MS module 4 Chapter 43 HEARING

Audiometry

the use of an audiometer to measure hearing acuity

While taking a history, the nurse notices a deformity of a client's right external ear. What is the priority nursing assessment? Visual accuracy Hearing deficits Cardiopulmonary history Kidney or urinary tract problems

ANS: D The external ear develops in the embryo at the same time as the kidneys and urinary tract. Thus any person with a defect of the external ear should be examined for possible problems of the kidneys and urinary systems. Other assessments can be completed afterward.

The client's daughter asks what she can do to better communicate with her mother. 3. What suggestions will the nurse make?

Promoting family dialogue about hearing aids opens the door for more understanding about a reasonable approach to better communication.

hearing Nursing Diagnosis

Readiness for Enhanced Communication Pattern of exchanging information and ideas with others Anxiety Impaired Social Interaction Ineffective Coping Risk for Loneliness Risk for Injury

What is the priority nursing intervention when providing care to a client with hearing loss? Creating a safe environment Providing written information regarding medications that are prescribed Having the client repeat instructions to evaluate additional teaching needs Ensuring that the client can directly visualize the nurse who is providing teaching

ANS: A Safety concerns are always the priority because the client may not hear warning sounds such as alarm in the room. All other interventions are subsequent to safety concern. A client with hearing loss will use other senses such as sight to help interpret communication; the nurse should sit in adequate light and face the client to allow him or her to see the nurse speak. Written information and assessment of client comprehension augments all teaching interventions completed by a nurse.

A week later, the client's hearing is tested by audiometry and it is recommended that she would benefit from a hearing aid. 4. Which client statement indicates the need for additional nursing teaching about hearing aid care? "I can wear my hearing aid at all times, even when bathing." "I should check and replace the battery whenever needed." "I can clean the hole in the hearing aid of debris with a toothpick." "I should adjust the hearing aid's volume to the lowest setting that lets me hear without hearing feedback."

ANS: A The client should keep the hearing aid dry. The ear mold can be cleaned with mild soap and water, but excessive wetness should be avoided. All of the other responses are correct teaching points for hearing aid care.

2. The client is diagnosed with suspected hearing loss. What teaching will the nurse provide? (Select all that apply.) Have hearing assessments annually. Avoid exposure to loud music or other noises. Ear plugs should be used if you are swimming. Use cotton swabs to clean your ear canal showering. Nothing smaller than a fingertip should be inserted into the ear canal.

ANS: A, B, C, E It is important to teach about having annual hearing assessments, avoiding loud music or noises that can further damage hearing, protecting the ears if swimming, and not placing anything smaller than a fingertip in the ear canal. The nurse will discourage the use of cotton swabs.

Hearing Planning and Implementation:

Increasing hearing (Nonsurgical management + Surgical management) Maximizing communication

Which assessment finding alerts the nurse that a client is at risk for hearing loss? Select all that apply. Is male Advanced age Takes furosemide regularly Has a history of heart failure Worked as a sound manager for a band

ANS: B, C, E Advanced age placed a client at risk for hearing loss due to normal changes associated with aging. Taking ototoxic drugs like furosemide can impact hearing. Working around loud noises on a consistent basis can impact hearing. Hearing loss does not affect males more than females. While it is true that heart failure affects tissue perfusion, the likelihood is that this can affect comprehension of what is heard - not the actual hearing mechanism itself.

Mastoiditis

Infection of mastoid air cells caused by progressive otitis media Swelling behind ear; pain when moving ear or head; red, dull, thick, immobile eardrum

Conductive hearing loss causes

Inflammation Obstruction of external or middle ear Changes in eardrum Otosclerosis

The daughter of an 80-year-old client reports that her father's hearing has significantly diminished over the past few years. The client tells the nurse, "that's not true; my hearing is just fine." 1. What is the appropriate nursing response? "I'm sure you are just fine, too." "Why don't you believe your daughter?" "Everyone worries about losing their hearing." "It must feel frightening to think about losing your hearing."

