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Nursing skills 2 > ear exam > Flashcards

ear exam Flashcards

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1
Q

Common complaints for ear exams

A

Scratching at ears
* Wounds, redness, discharge, strong smell
* Masses/growths
* Swollen ear
* Head shaking
* Head tilt
* Loss of balance
* Horner’s syndrome (dropped ear, dropped eyelid, raised 3rd eyelid, miosis – all on one side of the face)
* Loss of hearing

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2
Q

Basic equipment for an ear exam

A

Otoscope
* 2 clean, appropriate sized otoscope cones (ONE PER EAR)
* Swabs
* Slides
* Quick stain (e.g. DiffQuik)
* Microscope
* Ear cleaning solution
* Gauze/cotton wipes

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3
Q

Otoscope cleaning

A

Cleaning barrel and lens
* Clean the lens & inside of head
* Use clean dry lens paper or optical grade cloth
* Never submerge the head
* Outside can be cleaned with an isopropyl alcohol disinfectant wipe or a cloth dampened with 1:10 bleach solution

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4
Q

Otoscope ear tip cleaning

A

Ear tips are single use only
* Use 1 tip per ear – to prevent cross contamination
* Tips must be cleaned and disinfected after each use
* Wash with soap and water to remove biofilm
* Scrub inside with a soft bristle brush to remove secretions/wax/discharge
* Disinfect after washing:
* At minimum, soak in disinfectant (ex. Accel, 70% alcohol) for minimum of 20 minutes, rinse, let dry
* Better if sterilized - Cold sterilant solution or autoclave

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5
Q

Steps to basic ear exam

A
  1. History
  2. Distance exam – balance, hearing
  3. Systemic exam
  4. Focused exam
  5. Head
  6. Pinnae
  7. Opening of canal
  8. Otoscopic exam of canals and tympanic membrane
  9. Diagnostics
  10. Treatment
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6
Q

History for an ear exam

A
  • How long the issue has been occurring
  • Which ear(s)
  • Has it happened before, how frequently, which ear(s), prior treatment (YOU should also check prior record)
  • Has the owner put anything (meds, cleaners, home- remedies, etc.) into the ear
  • Current diet and any diet changes
  • Environment/lifestyle – swimming, groomer, baths
  • Are other pets in the home also affected
  • Ask if they have been head shaking, scratching, head tilting, or incoordination
  • Loss of hearing
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7
Q

What to observe in the distance ear exam

A

Head tilt
Balance
Response to sound

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8
Q

Exam of head during ear exam

A

Look for:
Injuries
Head tilt, asymmetry
Horners syndrome

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9
Q

Horners syndrome is

A

A collection of changes caused by damage to the sympathetic nerves feeding the ear, eye, face
* Lots of different causes including lesions in the middle ear

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10
Q

Pineal exam

A

Common conditions
* Frostbite
* Infection, wounds
* Hematoma = bursting of capillaries in the pinnae causing bleeding under the skin (same day emergency)

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11
Q

Exam of the opening and canal

A
  • Naked eye can only visualize the opening and distal vertical canal (not definitive)
  • Must use otoscope to visualize deep vertical and horizontal canals, and tympanic membrane (TM)
  • Never place solution/medication in the ear until an intact TM is confirmed
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12
Q

Stenotic

A
  • Swollen, excessive tissue
  • Canal may be closed off
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13
Q

Otoscope exam

A
  • To visualize vertical and horizontal ear canal and TM
  • Must be familiar with the ear anatomy to evaluate
    properly
  • If ear is stenotic or very painful, vet may opt to delay examining/treating the canal until some of the inflammation can be controlled
  • Only rule: Animal can’t move
  • Gently restrain by chin or muzzle to prevent lateral movement
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14
Q

Accessing the ear canal

A
  • Direction is very important
  • Pulling gently on pinnae will elongate the canal
  • Avoid “into the head”
  • Direct “towards the cheek”
  • Make sure head does not move
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15
Q

Cotton tipped applicator used when

A
  • Clean, but not sterile
  • Swabs for cytology
  • Cleaning around opening
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16
Q

Sterile culture used when

A
  • For culture and sensitivity
  • Swab is stored/shipped in transport media
  • One per affected ear
17
Q

Ear swan is taken when

A
  • Take sterile cotton swab and roll it along affected parts of the ear to collect discharge
  • If ear is dry, may need to moisten with sterile isotonic saline
  • Wetting the swab reduces cell damage during collection and smear preparation
18
Q

What to do with the ear swab after collection

A
  • After collecting the sample, gently roll along the flat surface of a glass slide
  • If multiple parts of the ear are affected, swab separately.
19
Q

Cytology for bacteria/yeast

A
  • Heat fix
  • Stain (Simple stain, DiffQuick, Gram)
  • Hint for waxy ears and DiffQuik:
  • Leave longer in #3 (1 min final dip)
  • Evaluate under oil field and record:
  • Epithelials (+/-)
  • Bacteria (cocci/rods, approx #/oil)
  • Yeast (budding or not, approx #/oil)
  • WBCs (+/-)
  • If rods or recurrent otitis, check if sterile swab for culture and sensitivity is requested before cleaning
20
Q

