MEDICAL SURGICAL NURSING CHAPTER 49

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MEDICAL SURGICAL NURSINGCHAPTER 49

• CARING FOR CLIENTS WITH EAR DISORDERS

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Hearing Impairment

• Described from normal to total deafness. See
  table 49-1
• Can be due to conductive disorders like wax
  impaction or sensorineural hearing loss from
  arteriosclerosis or drug toxicity
• Box 49-1

• Tinnitus is hearing buzzing, whistling or ringing
  noises in one or both ears
• Impairment depends on when the loss occurs in the
  persons development

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Medical/Surgical Management

• Medical
• Sign language or speech reading or lip reading
• Recommendation of hearing aides
• Special devices to assist the deaf or hearing
  impaired areTODD, etc
• Surgical
• Cochlear implants fig 49-2

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Nursing management

• Observe for signs of impairment
• Determine how the client best communicates
• Assist with use of hearing aides

• Include a family member in teaching if possible
• Use written materials if appropriate
• Nursing Guidelines 49-2

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Disorders of the External Ear

• Impacted Cerumen is when ear wax obstructs the
  ear canal
• S/S a sense of fullness in the ears with
  diminished hearing
• Treatment instillation of a hydrating agent
  such as peroxide, warm glycerin or mineral oil or
  medications such as Debrox or Cerumenex followed
  by irrigation

• Foreign Objects such as insects, beans, Q-tips
• S/S discomfort, diminished hearing, feeling
  movement
• Treatment Mineral oil instillation to kill the
  insect or removal of the foreign object by an MD
  with small forceps
• Teaching do not insert objects into the ear,
  wear hats with ear flaps or a scarf

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Otitis Externa

• An inflammation of the tissue within the middle
  ear
• Usually caused by an overgrowth of pathogens
  following trauma, or retained moisture from
  swimming
• S/S pain that worsens with ear movement,
  reduced hearing, fever lymph node enlargement
• Treatment warm soaks, analgesics antibiotic
  ear medications
• Nursing teaching regarding prevention

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Disorders of the Middle Ear

• Otitis media is an inflammation or infection of
  the middle ear
• More common in children
• Can be acute or chronic
• Serous is the accumulation of fluid behind the
  tympanic membrane due to respiratory allergies
• Purulent is when microorganisms spread from the
  eustachian tube into the middle ear during URIs

• S/S hx of URI or seasonal allergies, fever,
  malaise, tinnitus, severe earache or diminished
  hearing
• Treatment antibiotics, myringotomy, antipyretics

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Otosclerosis

• The result of bony overgrowth of the stapes that
  occurs gradually overtime. More common in women
  in their 20s 30s, hereditary
• S/S-progressive, bilateral hearing loss

• Treatment no cure, use of hearing aids or a
  stapectomy is performed a prosthesis is
  inserted
• Nursing care use alternative communication
  methods, preop teaching very important
• See nursing process - client recovering from
  stapedectomy

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Inner Ear Disorders

• Menieres disease is the episodic symptoms
  created by fluctuations in the production
  reabsorption of fluid in the inner ear
• Usually unilateral, appears during middle age
• S/S hearing loss, severe vertigo tinnitus
  n/v sometimes accompanies the vertigo

• Attacks may come on suddenly last from a few
  minutes to weeks
• Treatment
• Antivert
• Valium
• Phenergan
• HCTZ
• Box 49-2
• Nursing care supportive, safety

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• OTOTOXICITY
• the detrimental effects of some drugs
• S/S- tinnitus, sensorineural hearing loss
• Box 49-3

• ACOUSTIC NEUROMA
• benign Schwann cell tumor
• S/S hearing loss, impaired facial movement
• Treatment surgical removal