timby/smith: introductory medical-surgical nursing, 10/e 01/16 pg 625

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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/16 Pg 625

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/16 Pg 625

Unit 10 Chapter 43: Caring for Clients with Ear Disorders By: P.K. Williams, RN


19 Words to Know 02/16 Pg 624 19 Words to Know 02/16 Pg 624

• Acoustic neuroma Cochlear implant Labyrinthitis

• Mastoidectomy Mastoiditis Myringotomy

• Meniere’s disease Otalgia* Otitis externa

• Otitis media Otosclerosis Ototoxicity

• Presbycusis Sign languageStapedectomy

• Speech reading TinnitusTympanotomy


11 Objectives 03/16 Pg 624 11 Objectives 03/16 Pg 624

On completion of this chapter, you will be able to:

01 List types of hearing impairment and the acuity levels for each.

02 Name techniques that clients with impaired hearing use to communicate with others.

03 Give examples of support services available for the hearing impaired.

04 Discuss the role of the nurse in caring for clients with a hearing loss.

05 Name conditions that involve the external ear.


11 Objectives 04/16 Pg 624 11 Objectives 04/16 Pg 624

06 Explain the technique for straightening the ear canal of adults to facilitate inspection and the

administration of medication.

07 Discuss methods for preventing or treating disorders of the external ear.

08 Name conditions that affect the middle ear.

09 Describe nursing interventions appropriate for managing the care of a client with ear surgery.

10 Explain the pathophysiology of Ménière’s disease, and name some consequences of this inner-ear disorder.

11 Discuss the nursing management of clients with Ménière’s disease.


Hearing Impairment 05/16 Pg 624 Hearing Impairment 05/16 Pg 624

• Mild, Moderate, Severe, or Profound

• Causes: Excessive noise; Conductive loss; [Sensorineural loss]

• Consequences Depend on Age, Severity

– <3 years: Affects language development, communication, safety

• Medical Management: Hearing aids; Sign language; Speech reading; Technology; Assist dogs

• Surgical Management: Cochlear implant; Bone conduction device; Semi-implantable hearing aid

• Nursing Management


Cochlear Implant*** 06/16 Pg 626 Cochlear Implant*** 06/16 Pg 626


Impacted Cerumen*** 07/07 Pg 627 Impacted Cerumen*** 07/07 Pg 627

• Pathophysiology, Etiology

– Interferes with sound carried on airwaves

• Assessment Findings

– Otalgia; Diminished hearing

– Orange-brown accumulation of cerumen

• Medical Management: Hydration; Irrigation; Removal (cerumen spoon)



Foreign Objects*** 08/16 Pg 634 Foreign Objects*** 08/16 Pg 634


– Scratched skin; Blunt penetration of eardrum; Local tissue inflammation

• Assessment Findings: Discomfort; Diminished hearing; Feeling movement; Buzzing sound

• Diagnostic Findings: Inspection (Penlight, otoscope)

• Medical Management: Mineral oil instillation (insects); Removal of solid object (small forceps)



Otitis Externa*** 09/16 Pg 628 Otitis Externa*** 09/16 Pg 628


– Overgrowth of pathogens; Infected hair follicle


– Redness; Edema; Diminished hearing

– Fever; Enlarged lymph nodes behind ear

• Diagnostic Findings: Otoscope examination; C & S

• Medical Management

– Warm soaks; Analgesics; Antibiotics



Otitis Media*** 10/16 Pg 629 Otitis Media*** 10/16 Pg 629


– Respiratory allergies; Enlarged adenoids; Eardrum pressure

• Assessment Findings: History: Recent upper respiratory infection; Seasonal allergies; Fever; Tinnitus; Malaise; Earache; Diminished hearing

• Medical, Surgical Management: Prevention of rupture of the eardrum

– Antibiotics; Needle aspiration; Myringotomy; Tympanotomy; Myringoplasty



Otosclerosis*** 11/16 Pg 629 Otosclerosis*** 11/16 Pg 629


– Decreased vibration of stapes diminished transmission of sound to inner ear

• Assessment Findings: Signs and Symptoms

– Progressive, bilateral hearing loss; Nighttime tinnitus; Pinkish-orange eardrum

• Diagnostic Findings: Audiometric tests; CT scan

• Medical, Surgical Management

– Hearing aids; Stapedectomy



Otosclerosis 12/16 Pg 630 Otosclerosis 12/16 Pg 630


Ménière’s Disease 13/16 Pg 631 Ménière’s Disease 13/16 Pg 631


– Changes of fluid volume within labyrinth


– Vertigo; Tinnitus; Hearing loss; N/V

– Nystagmus; Preattack headache

• Medical, Surgical Management

– Low-sodium diet; Bed rest; Medication therapy; Surgery



Ototoxicity*** 13/16 Pg 634 Ototoxicity*** 13/16 Pg 634

• Medications

– Salicylates; Loop diuretics

– Quinidine; Quinine

– Aminoglycosides

• Signs and Symptoms

– Tinnitus; Sensorineural hearing loss

– Vestibular toxicity: Lightheadedness; Vertigo; N/V



Acoustic Neuroma*** 15/16 Pg 634 Acoustic Neuroma*** 15/16 Pg 634

• Pathophysiology, Etiology: Rare; Unknown cause; Cochlear nerve compression; Blood supply interruption

• Assessment Findings: Gradual hearing loss; Vertigo; Impaired facial movement, sensation; Tinnitus

• Diagnostic Findings: MRI; CSF studies

• Medical, Surgical Management: Neurectomy

– Retain cranial nerve VIII function


• [Classification of neuroma based on specific portion of nerve effected]


End of Presentation Now NCLEX

By: P.K. Williams, RN 16/16 Pg 634 pkwilliams@DNI. edu

timby/smith: introductory medical-surgical nursing, 10/e 01/16 pg 625

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