Cytology for ear mites steps

A
  • More common in cats
  • Collect discharge from the inside of the vertical canal by gently wiping a cotton swab along the wall of the canal
  • Place a drop of mineral oil on a glass slide
  • Roll the sample along the glass slide in the oil
  • Evaluate under the microscope under low power (10x objective)
  • Otodectes cynotis mites may be seen at various life stages including the egg stage
  • Occasionally can be seen with otoscope as very small white flecks moving over discharge in the ear
  • Always check if there are other cats in household
  • ALL cats in a household must be treated to control an infection
21
Q

Reasons for ear cleaning

A
  • Important part of managing otitis externa
  • Indicated when there is discharge in the ear canal
  • Facilitates exam of ear canal
  • Removes microbes, material that harbours microbes, small foreign bodies
  • Exposes lining of the ear to topical therapy
  • Prevents inactivation of topical therapy
22
Q

general rules for ear cleaning and medication

A
  • Make sure all exam and diagnostic testing is completed before cleaning
  • Must confirm an intact tympanic membrane
  • Never clean with alcohol or antiseptics
  • Some cats are very sensitive to chemicals in the ear
  • Higher degree of drug absorption through the skin
  • Location of cranial nerve near TM
  • Purulent discharge can inactivate drug so ears must be cleaned out before medicating
  • Medication must reach the site of infection
  • Ears that are very painful or stenotic may require systemic treatment before any topical treatment
23
Q

Steps to clean ears

A
  1. Make sure animal is restrained to a degree
  2. If itchy, rubbing the ear will increase tolerance
    * Rub at the cheek (over horizontal canal)
  3. Gently extend pinnae
    * Place dispenser close to opening.
    * Do NOT touch container to ear or will contaminate bottle.
    * Do not release pressure on container until away from ear.
    * Fill canal to “brim” with cleaner4. Massage along length of ear canal for 30-60 seconds
    * Below the opening, along the “groove in the cheek”
    * This agitates the fluid to break down discharge
  4. Let patient shake
    * Stand back or hold towel over head
    * Repeat once if required
  5. Wipe excess cleaner from ear opening and pinnae with
    gauze/cotton/tissue
  6. Can use cotton swabs around opening only
  7. Allow 15 minutes to “dry” before medicating
24
Q

Using a Q-tip

A
  • Do not go further than you can see
  • Recommend owners not to use Q-tips
  • Wet gauze or tissue can be as effective for cleaning around opening
  • Can pack debris into the ear canal
  • Risk of perforating the tympanic membrane
  • Exception: can be handy to remove ear mites during cleaning process in very infected cats
25
Q

Different types of ear cleaners

A
  • Surfactant/foaming – mild detergent activity
  • Cerumenolytic – Soften/break down ear wax
  • Drying solutions – Remove excess moisture
  • EDTA – Good for purulent discharge, sensitive ears, can be a base for compounding topical ear medications; only one indicated if there is risk of rupture of TM
  • Sterile saline
26
Q

Ear cleaners used routine maintenance how often

A
  • Most are mildly acidifying or alkalizing to inhibit excessive growth of normal flora
  • Can also be used for routine maintenance (i.e., once a month, after getting water in ears, after grooming)
  • About 2-3x/week if treating otitis externa
  • Max is about q1w for maintenance
27
Q

Ear flush

A
  • Process where ears are cleaned with a solution delivered under mild pressure using a catheter/cannula placed into the canal (close to the tympanic membrane)
  • Only performed under general anesthesia
  • The patient needs to be intubated with the cuff inflated to prevent contamination of the respiratory tract if fluid drains through the Eustachian tube due to a ruptured tympanic membrane
  • It is performed when the patient’s ears are too painful, swollen, or the ear canal is obstructed with debris
28
Q

Most topical ear medications consist of

A
  • Anti-inflammatory
  • Antibiotic (treat bacterial infection)
  • Anti-fungal (treat yeast infection)
29
Q

How to increase effectiveness and reduce resistance to ear medication

A
  • Select the drug for the bacteria
  • Only as prescribed
  • Only if there is confirmed infection
  • For the prescribed frequency and duration
30
Q

How to give ear medications

A
  1. Clean ears – to remove debris and old medication
  2. Wait 15 minutes after cleaning
    * This allows the ear cleaner to dissipate so it will not interfere with medications
  3. Restrain so the head has minimal movement while applying the medication
    * Can try rubbing the ear canal to increase tolerance
  4. Gently extend pinnae to straighten canal. Can insert dispenser directly into ear canal (make sure not too
    deep if the dispenser is very long). Instill prescribed amount. Do not release pressure on tube until out of ear.
  5. Massage ears from base to opening to distribute medication along ear canal
  6. In some cases, drops may also need to be applied directly to the pinnae
  7. Follow cleaning directions as prescribed
31
Q

Increasing compliance for owners

A
  • ALWAYS demonstrate how to clean ears and how to medicate to client
  • In the event of adverse reaction to the ear medication, owner should clean out ears right away with cleaner and contact clinic
  • Adverse reactions:
  • Pain
  • Head tilt
  • Loss of hearing
  • Revisits to assess ear infections and treatment should be scheduled in 10-14 days time
32
Q
A

Nursing skills 2 (4 decks)

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