Sensory - Auditory Flashcards
Sensory Perception
the ability to receive sensory input and translate the stimulus/data into meaningful information
Why is sensory perception important in nursing care?
understand what you are asking and listening to them
Safety environment such as streets
What are the 12 cranial nerves in order?
Olfactory
Optic
Oculomotor
Trochlear**
Trigeminal
Abducens**
Facial**
Auditory (vestibulocochlear)
Glossopharyngeal
Vagus
Accessory
Hypoglossal
Cranial Nerve Function
OLFACTORY
smell (not usually tested)
Cranial Nerve Function
OPTIC**
Visual acuity
Cranial Nerve Function
OCULOMOTOR**
Opening of eyelids, eye mvmt (upward/medial, upward/lateral, medial, downward/lateral)
Cranial Nerve Function
TROCHLEAR**
eye mvmt (downward/medial)
Cranial Nerve Function
TRIGEMINAL
facial sensation, chewing mvmts
Cranial Nerve Function
ABDUCENS**
eye mvmt (lateral)
Cranial Nerve Function
FACIAL**
facial muscles mvmt (except chewing muscles) and eyelid closing
Cranial Nerve Function
AUDITORY (VESTIBULOCOCHLEAR)
hearing and balance
Cranial Nerve Function
GLOSSPHARYNGEAL
taste on the posterior 3rd of the tongue (not usually tested)
Cranial Nerve Function
VAGUS
Uvula (palate muscles) and swallowing
Cranial Nerve Function
ACCESSORY
shoulder shrug
Cranial Nerve Function
HYPOGLOSSAL
tongue mvmt
If you have mild hearing loss, you may not be able to hear
birdsongs
If you have moderate to severe hearing loss, you may not be able to hear
Conversation (moderate)
Phone (more severe)
If you have profound hearing loss, you may not be able to hear
cars and planes
What technique would you use when educating a pt with withdrawn hearing loss?
Teach Back “repeat back what I said?”
Hearing Loss
BROAD S/S
Ineffective communication leads to
decrease interaction
-withdraw (only nods and smiles)
-suspicion (who are you? - no nurse-pt relationship)
-loss of self-esteem (no autonomy)
-insecurity
If a hearing loss pt is suspicious of you, what way of communicating is effective?
writing and drawing
ALS if possible
ask family to stay
Conductive hearing loss occurs causes damage to what parts of the ear?
outer and middle
Sensoriurineal hearing loss occurs causes damage to what parts of the ear?
inner ear (nerve pathways)
Sensorineural hearing loss is damage to what cranial nerve?
8 vestibulocochlear
Mixed hearing loss occurs causes damage to what parts of the ear?
outer and middle ear
ALSO inner ear damage
Otoscope
shines light to visualize and examine the condition of the ear canal and drum
-shows causes of symptoms (ache, full, or hearing loss)
How do you assess for hearing loss?
Otoscope
weber’s
Rinne’s
Weber’s test process
Strike a tuning fork and place on the forehead an equal distance between both ears
- Assess the hearing difference and which one is weaker
Weber’s test Results
Equal sounds in Both Ears
Normal hearing
Weber’s test Results
Sound is heard best in the abnormal ear
Conductive loss
Weber’s test Results
Sound will be heard best in the normal ear
Sensorineural
Rinne’s test
- differentiates sound transmission via air conduction or bone conduction
-done with Weber for sensorineural hearing loss - Quick test for conductive hearing loss
Rinne’s test Results
bone >/= air conduction
Conductive hearing loss on that side
Rinne’s test Results
air >/= bone conduction
Normal hearing
What do you assess for on a auditory impaired pt?
tinnitus (ringing ears)
vertigo (spins while still)
If you have vertigo, what precaution needs to be taken?
high fall risk
- slow rise, someone in the room every time they get up, fall bundle
PT work with them, patience, bed alarm
Otitis media w/ effusion
fluid or inflammation in the ear
peds more than adults
Poor Eustachian tube function
No draining of fluid for balance
Cerumen
earwax
What is a serious adverse reaction of tinnitus?
Suicide idealization
and attempts
leads to conductive hearing loss
Vertigo precautions
high fall risk
Vertigo can happen due to which diseases?
Conductive hearing loss reasons
Otitis media w/ effusion (fluid or inflammation in the ear)
Poor Eustachian tube function (no draining of fluid for balance)
impacted cerumen - earwax
tumors/objects present
middle ear disease
otosclerosis
Something is blocking the path of sound from entering the ear drum
Middle ear disease
Chronic otitis media (inflammation of the ear of the middle ear leading to a build-up of fluid behind the eardrum)
What is the proper way to educate pts on cleaning their ears?
put hydrogen peroxide in their ears
-not QTips-
Otosclerosis
genetic problem preventing sounds from being transmitted due to bony overgrowth of tissue
Patients actually hear better in noisy environments
Bone is better than air conduction
Conductive Hearing loss
Conductive hearing loss tx
underlying cause
recommend hearing aid
Conductive patients hear better with
bone than air conduction
noisy environments
What is the most common type of permanent hearing loss?
