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Chapter 13
Unit 2: Nursing care of clients with neurosensory disorders
| Term | Definition |
|---|---|
| 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!
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