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NURS 252 > Eyes and Ears > Flashcards

Eyes and Ears Flashcards

1
Q

External ocular structures

A

external eye is composed of eyebrows, upper and lower eyelids, eyelashes, conjunctivae, and lacrimal glands

  • palpebral fissure: the opening between eyelids
  • conjunctivae: two thin-transparent mucous membranes, between eyelids and eyeball
  • bulbar conjunctiva: covers scleral surface of eyeball
  • palpebral conjunctiva: lines eyelids and contains blood vessels, nerves, hair follicles and sebaceous glands
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2
Q

Subjective eye assessment: history taking

A
  • vision difficulty (decreased acuity, blurring, blind spots)
  • pain
  • diplopia (double vision)
  • redness, swelling
  • watery discharge
  • glaucoma (increased intraocular pressure, second most common cause of vision loss in older adults in Canada, involves damage to the optic nerve resulting in a gradual loss of peripheral vision)
  • glasses, contact lenses
  • medications
  • coping with visual changes or loss
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3
Q

Physical eye assessment: General inspection

A
  • General: patient able to move around room, avoid obstacles, facial expression relaxed
  • Eyebrows: present bilaterally, move symmetrically with facial expression, no scaling or lesions
  • Eyelids: Upper eyelids, overlap superior iris and meet lower eyelids when closed, skin intact, no redness, swelling, discharge, lesions, unexpected- ptosis (dropping of upper eyelid), edema, unable to completely close
  • Eyelashes: evenly distributed, curve outward
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4
Q

Physical eye assessment: External structure

A
  • Eyeballs: aligned in sockets, not sunken or protruding
  • Sclera: White, grey-blue (in darker skin individual)
  • Conjunctiva: Pull down on lower eyelid to visualize- clear, moist, glossy, reflect color of underlying tissue
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5
Q

PERRLA

A

P- pupils

E- Equal

R- Round

R- Reactive to

L- Light

A- Accommodation

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6
Q

Physical eye assessment: Pupils

A

round, 3-5 mm, equal bilaterally

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7
Q

Physical eye assessment: Iris

A

flat, round, even coloration

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8
Q

Physical eye assessments (objective data)

A
  • visual acuity: Snellen’s chart, Jaeger’s card
  • peripheral vision: Confrontation
  • alignment: Cover/uncover test
  • corneal light reflex
  • extra-ocular movement: Cardinal directions
  • pupillary response: Pupillary light reflex
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9
Q

Physical eye assessment: Central visual acuity - Snellen Eye Chart

A
  • Position Snellen eye chart at eye level, 6.1m (20 feet) from the patient
  • Have the patient hold a card to shield eye one at a time during test. Leave glasses on, remove only reading glasses
  • Ask the patient to read the chart to the smallest line of letters
  • Test each eye separately
  • Record the result using the numerical fraction at the end of the last line
  • Patient may read 1 or 2 letters incorrectly and still have vision equal to that line
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10
Q

Physical eye assessment: Central visual acuity - Near Vision

A
  • for patients older than 40 years or for those who report increasing difficulty reading, test near vision with a hand held vision screener with various sizes of print
  • Instruct patient to hold handheld screener 35 cm (14 inches) from eyes
  • Test each eye separately with glasses on
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11
Q

Physical eye assessment: Ocular fundus

A
  • Darken room and instruct patient to look at light switch or specific mark on wall
  • Hold opthalmoscope with right hand up to your right eye to assess patient’s right eye
  • Place free hand on patient’s forehead
  • Begin about 25 cm away from patient at an angle of approx. 15 degrees lateral to the patient’s line of vision
  • Note the red reflex (red glow filling the patient’s pupil) and steadily move closer to the eye
  • As you move forward adjust the lens to +6 diopters and note any opacities (appear as dark shadows or black dots that interrupt the red reflex)
  • Adjust the diopter setting to bring the ocular fundus into sharp focus
  • If you and the patient have normal vision, the setting should be at 0
  • Move the diopter setting to compensate for nearsightedness (move to red numbers) or farsightedness (move to black numbers)
  • Systematically inspect the structures in the ocular fundus: optic disc, retinal vessels, general background, macula
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12
Q

