Otitis

Physiologically, the middle ear, containing the three ossicles, serves primarily to: A Maintain balance B Translate sound waves into nerve impulses C Amplify the energy of sound waves entering the ear D Communicate with the throat via the Eustachian tube.

C. The middle ear contains the three ossicles—malleus, incus, and stapes—which, along with the tympanic membrane and oval window, form an amplifying system.

The nurse is speaking with a client with a hearing impairment. The nurse refrains from doing which least likely helpful action when communicating with this client?

Using many exaggerated hand gestures while talking

Which intervention should be implemented for the older client with presbycusis who has a hearing loss?

Use low-pitched tones.

The nurse assists with preparing the client for ear irrigation as prescribed by the primary health care provider (PHCP). Which action should the nurse plan to take?

Warm the irrigating solution to 98° F (36.6° C).

An adult client with a history of ear infections reports a right earache accompanied by a sensation of fullness. The client also reports nausea and has a temperature of 100.6° F. The nurse questions the client about which aspect of the client's history?

Whether the client has had a recent upper respiratory infection (URI)

What must topical agents for otitis externa have?

acid, steroid, antiseptic, atb

fungal cause of Otitis externa

aspergillus

Is otitis externa usually due to bacteria or viruses?

bacteria

If someone has chronic otitis externa, what should you do?

culture it and refer to ENT

MC bacterial cause of otitis externa.

gram - rods-->pseudomonas

What is a dermal disease that can cause otitis externa?

psoriasis

How do you treat otitis externa?

remove debris, topical agents

3 epidemiologies of otitis externa.

swimming, too much cleaning/itching, devices blocking canal

Who is otitis externa common in? when?

7-12; summer "swimmers ear"

Surgery has been recommended for the client with otosclerosis. The client tells the nurse that she would prefer not to have surgery and asks the nurse about alternative methods to improve hearing. The nurse should make which appropriate response to the client?

"A hearing aid may improve your hearing."

A myringotomy is performed on a client in the ambulatory care center. The ambulatory care nurse calls the client 24 hours after the procedure to evaluate the status of the client. The client reports to the nurse that a small amount of brownish drainage has been coming from the ear. Which instruction should the nurse provide to the client?

"Continue to monitor the drainage because this is normal and may occur for 24 to 48 hours following the surgery."

A client with a diagnosis of otosclerosis is admitted to the ambulatory care unit for stapedectomy, and the nurse reinforces instructions to the client regarding home care following the procedure. Which statement by the client indicates a need for further teaching?

"I need to avoid air travel for at least 6 months."

A client has been diagnosed with a hearing loss caused by age-related changes in the ear. The nurse reinforces information about obtaining and learning to use a hearing aid. Which statement by the client indicates understating of the information?

"I should obtain a hearing aid as soon as possible."

The nurse is reinforcing instructions to a client regarding the use of a hearing aid. Which statement by the client indicates a need for further teaching?

"I should turn the hearing aid off after removing it from my ear."

The nurse is assigned to care for a client with a diagnosis of Ménière's disease. After reinforcing discharge instructions, which client statement indicates a need for further teaching?

"I will become totally deaf if I don't follow instructions."

An adult client has increased fluid in the middle ear that is causing vertigo. The nurse checks this client for which associated signs and symptoms of this condition?

Nausea and vomiting

The nurse is assisting the primary health care provider with performing a Rinne tuning fork test on a client. The nurse expects that the steps of the testing will be performed in which priority order? Arrange the actions in the order that they would be performed. All options must be used.

1 Tap tuning fork to activate. 2 Place base of tuning fork on the mastoid bone. 3 Have client indicate when the sound disappears. 4 Move the tuning fork close to the ear canal. 5 Ask the client if he or she hears the sound and to indicate when the sound disappears. 6 Document whether bone or air conduction is better.

Which medications cause ototoxicity? Select all that apply.

1.Ibuprofen 3.Furosemide 4.Vancomycin

The nurse is caring for a client hospitalized with an acute attack from Ménière's disease. The client verbalizes concern because the client has experienced a hearing loss as a result of the attack. Which response should the nurse make to the client regarding the hearing loss?

