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Chapter 13

Unit 2: Nursing care of clients with neurosensory disorders

Middle and Inner ear disorders (Pg. 135) -What does the middle ear consist of? Tympanic membrane (eardrum), 3 ossicular bones (malleus, incus, stapes) -Connects to the oropharynx via the eustachian tube
What does the inner ear consist of? Oval window, cochlea (hearing organ), vestibular system (balance)
Middle and inner ear changes w/ age include? -tympanic membrane & corti & ossicles -Thickening of the tympanic membrane -loss of sensory hair cells in the organ of corti -Limitations to movement of the ossicles
What are middle ear infections called? Otitis media -inflammation of ossicles & purulent drainage -tx w/ abx or surgery
What are inner ear problems called? Tinnitus, vertigo & dizziness
What is tinnitus? Inner ear issue -Continuous ringing in the ears
What is vertigo? Whirling sensation
What ear do Labyrinthitis & Meniere's disease go with? Inner ear
What is Labyrinthitis an infection of? The labyrinth -Usually 2nd to otitis media
What is Meniere's disease? Vestibular disease -tinnitus, unilateral hearing loss, vertigo
What are risk factors for middle ear disorders? Recurrent colds/otitis media Enlarged adenoids trauma & changes in air pressure (scuba diving, flying)
What are inner ear risk factors? Viral or bacterial infections -Damage from ototoxic medications
S/s of middle ear issues? Hearing loss, full/pain in ear -red, inflamed -bulging tympanic membrane, fluid/bubbles behind it
S/s of inner ear disorders? Vomit, nystagmus, balance issues
What is nystagmus? Rapid involuntary movement of the eyes
Dx procedures? Tympanogram: Measures the mobility of the ™ & middle ear structures relative to sound -for middle ear dx
Dx procedures? Otoscopy: Examines external auditory canal, ™, malleus bone -done if auditory results indicate impairment of their is ear pain
Which way on the ear do you pull for an adult and for a kid? Up and back adult down and back kid
What color should the tympanic membrane be? Pearly gray color & intact -should provide complete structural separation of the outer & middle ear
What is the light reflex? Visible from the center of the TM anteriorly -if fluid/infection causes inflamed TM to bulge.. light reflex is displaced; dx finding -5 o'clock right ear -7 o'clock left ear
Dx procedures? ENG Electronystagmography; determines type of nystagmus elicited by stimulation of the acoustic nerve
How is ENG done? Electrodes are placed around the eyes -Eye movements recorded when ear canal is stimulated w cold water or air injection
during/post ENG procedure nursing care? -Alert, eating/rest -nurse should ask Q's to make sure client stays alert during -Bed rest & NPO after until vertigo subsides
Preprocedure ENG nursing? Fast immediately before -no caffeine, alcohol, sedatives, antihistamines 24hr prior to test
ENG cannot be performed on clients with a..? Pacemaker
Dx procedures? Caloric testing Water (warm/cold) instilled in ear to induce nystagmus -vestibular disorder dx from eye responses -can be done w ENG.. same nursing instructions
Ototoxic medications: -Gentamicin, amikacin, metronidazole -lasix -Aspirin or ibuprofen (advil) -Cisplatin Antibiotics Diuretics NSAIDs Chemotherapeautic agents
Other meds: Meclizine (Antivert) Antihistamine & anticholinergic effects -vertigo tx -restrict w clients w closed-angle glaucoma -Sedative effects
Other meds: Droperidol (Inapsine) Antiemetic -vertigo nausea/vomit tx -postural hypotension & tachy
Other meds: Diphenhydramine (Benadryl) & Dimenhydrinate (Dramamine) Antihistamines tx vertigo nausea/vomit -urinary retention, sedative effects, dry mouth
Other meds: Scopolamine (Transderm Scop) Anticholinergics -nausea tx -urinary retention, sedation, glaucoma, dry mouth
Other meds: Diazepam (Valium) Benzodiazepine; anti vertigo effects -sedative effects, glaucoma, small-doses
Alcohol & caffeine do what to vertigo? Make it worse; avoid
What kind of env't can help vertigo? Quiet, dark
What can help with balance? Assistive devices, safe env't free of clutter
Surgical interventions: Stapedectomy: Middle ear; stapes removed & replaced w a prothesis -through external ear canal & TM
What is placed postop a Stapedectomy? Sterile ear packing
When is Stapedectomy done? When otosclerosis develops & bones of the middle ear fuse together
What are expectations after a stapedectomy? -Hearing, avoid, hair Hearing initially worse, will improve w healing Avoid straining, coughing, sneezing w mouth closed, air travel, rapid head movements -no water should enter ear, wash hair with dressing over ear
Surgical interventions: Cochlear implant: (Pg. 140) Sensorineural hearing loss -Microphone picks up sound, eventually converts sound into electrodes to the auditory nerve
For a Cochlear implant, where is the implant's transmitter located? Outside the head behind the ear -connects via a magnet to the receiver located immediately below it under the skin
People w a Cochlear implant should avoid what? MRI's
When after surgery is the external unit applied & the speech processor programmed? 2-6 weeks
Surgical interventions: Labyrinthectomy: Removes the labyrinth to tx vertigo
Post op after a Labyrinthectomy what should the client expect? Severe nausea & vertigo -hearing loss is expected in the affected ear
Created by: mary.scott260!