Showing posts with label ear disorder. Show all posts
Showing posts with label ear disorder. Show all posts

DISORDERS OF THE EAR

Wednesday, May 21, 2008 | Labels: | 0 Comments  

Otitis Media

  1. General information
    1. Bacterial or viral infection of the middle ear
    2. More common in infants and preschoolers as the ear canal is shorter and more horizontal than in older children; also found in children with cleft lip/palate
    3. Blockage of eustachian tube causes lymphedema and accumulation of fluid in the middle ear
  2. Medical management
    1. Drug therapy
      1. Systemic and otic antibiotics
      2. Analgesics/antipyretics
    2. Surgery: myringotomy, with or without insertion of tubes (incision into the tympanic membrane to relieve the pressure and drain the fluid)
  3. Assessment findings
    1. Dysfunction of Eustachian tube
    2. Ear infection usually related to respiratory infection
    3. Increased middle ear pressure; bulging tympanic membrane
    4. Pain; infant pulls or touches ear frequently
    5. Irritability; cough; nasal congestion
    6. Diagnostic tests: C&S of fluid reveals causative organism
  4. Nursing interventions
    1. Administer antibiotics as ordered, for a full 10-day course. When administering ear drops pull earlobe up and back for older children and down and back for infants.
    2. Administer acetaminophen for fever and discomfort.
    3. Administer decongestants to relieve Eustachian tube obstruction as ordered.
    4. Provide care for child with a myringotomy tube insertion (day surgery)
      1. Child should wear earplugs when showering or having hair washed; do not permit diving.
      2. Be aware that tubes may fall out for no reason.
    5. Provide client teaching and discharge planning concerning
      1. Medication administration
      2. Post-op care, depending on the type of surgery

Tuesday, May 20, 2008 | Labels: | 0 Comments  

Deafness

  1. Causes
    1. Conductive: interference in transmission from outer to middle ear from chronic otitis media, foreign bodies
    2. Sensorineural: dysfunction of the inner ear; damage to cranial nerve VIII (from rubella, meningitis, drugs)
  2. Medical management
    1. Treatment of causative disorders
    2. Speech/auditory therapy
    3. Hearing aids
    4. Surgery, depending on the cause
  3. Assessment findings
    1. Infant
      1. Fails to react to loud noises (does have a Moro reflex, but not to noise)
      2. Makes no attempt to locate sound
      3. Remains in babbling stage or ceases to babble
      4. Fails to develop speech
      5. Startled by sudden appearances
    2. All children
      1. Respond only when speaker's lips are visible
      2. Cannot concentrate for long on visual images; constantly scan the surroundings for change
      3. May have slow motor development
      4. Appear puzzled or withdrawn, or strain to hear
      5. Use high volume on TV/radio
    3. Audiologic testing
      1. Slight hearing deficit: difficulty hearing faint sounds, very little interference in school, no speech defect, benefits from favorable seating
      2. Mild hearing deficit: can understand conversational speech at 3-5 feet when facing the other person, decreased vocabulary, may miss half of class discussions
      3. Marked hearing deficit: misses most of conversation, hears loud noises, needs special education for language skills
  4. Nursing interventions
    1. Speak slowly, not more loudly.
    2. Face child.
    3. Get child's attention before talking; let child see you before performing any care.
    4. Get feedback from child to make sure child has understood.
    5. Decrease outside noises that could interfere with child's ability to discern what you are saying.
    6. Be careful not to cover your mouth with hands.
    7. Teach language through visual cues, touch, and kinesthetics.
    8. Use body demonstrations or use doll play.
    9. Provide appropriate stimulation (puppets and musical toys are inappropriate).
    10. Provide client teaching and discharge planning concerning
      1. General child care, with adaptation for safety and developmental/functional levels
      2. Availability of support groups/community agencies
      3. Special education programs
      4. Care and use of hearing aids
      5. Interaction with peers: assist child as needed