"The attack leaves a hearing loss in the involved ear."

The nurse is assisting a client who has just been given a hearing aid to wear for the first time. When reinforcing client teaching, the nurse should include which instruction?

"The hearing aid should not be worn if an ear infection is present."

The nurse is reinforcing discharge instructions with a client who is being discharged following a fenestration procedure for the treatment of otosclerosis. Which should be included on the list of instructions prepared for the client?

"You need to avoid air travel."

A perforated eardrum is suspected in a client who was hit in the ear with a basketball. A tympanoplasty was performed. The nurse is giving the client discharge instructions. Which client statement indicates a need for further teaching?

"I will drink from the plastic bottle mouth since I can't use drinking straws."

The nurse is providing discharge instructions for a client who has had a fenestration procedure for the treatment of otosclerosis. Which statement by the client indicates an understanding of the instructions?

"I will take stool softeners as prescribed by my doctor."

A nursing student is preparing to assist with an ear irrigation on an assigned client who has a buildup of cerumen in the left ear. The nursing instructor asks the student about the procedure for the irrigation. The student nurse should perform the procedure in which correct order? Arrange the actions in the order that they should be used. All options must be used.

1 Warm the prescribed solution to body temperature (95° F to 105° F). 2 Have the client sit up holding an emesis basin under the ear to be irrigated with a drape under the basin. 3 Straighten the external canal of an adult by pulling the auricle up and back. 4 Select an irrigating syringe or bulb syringe with a tip that is smaller than the canal. 5 Direct the solution toward the top of the canal in a steady stream, not toward the eardrum.

The nurse is reinforcing discharge instructions to a client who just underwent a myringotomy with placement of a polyethylene tube in the left ear. Which statement by the client indicates a need for further teaching? Select all that apply.

1."I may wash my hair tomorrow." 4."I will irrigate the ear with gentle pressure." 5."I can expect to feel pressure inside the ear."

Otosclerosis is a common cause of conductive hearing loss. Which such a partial hearing loss: A Stapedectomy is the procedure of choice B Hearing aids usually restore some hearing C The client is usually unable to hear bass tones D Air conduction is more effective than bone conduction

B. With a partial hearing loss that auditory ossicles have not yet become fixed; as long as vibrations occur, a hearing aid may be beneficial.

A client who is complaining of tinnitus is describing a symptom that is: A Objective B Subjective C Functional D Prodromal

B. A subjective symptom such as ringing in the ears can be felt only by the client.

The part of the ear that contains the receptors for hearing is the: A Utricle B Cochlea C Middle ear D Tympanic cavity

B. The dendrites of the cochlear nerve terminate on the hair cells of the organ of Corti in the cochlea.

The nurse is assisting the primary health care provider in performing a caloric test on a client. Following instillation of cool water into the ear, the nurse observes the presence of nystagmus. The nurse should document the findings of this test as indicative of which result?

Normal

A client is experiencing blockage of the eustachian tubes. The nurse teaches the client that which activities by the client may forcibly open the eustachian tube?

Performing the Valsalva maneuver

Is otitis externa itchy?

yes

A client susceptible to motion sickness asks the nurse about the use of medication to prevent an occurrence. The nurse plans to incorporate into the discussion that the medication works effectively if which guideline is followed?

Taking the medication 1 hour before a triggering event

What two iv meds treat malignant otitis externa?

amoxicillin clavulanate, ceftriaxone

Good topical agents for otitis externa?

cipro, cortisporin, tobradex, pred g

What medications can we give to treat serous otitis media?

- decongestants and antihistamines - vasoconstrictive nose sprays - antibiotics

What are the signs and symptoms of serous otitis media?