Physical eye assessment: fundoscopy

A
  • Fundus: light red to dark brown
  • Optic disc: round, oval, defined margins, physiologic cup bright yellow-white and less than 1/2 disc diameter
  • Retinal vessels: paired artery and vein in each quadrant; artery lighter and narrower than veins
  • Macula: darker compared to fundus, foveal light reflex (opthalmoscope)- tiny white glistening dot that represents a reflection of your opthalmoscope’s light
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13
Q

Developmental considerations (Eye): At birth

A

macula is not fully developed, but is developing by age 4 months; matures at 8 months

peripheral vision intact in newborn infant

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14
Q

Developmental considerations (Eye): By 3-4 months

A

infant can fixate on single image with both eyes simultaneously (does not mean they cannot see)

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15
Q

Developmental considerations (Eye): Neonates

A

most neonates are farsighted, changes over time

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16
Q

Developmental considerations (Eye): Changes from birth

A

Pigmentation of the iris, lens is spherical at birth and becomes more flat over the lifespan

Eyeball reaches full size around 8 years of age

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17
Q

Developmental considerations (Eye): Older adults

A
  • Presbyopia as early as 40-50 years of age (lens loses elasticity, becoming hard and glasslike, decreasing the len’s ability to change shape to accomodate for near vision)
  • Debris may accumulate (floaters)
  • Visual acuity diminishes after 50, even more after 70
  • Increased risk of falls
  • Physical changes: drooping, loss of orbital fat, dryness (decreased tear production by the lacrimal apparatus)
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18
Q

Health promotion (Eye)

A
  • Annual eye examinations
  • Diet
  • Eye protection
  • Awareness of irritants
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19
Q

Ear anatomy/physiology

A
  • ear is a sensory organ for hearing and maintaining equilibrium
  • divided into 3 sections: external ear, middle ear, inner ear
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20
Q

Acute assessment of the ear

A
  • foreign object
  • foul smelling drainage
  • trauma
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21
Q

Routine assessment for ear

A
  • health history: ask “do you have difficulty hearing now?”
  • yes= audiometric testing (refer)
  • no= screen using the whispered voice test
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22
Q

Subjective ear assessment: history taking

A
  • use OPQRSTUV
  • earache
  • infections
  • discharge
  • hearing loss: conductive vs sensorineural
  • environmental noise
  • tinnitus: ringing
  • vertigo: dizziness
  • otalgia: ear pain
  • self-care behaviors
  • medications
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23
Q

Objective ear assessment: physical examination

A
  • gather equipment: otoscope with clean speculums
  • prepare your patient: inspection, palpation, tests for hearing and conduction
  • otoscopic examination
  • auditory acuity
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24
Q

Physical examination: Inspect (ear)

A
  • size and shape
  • skin condition
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25
Q

Physical examination: Palpate (ear)

A
  • tenderness: pinna and tragus, mastoid process
  • external auditory meatus
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26
Q

Ear lobe: expected findings

A

equal bilaterally, no swelling, skin intact, consistent with facial skin, no lesions, there could be Darwin’s tubercle- small nodule at the helix

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27
Q

Ear lobe: unexpected findings

A

red, excessively warm, crusts, scaling, red-blue

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28
Q

Otoscope and specula: Assembling it

A

Select largest speculum that will fit comfortably in the ear canal, attach to otoscope

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29
Q

Otoscope examination

A
  • perform prior to testing hearing
  • impacted cerumen can emulate hearing loss
  • tilt patient’s head toward the opposite shoulder
  • adults and older children: pull the pinna up and back to straighten ear canal
  • infants and children younger than 3: pull pinna down
  • hold the otoscope upside down along your fingers, and have the dorsa (back) of the hand along the patient’s cheek braced to steady the otoscope
  • do not push/force otoscope into ear
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30
Q

