the partitions that separate the channels are shaped like the letter

Y. the stem of the Y is bony shell that protrudes into the canal; the wing of

the Y are composed mainly of membranous labyrinth. The channel above the

bony partition is the scala vestibule, which ends at the oval window; the

channel below is the scala tympani, which ends at the round window. The

scala vestibule and scala tympani both contain perilymph and are completely

separated, except for an opening at eh apex of the cochlea, the helicotrema.

The cochlea adjoins the wall of the vestibule, into which the scala vestibule

opens. The perilymph in the vestibule is continuous with that of the scala

vestibule. The third channel is the cochlear duct or scala media. The

vestibular membrane separate the cochlear duct from the scala vestibule,

and the basilar membrane separates the cocholear from the scala tympani.

Resting on the basilar membrane is the spiral organ of corti. The spiral corti

is a coiled sheet of epithelial cells, including supporting cells and about 16

thousands hair cells, which are the receptors for hearing. There are 2 groups

of hair cells; the inner hair cells are arranged in a single row whereas the

outer hair called are arrange in 3 rows. At the apical tip of each hair cell is a

hair bundle, consisting of 30-100 streocilia that extends into the endolymph

of the cochlear duct. Despite their name, stereocilia are actually long hair

like microvili arrange in several rows of graded height. At their ends, inner

and outer cells synapse both with first-order sensory neurons and with motor

neurons from the cochlear branch of the vestibulucocholear. Cells bodies of

the sensory neurons are located in the spiral ganglion. Although outer hair

cells outnumber them by 3-1 the inner hair cells synapse 90-95% of the first

order sensory neurons in the cochlear nerve that relay auditory information

to the brain. By contrast 90% of the motor neurons in the cochlear nerve

synapse in the outer hair cells. Projecting over and in contact with hair cells

of the spiral organ is the tectorial membrane, a flexible gelatinous

membrane.


11/14


12/14

Pathophysiology of Chronic Otitis Media

Definition: chronic inflammation of the middle ear with tissue damage

Precipitating factors Predisposing

Factors

Hemolytic streptococci Lifestyle

S. pnuemoniae Age

H. Influenzae

Invision of the middle ear

Immune system fights back and try to

Eliminate baterias

Inflammation of the middle ear

Pus accumulate in the middle

Necrosis of middle ear tissue

Damage of tympanic membrane

And ossicles

Infections extends to the mastoid cells

(mastoiditis)

Cholesteatoma form

Chronic Otitis media

Fever, pain

at infected

Hearingloss, pain atinfected ear


13/14

Nursing Diagnosis:Disturbed auditory Sensory Perception related to surgicaldisturbance of middle ear structures

Objectives: at the end of 2days of intervention, patient will be able to identifyways to communicate and compensate for deficits

SubjectiveDili na gyud siya maka dungog sir as verbalized by significant other

ObjectiveDeafDoesnt look relax

Interventions RationalePosition client to see surroundings and activities.

Provide uninterrupted sleep and rest periods.

Provided common sign language during

communication

Provides sensory input for stimulation

Reduces sensory overload, enhances orientationand coping abilities

To facilitate learning for communicating

Evaluation: at the end of 2 days intervention, patient had not learned how tocommunicate and still in denial stage.


14/14

Nursing Diagnosis: Low self esteem related to situational crises

Objectives: at the end of 2 days intervention, patient will be able to accept thesituation in her life and develop realistic plans in adapting new role in life

SubjectivePermi lagi na siya guol ug nawong sir, unya usahay pud maghilak na siya

ObjectivesLack of eye contactAnxiousWeak

Intervention RationaleEncourage SO to treat client as normally as

possible

Visited patient very often

Interact to patient as if no health problem exist

Involving client in family unit reduces feelings of

social isolation, helplessness, and uselessness

There are time that patient is alone,to provide company for the patient,so she may feel shes not alone

For patient to regain the confidenceshe once lost

Evaluation: at the end of 2days intervention, patient still in denial stage anddoesnt like to mingle with me or other people around

otitis media_cs

Documents