- feeling of fullness in the ear - popping or cracking or the ear - retracted ear drum - unnatural reverberation of voice - hearing loss (conductive)

Acute Otitis Media Clinical Findings 2 Findings critical in establishing DX of AOM

1) Middle ear inflammation 2) Acute infection must be present Presence of Middle ear effusion- best determined by visual examination and either pneumatic otoscope or tymapnometry Otoscopic findings= an opacified and inflamed eardrum sometimes squamous exudate or bull on eardrum bulging TM, impaired visibility of ossicular landmark yellow or white effusion (pus) an opacified and inflamed eardrum sometimes squamous exudate or bull on eardrum

Treatment of Acute otitis media

1. Pain management 2.Observation option 3.Antibiotic therapy 4.Tympanocentesis

Acute Otitis Media Pathophysiology and predisposing factors

1.Eustachian tube dysfunction (ETD)- ETD of infants and young children is more prone to dysfunction because it is shorter more compliant and more horizontal than in adults. ETD reaches its adult configuration by the age of 7 years. Infants with craniofacial disorders, such as Down syndrome or cleft palate may be particularly susceptible to ETD. 2.Bacteria colonization-Nasopharyngeal colonization with S. pneumonia, Haemophilus influenza, or Moraxella catarhalis increases the risk of AOM whereas colonization with normal flora such as viridian's streptococci may prevent AOM by inhibiting growth of these pathogens. 3.Viral Upper respiratory infections 4.Smoke exposure 5.Impaired hos immune defenses 6. Bottle feeding 7.Season 8.Day care attendance 9. Genetic susceptibility Age

Examination Techniques and procedure of Acute otitis media

1.penumatic otoscope 2.Cerumen removal 3.Tympanometry

First line treatment of Acute otitis media

Amoxicillin 80-90mg/kg/in 2 divided doses for children less than 2 yrs with severe doses treat for 10days Age 2-6 with mild-moderate symptoms treat for 7days greater than 6 mild-moderate symptoms treat 5days

For patient who have received amoxicillin in previous 30 day or who have otitis-conjunctivitis syndrome

Amoxicillin-Clavulanate (90mg/kg/d or amoxicillin with 6.4mg/kg/d of clavulanate in two divided doses

Antibiotic treatment after 48-72 hours of failure of initial antibiotic of first line treatment

Amoxicillin-clavulanate (90mg/kg/d or amoxicillin with 6.4 mg/kg/d of clavulanate in 2 divided doses

Patients who have received amoxicillin in previous 30 days or who have otitis-conjunctivitis syndrome?

Amoxicillin-clavulanate (90mg/kg/d or amoxicillin with 6.4 mg/kg/d of clavulanate in 2 divided doses

During a hearing assessment, the nurse notes that the sound lateralizes to the clients left ear with the Weber test. The nurse analyzes this result as: A A normal finding B A conductive hearing loss in the right ear C A sensorineural or conductive loss D The presence of nystagmus

C. In the Weber tuning fork test the nurse places the vibrating tuning fork in the middle of the client's head, at the midline of the forehead, or above the upper lip over the teeth. Normally, the sound is heard in equally in both ears by bone conduction. If the client has a sensorineural hearing loss in one ear, the sound is heard in the other ear. If the client has a conductive hearing loss in one ear, the sound is heard in that ear.

Alternative treatment if PCN allergy for Acute otitis media

Cefdinir 14mg/kg/d in 1 or 2 doses Cefuroxime 30mg/kg/d divided BID Cefpodoxime 10mg/kg/d in 2 divided doses **Ceftriaxone 50mg IM or IV per day for 1 or 3 day if unable to take oral

The nurse determines that the client diagnosed with Ménière's disease understands the reinforced dietary instructions when the client states that which food will be avoided in the diet?

Hot dogs

Acute Otitis Media Essential diagnosis

Moderate to severe bulging of the TM or new otorrhea not associated with otitis external Mild bulging of the TM and less than 48 hours of otalgia Middle ear effusion proven by pneumatic otoscope or tympanometry must be present

Acute Otitis Media Differential Diagnosis

Otitis media with effusion bulluous myringitis acute mastoiditis middle ear mass

What does the tube placement (myringotomy) help the patient with?

The Eustachian tube is normally closed but opens when we swallow, yawn or chew. This allows air to get into the middle ear and any mucus to get out. This keeps the air pressure equal either side of the eardrum. Having equal air pressure on each side of the eardrum and the middle ear free of mucus, helps the eardrum to vibrate. This vibration is needed for us to hear properly.