External auditory meatus: expected findings

A

no redness, swelling or discharge

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31
Q

Cerumen: expected findings

A

color is grey-yellow, light brown or black, texture is moist and waxy, dry and desiccated

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32
Q

Ear canal: expected findings

A

no redness, swelling, discharge, foreign bodies

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33
Q

Tympanic membrane: expected findings

A
  • shiny and translucent
  • pearly grey coloration
  • cone-shaped light reflex (reflection of your otoscope light) is prominent in the anteroinferior quadrant (at the 5:00 position in the right eardrum and at the 7:00 position in the left eardrum)
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34
Q

Tympanic membrane: unexpected findings

A
  • scarring or discharge (infections)
  • yellow-amber eardrum discoloration occurs with otitis media with effusion (serous)
  • redness occurs with acute otitis media
  • absent or distorted landmarks
  • air/fluid level or air bubbles behind eardrum indicate otitis media with effusion
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35
Q

Hearing acuity tests

A

whisper test, weber test, rinne test

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36
Q

Developmental considerations (ear): children

A
  • hearing acuity
  • newborn: startle (moro) reflex
  • 3 to 4 months: acoustic blink reflex; stopping movement and appearing to listen
  • 6 to 8 months: turn head to localize sound, responding to own name
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37
Q

Developomental considerations (ear): Older adult

A
  • otosclerosis (adults 20-40 years)
  • age related changes in older adults- conductive hearing loss, gradual hardening of stapes impedes transmission to oval window (note difficulty hearing consonants during conversational speech)
  • cilia lining the ear canal becomes coarse and stiff, may cause a decrease in hearing because it impedes sound waves travelling toward the eardrum
  • impacted cerumen-can lead to conductive hearing loss if not removed
  • pendulous earlobes due to wrinkling/loss of skin elasticity
  • otoscopy- eardrum whiter, more opaque, duller, thickened
38
Q

Determinants of health: ear

A
  • ear position: top of pinna horizontal to outer canthus
  • shorter, wider Eustachian tube- frequent ear infections
  • feeding practice
  • second-hand smoke
  • day care attendance
  • low birth weight
  • social isolation- older adult
39
Q

Psychological and social impacts of impaired visual acuity in older adults

A

Impaired visual acuity negatively impact functioning and quality of life- shown to be associated in older adults with decreased participation in social and leisure activities, difficulty in family relationships, depressive symptoms

40
Q

Snellen eye chart: normal findings

A

normal visual acuity is 20/20 (top number indicates the distance the patient is standing from the chart; bottom number is the distance at which a normal eye could have read that particular line)

41
Q

Snellen eye chart: abnormal findings

A

larger the denominator, the poorer the vision. If vision is poorer than 20/30, refer to an opthalmologist or optometrist. Vision may be impaired as a result of refractive error, opacity in the media (cornea, lens, vitreous), or disorder in the retina or optic pathway

42
Q

Near vision: normal findings

A
  • 14/14 in each eye
  • reading without hesitancy and without moving the card closer or farther away
43
Q

Near vision: abnormal findings

A

if the patient moves the card father away, this is a possible sign of presbyopia, the decrease in power of accomodation with aging

44
Q

Test visual fields: Confrontation test

A
  • Position yourself at eye level with the patient, about 60 cm away
  • Direct the patient to cover one eye with an opaque card and to look straight at you with the other eye
  • Cover your own eye opposite to the patient’s covered one
  • You are testing the uncovered eye
  • Hold a pencil or your flicking finger as a target midline between you and the patient, at the periphery of vision, and slowly advance it inward from the periphery in several directions
  • Ask the patient to say “now” when the patient first sees the target, this location should be the same as when you also see the object
  • estimate the angle between the anteroposterior axis of the eye and the peripheral axis where the object is first seen
45
Q

Confrontation test: normal findings

A

50 degrees upward, 90 degrees temporal, 70 degrees downward, and 60 degrees nasal

