EAR Modules

Key Problem/Nsg Dx # 1 Disturbed sensory perception: Auditory Supporting data: Rinne and Weber tests indicating conductive hearing loss Tinnitus Key Problem/Nsg Dx # 2 Impaired verbal communication Supporting data: Difficulty understanding conversation Having to repeat said words Key Problem/Nsg Dx # 3 Safety: Risk for fall Supporting data: Propioception (balance) affected

Key Assessment: Hearing loss bilateral, asymmetrical Communication difficulty with ordinary conversation but adequate use of the phone (due to retention of bone conduction) Rinne test bone conduction equal to or longer than air conduction Weber test lateralization to the impaired ear

OTOSCLEROSIS Pathophysiology/Etiology: Hereditary disorder Common in young Caucasian females Exacerbated by pregnancy Abnormal bone growth around the ossicles causing stiffening of the stapes and decrease in sound transmission to the inner ear. Treatment and Intervention: Use of hearing aids

Key Problem/Nsg Dx # 4 Risk for Social Isolation Supporting data: Difficulty engaging in conversation

Client Education: (Post-ear surgery) Keep outer ear dressing clean and dry. DO NOT remove inner dressing without surgeons approval. Avoid blowing nose (blow one nostril at a time), sneezing/coughing (cough/sneeze with open mouth), straining (use measures to avoid constipation) Avoid air travel, avoid drinking through straw for 2-3 weeks Keep ear dry for 6 weeks with petrolatum-coated cotton ball, avoid showering/shampooing hair, diving until approved by surgeon Avoid respiratory infections, know medications and implications

Sodium Flouride to slow bone overgrowth Enhance communication strategies: -Approaching within line of vision -Reducing background noises -Get client attention before speaking -Face client, speak slowly and clearly -Utilize non-verbal cues and written messages -Repeat sentences, ask client to repeat words/conversation Surgery: Stapedectomy with fenestration (microsurgical removal of diseased stapes); Stapedotomy (insertion of a wire or platinum prosthesis Post test into small hole created in the stapes)

Complete the following care Report: persistent post-op headache, increasedplan using drainage/bleeding from site, fever, new/increased ear pain/dizziness, decreased hearing

the problem below.

Referral to appropriate community agencies

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Problem # Disturbed Sensory Perception: Auditory General Goal: Predicted Behavioral Outcome Objective(s): The patient will 1. Nursing Interventions and Teaching 1. 2. 3. 4. 5. 1. 2. 3. 4. 5. Expected Patient Responses to Interventions

Evaluation: Summarize patient progress toward outcome objectives:

Key Problem/Nsg Dx # 1 Disturbed sensory perception: Auditory Key Problem/Nsg Dx # 3 Supporting data: Disturbed sleep pattern Rinne and Weber tests indicating sensorineural hearing loss Tinnitus/Ear fullness Diagnostic tests (High sodium) Supporting data: Vertigo/tinnitus/nausea affecting sleep Key Problem/Nsg Dx # 4 Safety: Risk for injury/fall Supporting data: Nystagmus/vertigo affecting proprioception (balance)

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MENIERES DISEASE Pathophysiology/Etiology: Unknown etiology, can be hereditary, viral, immune dysfunction, damage to the inner ear d/t trauma or infection Key Assessments: Hearing loss unilateral, gradual, progressive Weber test lateralization to the good ear Rinne test Air conduction longer than bone conduction Recurrent severe attacks of vertigo lasting minutes to hours (may be associated with hypotension, diaphoresis, nystagmus) Fullness in the ears and tinnitus Nausea/Headache Labs/Diagnostics- high sodium, CT scan, xray, electronystagnography Triggers:vasoconstriction, fluid retention, stress, allergies Client Education: Learn signs of impending attacks of vertigo lie down in bed in a dark room OR pull off the road for safety Avoid sudden movements or change in position Practice balance training exercises, use white noise to mask tinnitus Follow diet restrictions Common both males and females (35-60 years old) Impaired reabsorption of endolymph causing dilation of lymph channels

Key Problem/Nsg Dx # 2 Imbalanced Nutrition: Less than body requirements Supporting data: Intake decreased Vertigo/nausea/vomiting affecting diet

Treatment and Intervention: Low sodium diet, avoid alcohol, caffeine, nicotine Bedrest to control vertigo, assist with ambulation Medications: atropine , valium or ativan (CNS depressant), diuretics, antihistamine, droperidol, antiemetics Surgery: (Post surgical teaching as above) Endolymphatic decompression to relieve pressure in the labyrinth (relieves vertigo in 70% of cases, hearing preserved, relieves tinnitus in 50% of cases) Vestibular neurectomy to control balance and sensation of vertigo (90% of cases) by severing a part of the 8th cranial nerve Labyrinthectomy - total removal of labyrinth, cochlear function and ability to hear destroyed (last resort) Cochlear implant device implanted in the ear to allow perception of sound, hence alerting client to danger. Normal hearing is not restored

Post test are the clinical manifestations of Menieres disease?

1. What Take prescribed medications

2. How is Menieres disease managed? What are the important teaching points?

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3. What are the nursing implications after surgery?

Indicates relationship

References Bickley, L. (2007). Bates pocket guide in physical examination and history taking. New York : Lippincott Williams & Wilkins. Hogan, M. (Ed.). (2008). Medical surgical nursing: Reviews and rationales. Upper Saddle, New Jersey : Prentice Education, Inc. Lemone, P. & Burke, K. (2007). Medical-surgical nursing: Critical thinking in client care. Upper Saddle, New Jersey : Prentice Education, Inc.