Children with sever penicillin allergies (IgE mediated events) or known cephalosporin allergy

Trimethoprim-Sulfamethoxazole macrolides Clindamycin (30-40mg/kg/d divided TID)

A client has had same-day surgery to insert a ventilating tube in the tympanic membrane. The nurse reinforces to the client to be sure to perform which action until the postoperative assessment by the primary health care provider?

Use a shower cap to protect the ears if taking a shower.

serous otitis media

a fluid buildup in the middle ear that can follow acute otitis media or can be caused by obstruction of the Eustachian tube

Acute Otitis Media

acute infection of middle aerospace associated with inflammation effusion or if a patent typanostomy tube or perforation is present otorrhea (ear drainage)

A client with a history of ear problems telephones the ambulatory care nurse to cancel an appointment because he will be away on business. The client mentions that he will be flying during this trip. The nurse advises the client to engage in which activities to prevent barotrauma during takeoff and landing? Select all that apply.

1.Chewing gum 2.Yawning occasionally 3.Swallowing a few times 5.Sucking on a piece of hard candy

The nurse has been assigned to a client with a hearing impairment. To enhance nurse-client communication, the nurse should plan to communicate with the client by speaking in which manner?

In a normal tone while facing the client

The nurse is preparing to administer eardrops to an adult client. The nurse administers the eardrops by which technique?

Pulling the pinna up and back

When reinforcing information to a client regarding how to appropriately care for a new hearing aid, the nurse should provide the client with which instruction?

To check the battery regularly to ensure that it is working before use

The nurse is assisting in preparing a teaching plan for a client with Ménière's disease. The nurse places highest priority on teaching the client information related to which information?

Safety

The nursing student is developing information for use in a clinical conference about hearing disorders. In the presentation, the student plans to include the statement that the ear is housed in which bones of the skull?

Temporal

The nurse is reviewing the primary health care provider's prescriptions for a client admitted to the hospital with a diagnosis of an acute attack of Ménière's disease. Which prescription noted on the client's chart should the nurse question?

The administration of a vasoconstrictor

The nurse is caring for a client who will be undergoing surgical treatment for Ménière's disease. The nurse plans care based on which expected outcome?

The surgery relieves pressure from accumulation of inner ear fluid in the endolymphatic sac.

The nurse is explaining how sound is conducted from the middle ear to the inner ear in teaching a client who is experiencing hearing loss. What is the order of structures conducting sound waves from the middle ear to the inner ear? Arrange the structures in the order that they should occur. All options must be used.

Tympanic membrane 1 Malleus, incus, stapes 2 Oval window 3 Cochlea 4 Organ of Corti 5

Which instruction is appropriate for the nurse to provide to a client who reports via telephone that he is certain an insect has flown into his ear because he can hear it "buzzing"?

Use a flashlight to coax the insect out of the ear.

A client with Ménière's disease is experiencing severe vertigo. The nurse reinforces instructions to the client to do which to assist with controlling the vertigo?

Avoid sudden head movements.

The nurse is reviewing the health care record of a client with a diagnosis of otosclerosis. Which signs and symptoms should the nurse note? Select all that apply.

1.Tinnitus 4.Difficulty hearing voices of others 5.Bone conduction better than air conduction

A nursing instructor asks a student about cochlear implants. The student understands that which clients are candidates for such a procedure? Select all that apply.

2.A client who has a profound hearing loss in both ears 4.A client who has received no benefit from conventional hearing aids

The nurse administers meclizine hydrochloride to a client diagnosed with an attack of Ménière's disease. Which observations demonstrate to the nurse that the medication is effective? Select all that apply.

2.Decrease in nausea 3.Decrease in vertigo

A client who frequently experiences hearing loss due to built-up cerumen in the ears asks the nurse about ways to deal with the problem including irrigating the ears. Which information is correct for the nurse to include in the teaching plan? Select all that apply.