46
Q

Confrontation test: abnormal findings

A

If the patient is unable to see the object as you do,the test result suggests peripheral field loss. Refer the patient to an optometrist or ophthamologist for more precise testing with a tangent screen

47
Q

Inspect extraocular muscle function: Corneal Light Reflex (Hirschberg’s test)

A

Assess the parallel alignment of the eye axis by shining a light toward the patient’s eyes. Direct the patient to stare straight ahead as you hold the light about 30 cm away

48
Q

Corneal Light Reflex: normal findings

A

reflection of light on corneas should be in exactly the same spot on each eye

49
Q

Corneal Light Reflex: abnormal findings

A
  • asymmetry of the light reflex indicates deviation in alignment as a result of eye muscle weakness or paralysis
  • if you see this, perform the cover-uncover test
50
Q

Inspect extraocular muscle function: Cover- Uncover test

A
  • detects small degrees of deviated alignment by interrupting the fusion reflex that normally keeps the two eyes parallel
  • Ask the patient to stare straight ahead at your nose even though the gaze may be interrupted
  • With an opaque card, cover one eye
  • now uncover the eye and observe it for movement
51
Q

Cover-uncover test: normal findings

A

steady fixed gaze

52
Q

Cover-uncover test: abnormal findings

A
  • if eye jumps to fixate on the desiganted point, it was out of alignment before
  • phoria: mild weakness noted only when fusion is blocked
  • tropia: more severe- a constant misalignment of the eyes
53
Q

Diagnostic positions test

A
  • Leading the eyes through the 6 cardinal positions of gaze reveals any muscle weakness during movement
  • ask the patient to hold the head steady and to follow the movement of your finger, pen, or penlight only with the eyes
  • hold the target back about 30 cm so that the patient can focus on it comfortably, and move it to each of the 6 positions, hold it momentarily, then back to centre
  • progress clockwise
  • In addition to parallel movement, note any nystagmus, a fine oscillating movement best seen around the iris- mild nystagmus at extreme lateral gaze is normal; nystagmus at any other position is not
  • note that the upper eyelid continues to overlap the superior part of the iris, even during downward movement- should not see a white rim of sclera between the eyelid and the iris
54
Q

Diagnostic positions test: normal findings

A

parallel tracking of the obejct with both eyes

55
Q

Diagnostic positions test: abnormal findings

A
  • Eye movement that is not parallel is abnormal
  • Failure to follow in a certain direction indicates weakness of an extraocular muscle (EOM) or dysfunction of cranial nerve innervating it
  • nystagmus occurs with disease of the semicircular canals in the ears, a paretic eye muscle, MS, or brain lesions
  • lid lag occurs with hyperthyrioidism
56
Q

Eyeballs: abnormal findings

A
  • strabismus- deviation in the anteroposterior axis of the eye, both eyes do not line up in the same direction (cross eyes)
  • exophthalmos (protuding eyes)
  • enophthalmos (sunken eyes)
57
Q

Conjunctiva: abnormal findings

A
  • general reddening
  • cyanosis of the lower eyelids
  • pallor near the outer canthus of the lower eyelid (may indicate anemia; the inner canthus normally contains less pigmentation)
58
Q

Sclera: abnormal findings

A
  • scleral icterus (an even yellowing of the sclera extending up to the cornea), indicative of jaundice
  • tenderness, foreign body, discharge or lesions
59
Q

Anisocoria

A

a small number of people (5%) normally have pupils of different sizes

60
Q

How to test pupil: Pupillary light reflex

A
  • darken room and ask patient to gaze into distance (this dilates pupils)
  • advance a light in from the side
  • normally you will see constriction of the same-sided pupil (a direct light reflex) and simultaneous constriction of the other pupil (a consensual light reflex)
61
Q

Pupillary light reflex: abnormal findings

A
  • dilated pupils
  • dilated and fixed pupils
  • contricted pupils
  • sluggish pupils
  • unequal or no response to light
62
Q