ANS: D The nurse should acknowledge the potential fear that the client may be having without being patronizing or confrontational. Telling the client there is nothing wrong with her exhibits false reassurance. Asking the client why she doesn't believe her daughter's statements exhibits confrontation by demanding an answer. Telling the client that everyone is afraid of losing their hearing minimizes the client's situation.

Otitis Media treatment

Analgesics, antihistamines, decongestants, possible myringotomy

Disease Processes

Otosclerosis Ménière's disease Acoustic neuromas Diabetes Cerebrovascular disorders Hypothyroidism Radiation to the head or neck Hypertension Viral infections Head injury Meningitis Hyperthermia

Ear Physical Assessment/Signs & Symptoms

Otoscopic examination by health care provider

Mastoiditis treatment

Antibiotics; surgical removal of infected tissue if no response to antibiotics

ear diagnostic assessment

Audiometry

Which letters of the alphabet become distorted as hearing loss progresses? A. f, n, s, v, y B. b, d, k, p, t C. a, e, i, o, u D. c, g, j, m, w

B. b, d, k, p, t An early functional consequence of presbycusis is the loss of ability to hear high-pitched sounds and sibilant consonants. As hearing loss progresses, explosive consonants, such as b, d, k, p, and t, become distorted

Which statement about tinnitus is true? A. Tinnitus is a rare pathologic condition B. Tinnitus is a periodic sensation of ringing in the ears C. People with tinnitus should be evaluated for associated pathologic conditions D. People with tinnitus hear things that originate in the external environment

C. People with tinnitus should be evaluated for associated pathologic conditions Tinnitus is a common pathologic condition in older adults that is highly associated with hearing loss, ototoxic medications, and Ménière's disease. Thus, people with tinnitus should be evaluated for associated pathologic conditions or any of the contributing factors

ear trauma

Can occur to eardrum, ossicles, middle ear structures Most eardrum perforations heal within a week or two without treatment. Repeat perforations heal slowly, scar Auditory sensory perception may or may not return if ossicles are damaged.

Ear Psychosocial Assessment

Communication struggles

Nursing Assessment of Hearing

Otoscopic examination for impacted cerumen Tuning fork tests for hearing Screening tool: The Hearing Handicap Inventory for the Elderly (HHIE-S)—10-item questionnaire (Fig. 16-4) Family history with past and present risks (Box 16-2) Attitudes about hearing aids if impairment is present Impact of hearing impairment on communication and quality of life Behavioral cues to impaired hearing

External Otitis

Painful, red, swollen external ear often caused by irritating or infectious agents; may have temporary hearing loss Ex. swimmers ear, chronic ear infections

Which is not a contraindication for clearing the impacted ear canal of cerumen? A. Recent ear infection B. History of ruptured tympanic membrane C. Pain or swelling D. Chronic disease of the respiratory system

D. Chronic disease of the respiratory system When an ear canal is impacted with cerumen, the nurse must determine whether there are any contraindications to irrigating, such as pain, swelling, a recent ear infection, and a history of ruptured tympanic membrane

Effects on Communication

Presbycusis Predisposition to impacted cerumen Psychosocial consequences

Nursing Interventions for Hearing Wellness

Promote hearing wellness Teaching about interventions to address modifiable risk factors Monitor for removing impacted cerumen Promoting referrals for audiology services Teaching about the use and care of hearing aids Communication techniques with hearing-impaired older adults Using assistive listening devices

Good hearing Promotes wellness

Promotes wellness through health promotion interventions to improve hearing and communication

Sensorineural hearing loss

Damage to inner ear or auditory nerve (cranial nerve VIII) Prolonged exposure to loud noises Autotoxic drugs Presbycusis

Psychosocial consequences of hearing deficits

Depression Social isolation Decline in cognitive function Diminished quality of life

Tinnitus testing

Diagnostic testing cannot confirm, but is used to assess hearing and rule out other disorders

