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Chapter 51 Care of Patients with Ear and Hearing Problems Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Conditions Affecting the External and Middle Ear External otitis Furuncle Perichondritis Cerumen or foreign bodies Otitis media Mastoiditis Trauma Neoplasms Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 2 Types of Interventions Infection control (equipment) Medications Surgical Compare/contrast with surgical interventions for other types of operative procedures Patient teaching Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 3 Earwick Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 4 Irrigation of the External Ear Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 5 Otitis Media Three types: Acute Chronic Serous Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 6 Conditions Affecting the Inner Ear Tinnitus Vertigo and dizziness Labyrinthitis Ménière's disease Acoustic neuroma Hearing loss Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7 Acoustic Neuroma Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 8 Anatomy of Hearing Loss Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 9 Types of Interventions Medical Early detection Safety measures (due to hearing loss) Dietary (nutrition, hydration) Medication Surgical Hearing aids Implants (e.g., cochlear devices) Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 10 Types of Interventions (cont’d) Communication Hearing aids Lip-reading, sign language Speech therapy Community resources Support groups Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 11 An 80-year-old patient presents for his annual check-up. His son reports that his hearing has significantly diminished over the past few years. The patient tells the nurse that he believes that his hearing is “just fine” and that “nothing is wrong” with him. When the patient states that he feels fine and nothing is wrong with his hearing, what is the appropriate nursing response? A. “You are right; there is nothing wrong with you.” B. “Why don’t you believe what your children are saying about your hearing?” C. “Don’t be scared of losing your hearing.” D. “It must feel frightening to think about losing your hearing.” Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 12 (cont’d) The patient is diagnosed with suspected hearing loss. Which precautions would you teach the patient and his family about ear care before discharge? (Select all that apply.) A. B. C. D. E. Use cotton swabs to clean your ear canal after every shower. Avoid exposure to loud music or other noises. Nothing smaller than a fingertip should be inserted into the ear canal. Use an ear irrigation syringe to remove built up ear wax (cerumen). Ear plugs should be used when engaging in all water sports to avoid infection. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 13 (cont’d) The patient’s son asks what he can do to better communicate with his father. Which teaching is most appropriate? A. Refer him and the patient to a sign language class. B. Encourage the patient to learn to read lips. C. Direct him to community support groups. D. Promote family dialogue about hearing aids. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 14 (cont’d) A week later, the patient’s hearing is tested by audiometry and it is determined that he needs a hearing aid. Which statement indicates the need for additional teaching about hearing aid care? A. “I can wear my hearing aid at all times, even when bathing.” B. “I should check and replace the battery whenever needed.” C. “I can clean the hole in the hearing aid of debris with a toothpick.” D. “I should adjust the hearing aid’s volume to the lowest setting that lets me hear to avoid feedback squeaking” Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 15 Chapter 51 Audience Response System Questions Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 16 Question 1 A priority nursing intervention for a patient with tinnitus is: A. Evaluate medications for ototoxicity. B. Encourage music or soft white noise during sleeping hours. C. Acknowledge the psychological stressors of the disorder. D. Provide education on loudness levels to prevent hearing loss. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 17 Question 2 A patient is reporting ear pressure, dizziness, and decreased hearing. What should the nurse do? A. Examine the ear for excessive ear wax (cerumen). B. Ask the patient if he or she is experiencing headaches, malaise, or pain. C. Establish a timeline for the patient’s symptoms. D. Examine the patient’s hearing acuity. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 18 Question 3 Which is a nursing intervention for maximizing communication with a patient with hearing loss while he or she is under Airborne Precautions? A. B. C. D. Speak loudly. Turn the TV volume down or off. Speak clearly and slowly. Ensure that you have the patient’s attention before speaking. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 19