Ophthalmoscope

A
  • enlarges your view of the eye so that you can inspect the media (anterior chamber, lens, vitreous) and ocular fundus ( the internal surface of the retina)
  • directs a beam of light through the pupil to illuminate the inner structures
63
Q

Macula: abnormal findings

A
  • clumping of pigment occurs with trauma or retinal detachment
  • hemorrhage or exudate in the macula occurs with AMD (Age-related Macular Degeneration)
64
Q

External ear

A
  • called the auricle/pinna
  • consists of movable cartilage and skin
  • has a characterisitic shape and serves to funnel sound waves into its opening, the external auditory canal
  • the canal terminates at the eardrum or tympanic membrane. It is lined with glands that secrete cerumen, a yellow waxy material that lubricates and protects the ear
65
Q

Tympanic membrane

A
  • also called eardrum
  • separates the external ear and middle ear
  • translucent, pearly grey membrane in which a prominent cone of light in the anteroinferior quadrant is the reflection of the otoscope light
  • eardrum is oval and slightly concave, pulled in at its centre by one of the middle ear ossicles, the malleus. The parts of the malleus show through the translucent eardrum; these are the umbo, the manubrium (handle), and the short process. The small, slack, superior section of the tympanic membrane is called the pars flaccida. The remainder of the eardrum, which is thicker and more taut, is the pars tensa. The annulus is the outer fibrous rim of the drum
66
Q

Middle ear

A
  • tiny air-filled cavity inside the temporal bone
  • contains tiny ear bones or auditory ossicles: malleus, incus and stapes
  • several openings
  • has 3 functions:
    1) conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear
    2) it protects the inner ear by reducing the amplitude of loud sounds
    3) its eustachian tube allows equalization of air pressure on each side of the eardrum so that the membrane does not rupture
67
Q

Inner ear

A
  • embedded in bone
  • contains the bony labyrinth, which holds the sensory organs for equilibrium and hearing
  • within the bony labryinth, the vestibule and the semicircular canals constitute the vestibular apparatus, and the cochlea contains the central hearing apparatus
  • not accessible to direct examination, its functions can be assessed
68
Q

Conductive hearing loss

A
  • involves a mechanical dysfunction of the external or middle ear
  • partial loss because the person is able to hear if the sound amplitude is increased enough to reach normal nerve elements in the inner ear
  • may be caused by impacted cerumen, foreign bodies, a perforated eardrum, pus or serum in the middle ear, or otosclerosis (decrease in mobility of the ossicles)
69
Q

Sensorineural hearing loss/perceptive loss

A
  • signifies pathology of the inner ear, cranial nerve VIII, or the auditory areas of the cerebral cortex
  • simple increase in amplitude may not enable the person to understand words
  • may be caused by presbycusis, a gradual nerve degeneration that occurs with aging, and by ototoxic medications , which affect the hair cells in the cochlea
70
Q

Mixed hearing loss

A

combination of conductive and sensorineural types in the same ear

71
Q

Vertigo

A
  • the 3 semicircular canals, labryinth in the inner ear constantly feed information to the brain about the body’s position in space
  • if the labyrinth ever becomes inflamed, it feeds the wrong information to the brain, creating a staggering gait and a strong, spinning, whirling sensation called vertigo
72
Q

Otosclerosis

A
  • common cause of conductive hearing loss in young adults between the ages of 20 and 40
  • gradual hardening that causes the footplate of the stapes to become fixed in the oval window, which impedes the transmission of sound and causes progressive deafness
73
Q

Presbycusis

A
  • type of hearing loss that occurs with aging
  • gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve
74
Q

Signs that hearing loss is happening

A
  • first a high-frequency tone loss
  • harder to hear consonants than vowels
  • much speech information is lost, and words sound garbled
  • ability to localize sound is also impaired
75
Q

SDOH for hearing

A
  • otitis media (middle ear infection):results from obstruction of the eustachian tube or of passage of nasopharnygeal secretions into the middle ear

One of the most common illnesses in children

Incidence and severity in Indigenous children higher than non-Indigenous children