Otitis Media

Ear pain, hearing may be reduced; tinnitus; headache; malaise, nausea, dizziness

Ménière disease

Episodic vertigo, tinnitus, and hearing loss Usually occurs in adults between 20 and 60 years old Hearing loss is reversible at first, yet repeated damage can lead to permanent loss Teach to move slowly; may need vestibular rehabilitation therapy, drug therapy, or labyrinthectomy

External Ear

Hearing begins with external ear Pinna Does not affect the change in conduction of sound Auditory canal Aging increases the potential for cerumen accumulation

Hearing hx assessment

Hearing changes Age Exposure to noises History of ear issues

What do studies of the psychosocial consequences of hearing impairment demonstrate? A. Hearing loss is less likely to have detrimental effects for people who have few social relationships B. Hearing loss has a greater social impact on older women C. Hearing loss has a greater emotional impact on older men D. Hearing loss has minimal effects on psychosocial function

Hearing loss is less likely to have detrimental effects for people who have few social relationships The extent of the psychosocial consequences of hearing impairment depends on the lifestyle of the person affected. Hearing impairment is relatively more detrimental for people whose occupations or interests are highly dependent on good hearing, and hearing loss is less likely to have detrimental effects for people who have few social relationships and who do not depend on hearing for occupational or leisure activities

Planning for hearing Wellness Outcomes

Improved communication Increased social interactions Improved quality of life Increased safety and functioning

Evaluating Effectiveness of Nursing Interventions

Improved communication Use of appropriate amplification aids Appropriate environmental modifications Increased participation in social activities Improved ability to communicate Effective use of hearing aids and amplification devices Increased participation in social activities Environmental modifications to eliminate background noises Participation in auditory rehabilitation program

External Otitis treatment

Remove materials from ear canal; heat to ear 3 times daily; topical antibiotics and eardrops

Tinnitus

Ringing in the ear(s) Can be caused by medications usually caused by a symptom of something else

ear Imaging assessment

Skull x-rays CT, MRI

tinnitus treament

Therapy focuses on ways to mask tinnitus.

Pathologic Factors Affecting Hearing

Tinnitus:

Ear Laboratory assessment

WBC count (look for sign of infection)

Which risk factors should the nurse discuss with the client concerning reasons for hearing loss? SATA a. Perforation of the tympanic membrane b. Chronic exposure to loud noisesc. Recurrent ear infections d. Use of nephrotoxic medications e. Multiple piercings in the auricle

a. Perforation of the tympanic membrane Rationale: The tympanic membrane is the eardrum, and if it is punctured it may lead to hearing loss b. Chronic exposure to loud noises Rationale: Loud persistent noise, such as heavy machinery, engines, and artillery, over time may cause noise-induced hearing loss c. Recurrent ear infections Rationale:Multiple ear infections scar the tympanic membrane, which can lead to hearing loss

The nurse is caring for a client diagnosed with acute otitis media. Which s/s support this medical diagnosis? a. Unilateral pain in the ear b. Green, foul-smelling drainage c. Sensation of congestion in the ear d. Reports of hearing loss

a. Unilateral pain in the earRationale: Otalgia (ear pain) is experienced by clients with otitis media

Conductive hearing loss:

abnormalities of external and middle ear interfering with sound conduction

Sensorineural hearing loss:

abnormalities of sensory and neural structures of inner ear, usually age related or noise induced

Which ototoxic medication should the nurse administer cautiously? a. An oral calcium channel blocker b. An intravenous amino glycoside antibiotic c. An intravenous glucocorticoid d. An oral lood diuretic

b. An intravenous amino glycoside antibioticRationale: Aminoglycoside antibiotics are ototoxic. Overdosage of these medications can cause the client to go deaf, which is why peak and trough serum levels are drawn while the client is taking a medication of this type. These antibiotics are also very nephrotoxic

The client is diagnosed with Meniere's disease. Which statement indicates the client understands the medical management for this disease? a."After intravenous antibiotic therapy, I will be cured". b. "I will have to use a hearing aid for the rest of my life". c. "I must adhere to a low-sodium diet, 2,000 mg/day". d. "I should sleep with the head of my bed elevated".

