Sensory - Module 9

Question 1

Meniere’s Disease

Answer 1

Abnormal inner ear fluid balance caused by malabsorption in the sac or blockage from the duct.

• Unknown cause – no cure
• Feeling of aura (pressure/fullness in ear)
• Episodic incapacitating vertigo with tinnitus (or roaring sounds)
• Attacks increase in frequency and symptoms

Question 2

S&S of Meniere’s Disease

Answer 2

• sudden attacks of vertigo
• tinnitus
• hearing loss
• N/V

After attack:

• vertigo 2-4 hours
• dizziness
• unsteadiness
• gait changes
• depression
• moody
• VS within normal limits
• hearing loss

Question 3

Management of Meniere’s Disease

Answer 3

• quiet, dark room
• low salt diet
• fluids 2500 cc/day
• avoid ETOH and caffeine
• safety: home, work, driving
• prevent attacks: avoid sudden head movement and flashing lights
• transmission of air waves into the fluid in the inner ear is having some success
• watch for potential hearing loss
• F&E balance

Question 4

Medication for Meniere’s Disease

Answer 4

• sedations/tranquilzers
• antihistamines (AntiVert)
• vasodilators
• diuretics
• anti-seizure drugs
• ototoxic

Question 5

Diagnosis of Meniere’s Disease

Answer 5

• Check symptoms
• perform Weber’s test
• Rule out other dz

Question 6

Mastoiditis

Answer 6

Inflammation of the mastoid resulting from a middle ear infection (otitis media)

Acute mastoiditis is rare r/t antibiotics

Chronic mastoiditis leads to cholesteatoma, which is an ingrowth of skin of the external layer of the eardrum into the middle ear. – use Otoscope.

Question 7

Clinical Picture of Mastoiditis

Answer 7

• postauricular pain and tenderness
• otorrhea: drainage
• mastoid area red and edematous
• fever, H/A

Question 8

Treatment for Mastoiditis

Answer 8

• Diagnosis is related to symptomology
• Meds - Antibiotics
• Surgery - myringotomy, mastoidectomy

Question 9

Tympanoplasty

Answer 9

• Common surgery for otitis media
• Surgical reconstruction of a perforated tympanic membrane, can also restore inner ear structures
• done Outpatient
• Improves hearing

Question 10

Otosclerosis

Answer 10

• New abnormal bone fixates the stapes
• The stapes cannot vibrate and sound cannot be conducted
• Common in white women and worsened by pregnancy

Question 11

Clinical Picture of Otosclerosis

Answer 11

• Progressive conductive hearing loss
• Tinnitus
• Bone conduction is better than air on Rinne test
• Audiogram indicates conductive hearing loss

Question 12

Treatment for Otosclerosis

Answer 12

• Fluoride supplement may mature spongy bone growth
• Amplification: hearing aids
• Surgical: stapledectomy with graft or prosthesis

Question 13

Acoustic Neuroma

Answer 13

• Slow growing benign tumor of the 8th cranial nerve
• In the internal auditory canal extending to press on the brain stem
• Equal in men and women at middle age
• Usually unilateral

Question 14

Treatment for Acoustic Neuroma

Answer 14

• Diagnosis by MRI or CT
• Surgical removal
• Preserve facial nerve function
• Approach depends on if there is hearing loss
• Complications: facial nerve damange, cerebrospinal fluid leak, infection, cerebral edema

Question 15

Cochlear Implant

Answer 15

• Profound sensorineural bilateral hearing loss
• Stimulates the auditory nerve
• The mic and signal processor is outside the body - implanted electrodes
• 1 year, adult with profound hearing loss, extensive rehab
• MRI will inactivate the device

Question 16

Presbycusis

Answer 16

• Hearing loss due to aging.

- Caused by exposure to noise, diseases, poor nutrition, ototoxic drugs.

Question 17

Conductive hearing loss

Answer 17

occurs in other and middle ear. Sound is impaired from outer to inner ear.

Most common cause: otitis media.

Hears better in noisy environment.

Question 18

Sensorineural loss

Answer 18

Impairment of the vestibulocochlear nerve (CN 8)

• hereditary, noise trauma, syphilis, TB
• High pitch ability decreases first (so don’t shout)
• Hearing aids may not always be helpful

Question 19

Nursing considerations for Presbycusis

Answer 19

• speak normally and slowly
• do not exaggerate facial expressions
• use simple sentences
• rephrase if not understood with different words
• do not shout
• do not cover mouth when speaking
• maintain eye contact

Question 20

Rosacea

Answer 20

• affects middle age adults
• marked by erythemia (cheeks) and pustules
• have more sebaceous glands

Treat:

• topically hydrocortisone (MetroGel)
• PO tetracycline

Question 21

Psoriasis

Answer 21

• chronic noninfectious inflammatory disease
• increase in epidermal cell production
• 15 - 50 years
• can be on scalp, elbows, knees, back and genitilia
• bilateral symmetry
• stress aggravates

Question 22

Clinical Picture of Psoriasis

Answer 22

• red raised patches
• may or may not itch
• medical management: remove scales, emollient creams
• corticosteriods, occlusive dressings and VITAMIN D
• intralesional injections
• systemic methotrexate, cytotoxic
• UV light helps shedding

Question 23

Nursing management for Psoriasis

Answer 23

• Anthran leaves brownish stains
• avoid sun exposure
• national psoriasis foundation
• self acceptance
• disease can generally be controlled but NOT CURED

Question 24

Eczema/Dermatitis

Answer 24

• many variant forms
• hereditary, allergies
• any age
• lesions spread
• avoid irritants, moisturizers
• Complications: secondary infections and pruritis

Question 25

Acne vulgaris

Answer 25

• androgens stimulate the sebaceous glands, accumulated sebum plugs the pilosebaceous ducts
• white heads (closed)
• black heads (open)
• papules, pustules, nodules, and cysts
• 12-35 age, puberty, family history.

Question 26

Mangement of Acne vulgaris

Answer 26

• reduce bacterial colonies
• salicylic acid and benzoyl peroxide, Vit A acid, tetracycline, clindamycin and erythromycin
• Cryosurgery, dermabrasion scarring
• Diet restrictions not recommended
• Wash twice/day - avoid over scrubbing, oil free cosmetics, no popping or squeezing