Ch 43 Flashcards
Hearing acuity: normal
0-25
Impacted cerumen is accumulated earwax that obstructs the __
External acoustic Meatus
Trapped cerumen interferes with the transmission of ___
Sounds carried on airways
Assessment findings of impacted cerumen
Sense of fullness or pain (otalgia) in the ears
Tests that reveal conductive hearing loss
Audiometric
Rinne
Weber
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
Never irrigate ear if ___
Tympanic membrane is not intact
How many mL to irrigate the ear
50-70 mL
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
Med management for foreign object
Mineral oil to smother insect
Solid object removed with small forceps
Inflammation of the tissue in the external auditory canal
Otitis Externa
Pathogen that causes otitis externa
Staph aureus
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)
Medical management for otitis externa
Warm soaks
An acute inflammation or infection in the middle ear
Otitis media
Pathogens that cause otitis media
Strep pneumoniae
Harmophilus influenzae
A collection of pathogen free fluid behind the tympanic membrane, results from irritation associated with respiratory allergies and enlarged adenoids
Serous otitis media
A collection of pathogen free fluid behind the tympanic membrane, results from irritation associated with respiratory allergies and enlarged adenoids
Serous otitis media
Results from the spread of microorganisms from the Eustachian tube to the middle ear during upper respiratory infections
Purulent otitis media
Clients with ___ are prone to repeated infections
Perforated tympanic membranes
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
Assessment findings of otitis media
(SATA)
Recent URI or seasonal allergies
S&S of the inflammation: fever, severe earache, diminished hearing
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
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
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
