Unit 2: Nursing care of clients with neurosensory disorders
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| 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
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| What does the inner ear consist of? | Oval window, cochlea (hearing organ), vestibular system (balance)
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| 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
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| What are middle ear infections called? | Otitis media
-inflammation of ossicles & purulent drainage
-tx w/ abx or surgery
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| What are inner ear problems called? | Tinnitus, vertigo & dizziness
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| What is tinnitus? | Inner ear issue
-Continuous ringing in the ears
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| What is vertigo? | Whirling sensation
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| What ear do Labyrinthitis & Meniere's disease go with? | Inner ear
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| What is Labyrinthitis an infection of? | The labyrinth
-Usually 2nd to otitis media
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| What is Meniere's disease? | Vestibular disease
-tinnitus, unilateral hearing loss, vertigo
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| What are risk factors for middle ear disorders? | Recurrent colds/otitis media
Enlarged adenoids
trauma & changes in air pressure (scuba diving, flying)
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| What are inner ear risk factors? | Viral or bacterial infections
-Damage from ototoxic medications
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| S/s of middle ear issues? | Hearing loss, full/pain in ear
-red, inflamed
-bulging tympanic membrane, fluid/bubbles behind it
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| S/s of inner ear disorders? | Vomit, nystagmus, balance issues
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| What is nystagmus? | Rapid involuntary movement of the eyes
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| Dx procedures? Tympanogram: | Measures the mobility of the ™ & middle ear structures relative to sound
-for middle ear dx
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| Dx procedures? Otoscopy: | Examines external auditory canal, ™, malleus bone
-done if auditory results indicate impairment of their is ear pain
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| Which way on the ear do you pull for an adult and for a kid? | Up and back adult
down and back kid
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| What color should the tympanic membrane be? | Pearly gray color & intact
-should provide complete structural separation of the outer & middle ear
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| 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
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| Dx procedures? ENG | Electronystagmography; determines type of nystagmus elicited by stimulation of the acoustic nerve
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| How is ENG done? | Electrodes are placed around the eyes
-Eye movements recorded when ear canal is stimulated w cold water or air injection
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| 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
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| Preprocedure ENG nursing? | Fast immediately before
-no caffeine, alcohol, sedatives, antihistamines 24hr prior to test
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| ENG cannot be performed on clients with a..? | Pacemaker
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| 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
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| Ototoxic medications: -Gentamicin, amikacin, metronidazole -lasix -Aspirin or ibuprofen (advil) -Cisplatin | Antibiotics
Diuretics
NSAIDs
Chemotherapeautic agents
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| Other meds: Meclizine (Antivert) | Antihistamine & anticholinergic effects
-vertigo tx
-restrict w clients w closed-angle glaucoma
-Sedative effects
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| Other meds: Droperidol (Inapsine) | Antiemetic
-vertigo nausea/vomit tx
-postural hypotension & tachy
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| Other meds: Diphenhydramine (Benadryl) & Dimenhydrinate (Dramamine) | Antihistamines tx vertigo nausea/vomit
-urinary retention, sedative effects, dry mouth
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| Other meds: Scopolamine (Transderm Scop) | Anticholinergics
-nausea tx
-urinary retention, sedation, glaucoma, dry mouth
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| Other meds: Diazepam (Valium) | Benzodiazepine; anti vertigo effects
-sedative effects, glaucoma, small-doses
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| Alcohol & caffeine do what to vertigo? | Make it worse;
avoid
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| What kind of env't can help vertigo? | Quiet, dark
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| What can help with balance? | Assistive devices, safe env't free of clutter
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| Surgical interventions: Stapedectomy: | Middle ear; stapes removed & replaced w a prothesis
-through external ear canal & TM
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| What is placed postop a Stapedectomy? | Sterile ear packing
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| When is Stapedectomy done? | When otosclerosis develops & bones of the middle ear fuse together
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| 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
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| Surgical interventions: Cochlear implant: (Pg. 140) | Sensorineural hearing loss
-Microphone picks up sound, eventually converts sound into electrodes to the auditory nerve
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| 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
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| People w a Cochlear implant should avoid what? | MRI's
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| When after surgery is the external unit applied & the speech processor programmed? | 2-6 weeks
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| Surgical interventions: Labyrinthectomy: | Removes the labyrinth to tx vertigo
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| Post op after a Labyrinthectomy what should the client expect? | Severe nausea & vertigo
-hearing loss is expected in the affected ear
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