CH-21 auditory problems (3)

.pdf

School

Houston Community College *

*We aren’t endorsed by this school

Course

2331

Subject

Chemistry

Date

May 16, 2024

Type

pdf

Pages

Uploaded by PrivateStarRam42

CH- 21 Auditory problems Auditory problem Assessment data Subjective data: Health history  Childhood: ear problems; surgery  Systemic conditions  Head injury  Allergies  Current symptoms  Family history  Medications: Ototoxic  Hearing aids Objective data  Ask: changes in hearing, ear pain, drainage, tinnitus?  Inspect ears: alignment, position, size, shape, symmetry, color, skin intact, discharge, or lesions, fever  Assess hearing: responses, whisper, watch  inspect and palpate external ear  check for balance & assess cranial nerve VIII Chronic otitis media and mastoiditis Etiology  infection of tympanum, ossicles, and middle ear. Clinical Manifestations  Swelling of auditory tube traps bacteria; pressure on TM  redness, bulging, and pain  Also see fever, malaise, drainage, and reduced hearing Diagnostic tests  otoscopic exam  culture and sensitivity  audiogram ( tests your ability to hear sounds.)  mastoid x-ray, MRI, CT scan Risk Factors  Pacifiers & attending day care  No routine vaccinations  History of chronic ear infections Parents that smoke Treatment  Surgery- myringotomy ( a procedure to create a hole in the ear drum to allow fluid that is trapped in the middle ear to drain out. Tympanostomy tube (ventilate ear) Medications  Oral antibiotics amoxicillin and eardrops.  Analgesics  Antiemetics  Allergy - antihistamines & nasal corticosteroid  Effusion (inflammation of middle ear with fluid collection) Symptoms  feel fullness  plugged  Popping  decreased hearing  Often follows acute otitis media  may last weeks to months Resolves without treatment& can recur Complications  Hearing loss, nausea, dizziness  Cholesteatoma (is an abnormal growth of skin in the middle ear behind the eardrum ) may develop Nursing intervention/implications  Clear infection  repair perforation  preserve hearing  Administer oral antibiotic (amoxicillin) and eardrops  Administer analgesics & antiemetics  Evacuation of drainage  Surgery by Tympanoplasty and/or mastoidectomy  Keep the room quiet  Speak directly to the pt.  Make sure no flickering light (can cause seizures)  Put side rails up Patient Teaching  Avoid air travel and sun exposure for 6 weeks.  Don’t strain while bowel movement  No swimming & keep ear dry  Change ear dressing daily per dr. order  Repost hcp for any excess drainage or severe dizziness. Otosclerosis Etiology  Abnormal growth of bone near the ear.  Most common cause of hearing loss in young adults.  Prevents movement of footplate in stapes  reduced transmission of vibration Clinical Manifestations  Hearing loss both ears or just 1 ear  Can’t hear at low frequency (whisper)  Tinnitus  vertigo Diagnostic T.  Schwartz’s sign  tuning fork (Rinne test)  audiogram Risk Factors  Hereditary autosomal dominant disease; conductive (air) hearing loss in young adults; often unaware until severe.  Pt had measles  Auto immune disorder  pregnancy

Treatment  Hearing aid  stapedectomy (Microdrill or laser surgical treatment involves opening the footplate) Medications  Oral sodium fluoride  vitamin D  calcium carbonate — slow progression Complications  complete deafness  infection  dizziness  pain  altered sense of taste Nursing intervention/implications  monitor vital signs  caution in ambulation as dizziness may occur.  Observe for any bleeding, nausea & vomiting  Administer antibiotics and analgesic  Put side rails up  Provide pre and post operative care  Provide pschychological support Patient Teaching  Educate patient & family members about disease  Call hcp if symptoms get worse or have any new symptoms  Avoid sudden movements & inner ear pressure. Ménière’s Disease Etiology  Accumulation of endolymph ( clear fluid ) in membranous labyrinth in one side  genetic and environmental factors Clinical Manifestations  Excess fluid and pressure  hearing and balance problems  Disability — sudden, severe attacks of vertigo, nausea, vomiting, sweating; unpredictable  Prior to attack: fullness in ear, tinnitus, and muffled hearing  Some experience feelings of: being pulled to the ground “drop attacks” or whirling in space  Unilateral gearing loss  vertigo Diagnostic tests  Audiogram — low frequency sensorineural hearing loss  Spontaneous vertigo on two occasions  Abnormal vestibular tests  Glycerol test Treatment  Surgical intervention: -Decompression -Vestibular nerve section -Ablation of labyrinth (unilateral disease) Medications Acute attack  Anticholinergics - block the action of a neurotransmitter called acetylcholine  inhibits nerve impulses responsible for involuntary muscle movements and various bodily functions  Antihistamines  Antienemics (vomiting)  Benzodiazepines (depressant)  corticosteroids Between attacks  Diuretics  Corticosteroids  low-sodium diet  stress reduction Nursing intervention  Patient safety -Fall precautions - side rails up - bed low position - call for help for OOB - assist with ambulation  Monitor intake and output  parenteral medication  fluid administration Patient Teaching, prevention  safety measures at home  Exercise for balance as tolerated  Sit down or lie down at the onset of dizziness.  Slow position changes  Avoid swimming & high places  Sodium restriction (to avoid excess fluid that swells the body)  Avoid smoking, caffeine & alcohol (can cause flare up) Acoustic Neuroma Etiology  Unilateral benign tumor where vestibulocochlear nerve (CN VIII) enters internal auditory canal. (develops on the nerve that connects the ear to the brain.  are benign tumors originating from the Schwann cells of CN VIII  Early diagnosis important to avoid compression of trigeminal and facial nerves and arteries.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version