Ch 43 Flashcards by Brandie Alnobani

Hearing acuity: normal

0-25

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Impacted cerumen is accumulated earwax that obstructs the __

External acoustic Meatus

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Trapped cerumen interferes with the transmission of ___

Sounds carried on airways

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Assessment findings of impacted cerumen

Sense of fullness or pain (otalgia) in the ears

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Tests that reveal conductive hearing loss

Audiometric
Rinne
Weber

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Medical management for impacted cerumen

Soften with carbamide peroxide (Debrox)
Mechanically removed with irrigation if the tympanic membrane is intact (50-70mL)
Using a cerumen spoon or curette

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Never irrigate ear if ___

Tympanic membrane is not intact

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How many mL to irrigate the ear

50-70 mL

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Assessment findings of a foreign object in the ear

Discomfort, diminished hearing, feeling movement, hearing buzzing sound
Inspection: evidence of abrasion from trauma or an object is seen

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Med management for foreign object

Mineral oil to smother insect
Solid object removed with small forceps

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Inflammation of the tissue in the external auditory canal

Otitis Externa

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Pathogen that causes otitis externa

Staph aureus

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Assessment findings of otitis externa
(SATA)

Tissue in external ear looks red
Tympanic membrane may be hard to see due to swelling
Discomfort that increases with manipulation during exam
Hearing reduced bc of swelling
Severe infection: fever, enlarged lymphoid behind ear
Otoscopic exam reveals diffuse or confined inflammation, swelling & pus (C&S purulent drainage for cause microorganisms)

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Medical management for otitis externa

Warm soaks

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An acute inflammation or infection in the middle ear

Otitis media

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Pathogens that cause otitis media

Strep pneumoniae
Harmophilus influenzae

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A collection of pathogen free fluid behind the tympanic membrane, results from irritation associated with respiratory allergies and enlarged adenoids

Serous otitis media

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A collection of pathogen free fluid behind the tympanic membrane, results from irritation associated with respiratory allergies and enlarged adenoids

Serous otitis media

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Results from the spread of microorganisms from the Eustachian tube to the middle ear during upper respiratory infections

Purulent otitis media

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Clients with ___ are prone to repeated infections

Perforated tympanic membranes

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In otitis media, infection may also extend to the ___, causing ___, or ___ may result from its extension to the brain.
If __ occurs, the infection can spread to the __ at the base of the brain & cause ___

Meninges
Meningitis
Brain abscess
Septicemia
Large veins
Lateral sinus thrombosis

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Assessment findings of otitis media
(SATA)

Recent URI or seasonal allergies
S&S of the inflammation: fever, severe earache, diminished hearing

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In otitis media, tenderness behind the ear indicates __. The tympanic membrane looks __ & ___. Pressure in the middle ear or dysfunction if the inner ear structures can cause ___, ___, & ___.
If the tympanic membrane perforates, fluid drains into the ___ & ___ is relieved

Mastoiditis
Red & bulging
Nausea, vomiting & dizziness
External acoustic canal
Pain

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Med/surg management of otitis media & description

Myringotomy or tympanotomy
Incision opening of tympanic membrane. Facilitates drainage of purulent material, eases pressure, relieves throbbing pain.
Incision heals readily, with little scaring

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The result of a bony overgrowth of the stapes and a common cause of hearing impairment among adults. Fixation of stapes occurs gradually over many years

Otosclerosis

More common in women that men. Usually becomes apparent in the second & third decades of life. Accelerated during pregnancy

Otosclerosis

Assessment findings for otosclerosis (SATA)

Progressive BL loss of hearing most characteristic symptom Notices hearing loss when it begins to interfere with ability to follow conversation Particular difficulty hearing others when speaking in soft, low tones but adequate hearing when sound loud enough Tinnitus appears of hearing loss progresses, especially noticeable at night when quiet, can be very distressing to pt *perform rinne & weber test

In otosclerosis, after surgery position pt on ___ side. Take care to prevent dislodgment of prostheses as a result of __, __, or ___. Assess ___ function by checking symmetry when the pt __ or __.