Besides the anatomy of the infant eustachian tube, other risks that predispose children to acute otitis media include absence of breastfeeding in the first 3 months of age, exposure to second-hand tobacco smoke, day care attendance, male sex, pacifier use, low brith weight, low socioeconomic status and formula feeding in the supine position

  • Cerumen is genetically determined and comes in 2 major ways: 1) dry cerumen, grey, flaky, and frequently forms a thin mass in the ear canal or 2) wet cerumen, honey brown to dark brown and moist
76
Q

Collecting health history on earaches and rationale

A
  • Ask 1: Any earache or other pain in ears? Does it feel close to the surface or deep in the head? Does it hurt when you push on the ear? Is it dull and aching or sharp and stabbing? Is it constant or does it come and go? Is it affected by changing position of head? Ever had this kind of pain before?
  • Rationale 1: Otalgia (ear pain)- may be caused by ear disease or may represent referred pain from a problem in the teeth or oropharynx
  • Ask 2: Any accompanying cold symptoms or sore throat? Any problems with sinuses or teeth?
  • Rationale 2: A virus/bacterium that causes upper respiratory tract infection may migrate up the eustachian tube to involve the middle ear
  • Ask 3: Ever been hit on the ear or on the side of the head or had any sports injury?
  • Rationale 3: Trauma may rupture the eardrum
77
Q

Collecting health history on ear infections and rationale

A
  • Ask 1: Any ear infections? In adulthood or in childhood?
  • Rationale 1: A history of chronic ear problems suggests possible sequelae (consequence of previous infection)
  • Ask 2: How frequent were they? How were they treated?
  • Rationale 2: Repeated infections in childhood can result in progressive loss of hearing. The insertion of “tubes” (tympanoplasty) continues to be a procedure that is recommended, despite little evidence to support its benefit over nonsurgical topical/systemic treatment approaches
78
Q

Collecting health history on ear discharge and rationale

A
  • Ask 1: Any discharge from your ears?
  • Rationale 1: Otorrhea (discharge) suggests infection of the canal or a perforated eardrum
  • Ask 2: Does it look like pus or is it bloody?
  • Rationale 2: External otitis- purulent, sanguineous or watery discharge, Acute otitis media with perforation- purulent discharge
  • Ask 3: Any odour to the discharge?
  • Rationale 3: Cholesteatoma- dirty yellow or grey discharge with foul odour
  • Ask 4: Any relationship between the discharge and the ear pain?
  • Rationale 4: With perforation: ear pain typically occurs first and stops with a popping sensation; then drainage occurs
79
Q

Collecting health history on hearing loss and rationale

A
  • Ask 1: Ever had any trouble hearing? Did the loss come on slowly or all at once? Do you have a family history of otosclerosis? Has all your hearing decreased, or just your hearing of certain sounds?
  • Rationale 1: Onset of presbycusis is gradual (over years), whereas hearing loss caused by trauma is often sudden. The onset of otosclerosis is generally during the second and third decades of life and is diagnosed on the basis of symptoms of conductive hearing loss
  • Ask 2: Do people seem to shout at you?
  • Rationale 2: Recruitment- condition in which loss is marked when sound is initially at low intensity but actually becomes painful when repeated loudly
  • Ask 3: Do ordinary sounds seem hollow, as if you are hearing in a barrel or under water?
  • Rationale 3: Character of hearing loss is affected when cerumen expands and becomes imapcted, as after swimming or showering
80
Q

During health history, note these clues from normal conversation with a patient that indicate possible hearing loss…

A
  • lip reading or watching your face and lips closely rather than your eyes
  • frowning or straining forward to hear
  • posturing of head to catch sounds with better ear
  • misunderstanding your questions or frequently asking you to repeat what you said
  • acting irritable or showing startle reflex when you raise your voice (recruitment)
  • speech sounding garbled; possible distorition of vowel sounds
  • inappropriately loud voice
  • flat, monotonous tone of voice
81
Q