Sensorineural
Can medicine and surgery fix sensorineural hearing loss?
no
Sensorineural hearing loss is caused by
illness
genetic (cranial nerve damage)
loud noise - occupational (MRI, planes)
- earplugs
ototoxicity permanent hearing loss through meds
aging – presbycusis
What 6 drugs and classes cause sensorineural?
Vancomycin - antibiotic IV
Gentamycin - antibiotic IV
Cisplatin - CA med
Furosemide - loop diuretic
Quinine - malaria
Aspirin - fever reducer
What should you tell the pt when giving them Vancomycin and Gentamycin through IV?
Notify me immediately to stop the infusion if you are experiencing ringing in your ears
- Better to catch it early than for hearing loss to be permanent
Presbycusis means
Elderly hearing loss
Presbycusis can cause
sensorineural loss
Presbycusis leads to =
- degeneration atrophy of the ganglion cells in the cochlea
- compromised vascular supply of the inner ear
What is the most common type of permanent hearing loss?
Sensorineural
Can surgery and medicine fix sensorineural hearing loss?
NO
Meniere’s syndrome S/S
tinnitus
fluctuating hearing loss (unilateral sensorineural hearing loss)
vertigo
How long does Meniere’s s/s last
hours to days
Can Meniere’s cause permanent hearing loss?
Yes over time
if attacks are frequent enough
- and gets lengthier over time
Meniere’s syndrome assessment
feelings of fullness in the ear
tinnitus
vertigo
N/V
nystagmus
severe HA
Nystagmus
eye vibrating back and forth
Meniere’s syndrome is
dilation of the endolymphatic system by overproduction or decreased reabsorption of the endolymphatic fluid
Meniere’s syndrome interventions
Prevent injury due to vertigo
Fall Bundle
Bed rest
Quiet environment
assist with ambulation - PT vestibular rehab
Move head slowly - not sharp
Na and fluid restriction
stop smoking
Avoid watching TV with flickering lights
control N/V
Mild diuretics for fluid volume
Meniere’s syndrome surgical interventions
Drill out bone and leave shunt to balance fluid
Drill around the bone and insert a clip
Most severe = cut Nerve #8
Meniere’s syndrome post-op interventions
packing and dressings on ear
speak on the unaffected side
pt safety
Perform neuro examinations
assist with ambulation
bedside commode
antivertigo and antiemetic meds as prescribed
Nursing Care for Hearing loss
asess = early detection
difference btw sensorineural and conductive hearing loss - for tx
Safety measures = educate and teach back if unable tell caregiver discharge plan
Dietary = nutrition and hydration
Medication = when to continue
Surgery = hearing aides (clean and change) - DOCUMENT
Community resources = Case Mgrs
Communication tech LOW AND SLOW
Do not yell
- What is Cranial nerve #8 responsible for?
a. Auditory (vestibulocochlear) is responsible for balance and hearing.
- What clinical manifestations are associated with hearing loss?
a. Ineffective communication, Decreased interaction, withdrawal, suspicion, loss of self-esteem and insecurity.
- How do you check if a patient with hearing loss understood what you were communication to them?
a. Have the patient teach back. Also, have a family/friend at bedside to also get education.
- What part of the ear is affected if the patient has conductive hearing loss?
a. Outer and middle ear
- What part of the ear is affected if the patient has sensorineural hearing loss?
a. Inner ear damage (nerve pathways)
- What are two of the priority symptoms that we are assessing for with hearing loss that is caused by compression of cranial nerve #8?
a. Tinnitus and vertigo
- What is tinnitus and what is your priority assessment for the patient suffering with tinnitus?
a. Ringing of the ears can cause suicidal ideation.
- What is Vertigo and what is your priority assessment for the patient suffering with vertigo?
a. Room is spinning while the patient is still. Patient is a high fall risk.
- What are the some of the causes of Conductive hearing loss?
a. Otitis media with effusion, poor eustachian tube function, impacted cerumen, tumors, objects present, middle ear disease, otosclerosis
- What are some of the causes of Sensorineural hearing loss?
a. Illness, genetics, loud noises, ototoxicity, and aging
- What medications cause ototoxicity in sensorineural hearing loss?
a. 1. Vancomycin 2. Gentamycin 3. Cisplatin 4. Aspirin 5. Furosemide 6. Quinine
- True or false: Sensorineural is permanent hearing loss that cannot be fixed by surgery or medicine?
true
- What is Meniere’s disease?
a. Refers to the dilation of the endolymphatic system by overproduction or decrease reabsorption of endolymphatic fluid. (Basically, too much fluid causing pressure on cranial nerve #8.
- What treatments can be done for a patient with Meniere’s disease?
a. Mild diuretics, vestibular rehabilitation, surgery.
- What communication technique is the most effective for a patient with hearing loss?
a. Talk Low and Slow. Can also use written instructions for patient.
