UNIT 3 Chapter 43 SENSORY: Assessment and Concepts of Care with Ear and Hearing Problems Flashcards
What is MENIERE’S diseases? What are they at risk for?
Tinnitus, one-sided sensorineural hearing loss, and vertigo that is related to overproduction or decreased reabsorption of endolymphatic fluid, causing a distortion of the entire inner canal system.
IT IS PROGRESSIVE
AT RISK FOR FALLS
Signs and symptoms of Ménière’s disease
tinnitus :A continuous ringing or noise perception in the ear.
vertigo: A sense of whirling or turning in space.
Signs and symptoms include vertigo, hearing loss, and tinnitus. Vertigo is often accompanied by nausea, vomiting, headache, and nystagmus (rapid eye movements). Blood pressure, pulse, and respirations may be elevated. Hearing loss occurs first with the low-frequency tones; in some patients, it progresses to include all levels and eventually becomes permanent. Patients may describe the tinnitus as having variable pitch and intensity, which may fluctuate or remain continuous.
Nystagmus
Risk Factors of MENIERE’S DISEASE
Nonpharmacologic treatment for Ménière disease includes diet and lifestyle adjustments, as some patients with this condition are sensitive to triggers such as high salt intake, caffeine, monosodium glutamate (MSG), alcohol, nicotine, stress, and allergens
Drug therapy for Meniere’s diseases
Antiemitic (Ondanstetron): to treat nausea and vomitting
Antihistamine: Diphenhydramine
reduces vertigo
Diuretics: furosemide, spironolactone
to aid in reducing the fluid in the ear
Nursing Interventions for a pt with Meniere’s disease
use bedside commode to avoid or reduce risk for falls
speak to pt on unaffected side
assist with ambulation
encourage bedrest
LOW SODIUM DIET
The client is diagnosed with Ménière’s
disease. Which statement indicates the client understands the medical management for this disease?
1. “After intravenous antibiotic therapy, I will be
cured.”
2. “I will have to use a hearing aid for the rest of
my life.”
3. “I must adhere to a low-sodium diet,
2,000 mg/day.”
4. “I should sleep with the head of my bed
elevated.”
- “I must adhere to a low-sodium diet,
2,000 mg/day.” - Sodium regulates the balance of fluid within the body; therefore, a low-sodium diet is prescribed to help control the symptoms of Ménière’s disease.
The client is complaining of ringing in the ears. Which data are most appropriate for the nurse to document in the client’s chart?
1. Complaints of vertigo.
2. Complaints of otorrhea.
3. Complaints of tinnitus.
4. Complaints of presbycusis.
- Complaints of tinnitus.
Tinnitus is “ringing of the ears.” It is a subjective perception of sound with inter- nal origins.
Which ototoxic medication should the
nurse recognize as potentially life altering or threatening to the client?
1. An oral calcium channel blocker.
2. An intravenous aminoglycoside antibiotic.
3. An intravenous glucocorticoid.
4. An oral loop diuretic.
- An intravenous aminoglycoside antibiotic.
Aminoglycoside antibiotics are ototoxic. Overdosage of these medications can cause the client to go deaf, which is why peak and trough serum levels are drawn while the client is taking a medication of this type. These antibiotics are also very nephrotoxic.
- The nurse is teaching new assistive personnel (AP) about caring for older adults. Which statement would the nurse include about hearing ability of this client group?
a. You need to talk very loudly when communicating with these clients.
b. You always need to check each client9s ears for excess ear wax.
c. Remember to face the client when talking with him or her.
d. Assess each client’s hearing ability using the voice or whisper test
c. Remember to face the client when talking with him or her.
ANS: C
Losing one’s hearing is not a normal change of aging although high frequency sounds may be more difficult to hear. AP does not perform assessments and it is not necessary to talk loudly or shout unless a hearing impairment exists. Therefore, facing the client is the best strategy when communicating with most older adults.
- The client’s electronic health record indicates a sensorineural hearing loss. What assessment question does the nurse ask to determine the possible cause?
a. Do you feel like something is in your ear?
b. Do you have frequent ear infections?
c. Have you been exposed to loud noises?
d. Have you been told your ear bones don’t move?
c. Have you been exposed to loud noises?
Sensorineural hearing loss can occur from damage to the cochlea, the eighth cranial nerve, or the brain. Exposure to loud music is one etiology. The other questions are related to conductive hearing loss.
- A nurse is teaching a community group about noise-induced hearing loss. Which client who does not use ear protection would the nurse refer to an audiologist as the priority?
a. Client with an hour car commutes on the freeway each day.
b. Client who rides a motorcycle to work 20 minutes each way.
c. Client who sat in the back row at a rock concert recently.
d. Client who is a tree-trimmer and uses a chainsaw 6 to 7 hours a day.
d. Client who is a tree-trimmer and uses a chainsaw 6 to 7 hours a day.
ANS: D
A chainsaw becomes dangerous to hearing after several hours of exposure without hearing protection. This client needs to be referred as the priority. Normal car traffic and motorcycle noise is safe unless for a very long time. Although a client was at a rock concert, he or she was in the back row and had less exposure. In addition, a one-time exposure is less damaging than chronic exposure.
- A client with Ménière disease is in the hospital when the client has an episode of this disorder. What action by the nurse is appropriate?
a. Assess vital signs every 15 minutes.
b. Dim or turn off lights in the client’s room.
c. Place the client in bed with the upper side rails up.
d. Provide a cool, wet cloth for the client’s face.
c. Place the client in bed with the upper side rails up.
ANS: C
Clients with Ménière disease can have vertigo so severe that they can fall. The nurse would assist the client into bed and put the side rails up to keep the client from falling out of bed due to the intense whirling feeling. The other actions are not warranted for clients with Ménière disease.
- A client is scheduled to have a tumor of the middle ear removed. Which perioperative health teaching is most important for the nurse to include?
a. Expecting hearing loss in the affected ear
b. Managing postoperative pain
c. Maintaining NPO status prior to surgery
d. Understanding which medications are allowed the day of surgery
ANS: A
Removal of an inner ear tumor will likely destroy hearing in the affected ear. The other teaching topics are appropriate for any surgical client.
- The nurse is teaching an older adult how to prevent buildup of ear wax. Which statement by the nurse is most appropriate?
a. Visit your primary health care provider each month for wax removal.
b. Drink plenty of water and other liquids to prevent hardening of the ear wax.
c. Irrigate each ear once a month to remove wax and prevent was buildup.
d. Put one drop of mineral oil in each ear once a week at bedtime.
ANS: D
Mineral oil provides lubrication to soften cerumen so that it flows out of the ears to prevent buildup. It is a safer method than irrigating the ears. If needed, the client would need to go to a primary health care provider for removal of impaction. Drinking water helps prevent hardening of wax but does not necessarily prevent wax buildup.
- The nurse is assessing a client’s medication profile to determine risk for tinnitus. Which drug classification is most likely to cause this health problem?
a. Cephalosporins
b. NSAIDs
c. Beta-adrenergic blockers
d. Osmotic diuretics
b. NSAIDs
None of these drug classifications except for NSAIDs pose a risk to clients for tinnitus as a side effect.