Collecting health history on tinnitus and rationale

A
  • Ask 1: Ever felt ringing, crackling, or buzzing in your ears? When did this occur?
  • Rationale 1: Tinnitus originate within the person, it accompanies some hearing or ear disorders. Tinnitus seems louder when there is no competition from environmental noise
  • Ask 2: Are you taking any medications?
  • Rationale 2: Many medications have ototoxic sequelae
82
Q

Collecting health history on vertigo and rationale

A
  • Ask 1: Ever felt vertigo? That is, do you feel the room spinning around or yourself spinning?
  • Rationale 1: A true sensation of rotational spinning occurs with dysfunction of the labryinth. In objective vertigo, people feel as if the room is spinning. In subjective vertigo, people feel as if they are spinning
  • Ask 2: Ever felt dizzy, as if you are not quite steady, like falling or losing your balance?
  • Rationale 2: Distinguish true vertigo from dizziness or lightheadedness
83
Q

Inspect and palpate the external ear: size and shape- normal findings

A

ears are of equal size bilaterally with no swelling or thickening. Ears of unusual size and shape may be a normal familial trait with no clinical significance

84
Q

Inspect and palpate the external ear: skin condition- normal findings

A

skin colour is consistent with the patient’s facial skin colour. The skin is intact, with no lumps or lesions. On some people you may note Darwin’s tubercle, a small painless nodule at the helix. This is a congential variation and is not significant

85
Q

Inspect and palpate the external ear: skin condition- abnormal findings

A
  • reddened, excessively warm skin indicates inflammation
  • crusts and scaling occur with otitis externa, eczema, contact dermatitis, and seborrhea
  • enlarged, tender lymph nodes in the region indicate inflammation of the pinna or mastoid process
  • red-blue discoloration indicates frostbite
86
Q

Inspect and palpate the external ear: tenderness- normal findings

A
  • move the pinna and push on the tragus
  • they should feel firm, and movement should produce no pain
  • palpating the mastoid process should also produce no pain
87
Q

Inspect and palpate the external ear: skin condition- abnormal findings

A
  • pain with movement occurs with otitis externa and furnucle
  • pain at the mastoid process may indicate mastoiditis or lymphadentitis of the posterior auricular node
88
Q

Inspect and palpate the external ear: external auditory meatus- normal findings

A
  • note the size of the opening to direct your choice of speculum for the otoscope
  • no swelling, redness, or discharge should be present
  • some cerumen is usually present. The colour varies from grey-yellow to light brown and black, and the texture varies from moist and waxy to dry and desiccated. A large amount of cerumen obscures visualization of the canal and eardrum
89
Q

Inspect and palpate the external ear: external auditory meatus- abnormal findings

A
  • atresia: absence or closure of the ear canal
  • Sticky yellow discharge accompanies otitis externa or may indicate otitis media if the eardrum has ruptured
  • impacted cerumen is a common cause of conductive hearing loss
90
Q

Test hearing acuity

A
  • pure tone audiometer gives a precise quantitative measure of hearing by assessing the person’s ability to hear sounds of varying frequency
  • with the patient sitting, prop the patient’s elbow on the armrest of the chair with the hand making a gentle fist
  • tell the patient, “you will hear faint tones of different pitches. Please raise your finger as soon as you hear the tone, then lower your finger as soon as you no longer hear the tone”
  • choose tones of random loudness in dB on the audio scope
  • each tone is on for 1.5 seconds and off for 1.5 seconds
  • test each ear separately and record the results
91
Q

Whispered voice test

A
  • stand arm’s length (half a metre, or 2 feet) behind the person
  • test on ear at a time while masking hearing in the other ear to prevent sound transmission around the head , this is done by placing one finger on the tragus and pushing it in and out of the auditory meatus
  • move your head to about 2 feet from the person’s ear
  • exhale fully and whisper slowly a set of 3 random numbers and letters
  • normally the person repeats each combination of 3 numbers and letters- passing score is correct repetition of at least 3 of a possible 6 numbers/letters
  • assess other ear using yet another set of whispered items

NURS 252 (5 decks)

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