Tuesday, May 20, 2008 | Labels: | 0 Comments  

Ménière's Disease


  1. General information
    1. Disease of the inner ear resulting from dilation of the endolymphatic system and increased volume of endolymph; characterized by recurrent and usually progressive triad of symptoms: vertigo, tinnitus, and hearing loss
    2. Incidence highest between ages 30 and 60
    3. Cause unknown; theories include allergy, toxicity, localized ischemia, hemorrhage, viral infection, or edema.
  2. Medical management
    1. Acute: atropine (decreases autonomic nervous system activity), diazepam (Valium), fentanyl, and droperidol (Innovar)
    2. Chronic
      1. Drug therapy: vasodilators (nicotinic acid), diuretics, mild sedatives or tranquilizers (diazepam [Valium]), antihistamines (diphenhydramine [Benadryl], meclizine [Antivert])
      2. Low-sodium diet, restricted fluid intake, restrict caffeine and nicotine.
    3. Surgery
      1. Surgical destruction of labyrinth causing loss of vestibular and cochlear function (if disease is unilateral)
      2. Intracranial division of vestibular portion of cranial nerve VIII
      3. Endolymphatic sac decompression or shunt to equalize pressure in endolymphatic space
  3. Assessment findings
    1. Sudden attacks of vertigo lasting hours or days; attacks occur several times a year
    2. Nausea, tinnitus, progressive hearing loss
    3. Vomiting, nystagmus
    4. Diagnostic tests
      1. Audiometry: reveals sensorineural hearing loss
      2. Vestibular tests: reveal decreased function
  4. Nursing interventions
    1. Maintain bed rest in a quiet, darkened room in position of choice; elevate side rails as needed.
    2. Only move the client for essential care (bath may not be essential).
    3. Provide an emesis basin for vomiting.
    4. Monitor IV therapy; maintain accurate I&O.
    5. Assist with ambulation when the attack is over.
    6. Administer medications as ordered.
    7. Prepare the client for surgery as indicated (post-op care includes using above measures).
    8. Provide client teaching and discharge planning concerning
      1. Use of medication and side effects
      2. Low-sodium diet and decreased fluid intake
      3. Importance of eliminating smoking

Monday, May 19, 2008 | Labels: | 0 Comments  

Stapedectomy

  1. General information
    1. Removal of diseased portion of stapes and replacement with a prosthesis to conduct vibrations from the middle ear to inner ear; usually performed under local anesthesia
    2. Used to treat otosclerosis
  2. Nursing interventions: preoperative
    1. Provide general pre-op nursing care, including an explanation of post-op expectations.
    2. Explain to the client that hearing may improve during surgery and then decrease due to edema and packing.
  3. Nursing interventions: postoperative
    1. Position the client according to the surgeon's orders (possibly with operative ear uppermost to prevent displacement of the graft).
    2. Have client deep breathe every 2 hours while in bed, but no coughing.
    3. Elevate side rails; assist the client with ambulation and move slowly (may have some vertigo).
    4. Administer medications as ordered: analgesics, antibiotics, antiemetics, anti-motion-sickness drugs.
    5. Check dressings frequently for excessive drainage or bleeding.
    6. Assess facial nerve function, i.e., ask client to wrinkle forehead, close eyelids, puff out cheeks, smile and show teeth; check for any asymmetry.
    7. Question client about pain, headache, vertigo, and unusual sensations in the ear; report existence to physician.
    8. Provide client teaching and discharge planning concerning
      1. Warnings against blowing nose or coughing; sneeze with the mouth open
      2. Need to keep ear dry in the shower; no shampooing until allowed
      3. No flying for 6 months, especially if an upper respiratory tract infection is present
      4. Placement of cotton ball in auditory meatus after packing is removed; change twice a day.

Monday, May 19, 2008 | Labels: | 0 Comments  

Otosclerosis


  1. General information
    1. Formation of new spongy bone in the labyrinth of the ear causing fixation of the stapes in the oval window; this prevents transmission of auditory vibration to the inner ear
    2. Found more often in females
    3. Cause unknown, but there is a familial tendency
  2. Medical management: stapedectomy is the procedure of choice.
  3. Assessment findings
    1. Progressive loss of hearing
    2. Tinnitus
    3. Diagnostic tests
      1. Audiometry: reveals conductive hearing loss
      2. Weber's and Rinne's tests: show bone conduction is greater than air conduction
  4. Nursing interventions: see Stapedectomy.

Monday, May 19, 2008 | Labels: | 0 Comments  

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