c. "I must adhere to a low-sodium diet, 2,000 mg/day".Rationale: Sodium regulates the balance of fluid within the body; therefore, a low-sodium diet is prescribed to help control the symptoms of Meniere's disease

The client is complaining of ringing in the ears. Which data are most appropriate for the nurse to document in the client's chart? a. Complaints of vertigo b. Complaints of otorrhea c. Complaints of tinnitus d. Complaints of presbycusis

c. Complaints of tinnitus Rationale: Tinnitus is "ringing of the ears". It is a subjective perception of sounds with internal origins

The client comes to the clinic and is diagnosed with otitis media. Which intervention should the clinic nurse include in the discharge teaching? a. Instruct the client not to take any over-the-counter pain medication b. Encourage the client to apply cold packs to the affected ear c. Tell the client to call the HCP if an abrupt relief of ear pain occurs d. Wear a protective ear plug in the affected ear.

c. Tell the client to call the HCP if an abrupt relief of ear pain occurs Rationale: Pain subsiding abruptly may indicate spontaneous perforation of the tympanic membrane within the middle ear and should be reported to the HCP

Which teaching instruction should the nurse discuss with students who are on the high school swim team when discussing how to prevent external otitis? a. Do not wear tight-fitting swim caps b. Avoid using silicone ear plugs while swimming c. Use a drying agent in the ear after swimming d. Insert a bulb syringe into each ear to remove excess water

c. Use a drying agent in the ear after swimming Rationale: A 2% acetic acid solution or 2% boric acid in ethyl alcohol is effective in drying the canal and restoring its normal acidic environment

pinna

cartilaginous structure

do's of hearing aids

charge daily, clean wax, have extra batteries, keep away from children, wear them every day

Hearing impairment types:

conductive, sensorineural, mixed

Auditory canal:

covered with skin, lined with hair follicles, and cerumen-producing glands

The client diagnosed with chronic otitis media is scheduled for a mastoidectomy. Which discharge teaching should the nurse discuss with the client? a. Instruct the client to blow the nose with the mouth closed b. Explain the client will never be able to hear from the ear c. Instill ophthalmic drops in both ears and then insert a cotton ball. d. Do not allow water to enter the ear for 6 weeks.

d. Do not allow water to enter the ear for 6 weeks. Rationale:Water should be prevented from entering the external auditory canal because it may irritate the surgical incision and is a medium for bacterial growth

Which statement best describes the scientific rationale for the nurse holding the otoscope with the hand in a pencil-hold position when examining the client's ear? a. It is usually the most comfortable position to hold the otoscope b. This allows the best visualization of the tympanic membrane c. This prevents inserting the otoscope too far into the external ear d. It ensures the nurse will not cause pain when examining the ear

d. Pull the auricle down and back prior to instilling dropsRationale: This will straighten the ear canal so the teardrops will enter the ear canal and drain toward the tympanic membrane (eardrum)

Good hearing is vital to important to

daily activities such as communicating, protecting oneself from danger, enjoying music, voices, various sounds, and noises

dont's of hearing aides

don't get wet, don't sleep, put away always, keep dirty

non-surgical hearing management

hearing aid devices removing ear wax

Mixed hearing loss:

involves both conductive and sensorineural impairments

What causes tinnitus?

old age, chronic exposure to loud noises, meniere disease, medications, wax build up, physical activity

Tinnitus:

persistent sensation of ringing, roaring, blowing, and buzzing Symptom of underlying condition Associated with hearing loss, ototoxic medications, and Ménière's disease Exacerbated with caffeine, alcohol, or nicotine

Which is the most prevalent risk factor for impaired hearing?

reduce exposure to noise The most prevalent risk factor for impaired hearing is exposure to noise, which can be viewed as both a lifestyle choice and an environmental factor. Prolonged or intermittent exposure to noise during occupational or leisure activities is a common and usually avoidable risk factor for damage to the auditory system

Presbycusis

sensorineural hearing loss Diminished ability to hear high-pitched sounds, especially in the presence of background noise

are hearing aides OTC

yes