Non operative side Coughing, sneezing, vomiting. Facial nerve function Smiles or frowns

Common problems after surgery for otosclerosis

Nausea and dizziness

Surgery performed for otosclerosis

Stapedectomy- all or part of stapes removed, prosthesis inserted that vibrates oval window

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

Vertigo

A person is stationary and the environment is moving (a sensation of things moving around oneself)

Objective vertigo

When a person feels motion but the surrounding environment is stationary (a spinning sensation)

Subjective vertigo

When a person feels motion but the surrounding environment is stationary (a spinning sensation)

Subjective vertigo

Vertigo is not a __ but a __ of a disease

Disease Symptom

A form of physiologic vertigo. Repeated and constant motion causes this disturbance

Motion sickness

Symptoms of motion sickness

N/V, preceded by pallor and diaphoresis

Treatment for motion sickness

OTC antihistamines such as dimenhydrinate (Dramamine) meclizine hydrochloride (Antivert) to prevent N/V

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

Meniere disease (endolymphatic hydrops)

This disorder causes distention of the endolymphatic compartment

Meniere disease (endolymphatic hydrops)

Characteristic triad of Meniere (endolymohatic hydrops)

Hearing loss Vertigo Tinnitus

Generally, Meniere affects ___, but can affect __

Only one ear Both

Clients with Meniere experience

Fluctuating periods of tinnitus Sensation if ear fullness Severe vertigo

With Meniere, when a person moves their head, the endolymph also moves. Nerve receptors within the ___ send signals to the brain about the movement

Membranous labyrinth

In Meniere, an increase in the __ causes the membranous labyrinth to __ like a __ referred to as __

Endolymph Dilate Balloon Endolymphatic hydrops

Meniere is typically __, appears during __, and occurs with __ in men and women

Unilateral Middle age Equal frequency

In meniere, at times the pt is symptom free except for __ as the number of attack increases

Permanent residual hearing loss

Causes of meniere

Viral infections of the inner ear Head injury Hereditary factors Allergic reactions

The onset of meniere

Sudden & symptoms may occur daily or infrequently

Most incapacitating symptom of meniere

Vertigo Pt reports whirling dizziness and the need to lie down

In meneire, severe vertigo causes ___. Typically, also experience __ and _ that lasts for several hours as well as __ and ___

N/V Tinnitus Hearing loss Headaches Abdominal discomfort

In meniere, __ of the eyes may result from ___ of eyemovement

Nystagmus An imbalance in vestibular control

In meniere, generally __ returns between attacks but ___ becomes __\ with ___

Hearing Gradually Worse Repeated attacks

Treatment for meniere

Reduce fluid production in inner ear Facilitating inner ear drainage Treating symptoms that accompany attack *low sodium diet

An antihistamine often prescribed because it suppresses the vestibular system

Meclizine (Antivert)

Or other tranqulizers, may be ordered for acute episodes to help control vertigo, used only for short term therapy because of the addictive potential

Diazepam (Valium)

Or other antiemetics, ordered to help control NV, also had an antihistamine effect

Promethazine (Phenergan)

Or other diuretics, may decrease the fluid in the endolymphatic system and relieve symptoms

Hydrochlorothiazide

Avoid _ & _ products, which can increase tinnitus and vertigo

ASA ASA products Tinnitus one of first symptoms of ASA toxicity

In meniere, nursing mang. Assess _\ & perform __ & __ test

Gross hearing Rinne & Weber

Ototo =

Vanco Tobra

During an attack in menieres the nurse administers prescribed drugs, __ and __

Limits movement Promotes clients safety

__ Describes the detrimental effect of certain medications on the _ or hearing structures

Ototoxicity 8th cranial nerve

Drugs associated with ototoxicity include

Sylicylates, loop diuretics, quinidine, quinine & aminoglycosides (vanc, tobra, genta)

Symptoms of ototoxicity

Tinnitus Sensorineural hearing loss

Vestibular toxicity S&S

Lightheadedness Vertigo N/V

Also know was vestibular schwannoma, a benign Schwann cell tumor that progressively enlarges and adversely affects cranial nerve __ (which consists of the vestibular & cochlear nerves)

Acoustic neuroma VIII