2.Irrigate the ear canal with lukewarm tap water around 98° F. 4.The ear irrigation should be stopped if the client becomes dizzy or nauseous. 6.Instill drops of mineral oil and hydrogen peroxide for several days to soften dried cerumen before irrigation.

Which actions should be performed when communicating with a client with presbycusis? Select all that apply.

2.Speak slowly and distinctly. 3.Face client when speaking.5.Use short sentences and phrases.

The nurse notes that the primary health care provider (PHCP) has documented a diagnosis of presbycusis on the client's chart. Which explanation should the nurse give to the client to explain this condition?

A sensorineural hearing loss that occurs with aging

The nurse is caring for a client that is hearing impaired. Which of the following approaches will facilitate communication? A Speak frequently B Speak loudly C Speak directly into the impaired ear D Speak in a normal tone

D. Speaking in a normal tone to the client with impaired hearing and not shouting are important. The nurse should talk directly to the client while facing the client and speak clearly. If the client does not seem to understand what is said, the nurse should express it differently. Moving closer to the client and toward the better ear may facilitate communication, but the nurse should avoid talking directly into the impaired ear.

The nurse is reinforcing home care instructions to a client following a fenestration procedure for the treatment of otosclerosis. Which instruction should the nurse give the client?

Increase fluids and take a stool softener daily.

A client arrives at the emergency department with a foreign body in the left ear that has been determined to be an insect. Which initial intervention should the nurse anticipate to be prescribed?

Instillation of mineral oil or diluted alcohol

The nurse is reinforcing education to a client who has just obtained a hearing aid about its use and maintenance. The nurse tells the client that it is helpful to follow which practice?

Keep an extra battery readily available.

The nurse is reviewing the record of a client with mastoiditis. The nurse should expect to note which signs and symptoms? Select all that apply.

1.Headache 2.Swelling directly behind the ear 5.Red and immobile tympanic membrane

A client is diagnosed with labyrinthitis. Which are signs and symptoms of labyrinthitis? Select all that apply.

1.Severe dizziness 4.Nausea and vomiting 5.Abnormal jerking movement of eyes

The nurse is assigned to care for a client hospitalized with Ménière's disease. The nurse expects that which would most likely be prescribed for the client?

Low-sodium diet

The nurse is communicating with a client who is hard of hearing in both ears. To facilitate communication with this client, the nurse should perform which?

Lower the voice pitch and face the client when speaking.

The nurse is caring for a client with acute otitis media. The nurse plans care knowing which treatment for this problem is likely to be included?

Myringotomy

The nurse is assisting the primary health care provider in performing a caloric test on a client. Following instillation of warm water into the ear, the client complains of vertigo. The nurse documents the findings of this test as indicative of which result?

Normal

The nurse is assisting a primary health care provider in performing a caloric test on a client. Following instillation of warm water into the ear, the nurse notes that nystagmus does not occur. The nurse should document the findings of this test as indicative of which result?

Positive

The nurse is attempting to communicate with a hearing-impaired client. Which strategy by the nurse would be least helpful when talking to this client?

Smiling continuously during conversation

A client is diagnosed with a disorder involving the inner ear. Which of the following is the most common client complaint associated with a disorder in this part of the ear? A Hearing loss B Pruritus C Tinnitus D Burning of the ear

C. Tinnitus is the most common complaint of clients with otological disorders, especially disorders involving the inner ear. Symptoms of tinnitus range from mild ringing in the ear, which can go unnoticed during the day, to a loud roaring in the ear, which can interfere with the client's thinking process and attention span.

The nurse is caring for a client following craniotomy for removal of an acoustic neuroma. The nurse understands that assessment of which cranial nerve should identify a complication specifically associated with this surgery?

Cranial nerve VII, facial nerve

Aling Martha, a 73-year-old widow, tells to the nurse during the admission process that she was recently diagnosed with age-related hearing loss. Upon receiving such information, the nurse is correct if he suspects: A Ménière's disease B Otalgia C Otitis media D Presbycusis

D. The term presbycusis refers to sensorineural hearing impairment in elderly individuals.

A nurse would question an order to irrigate the ear canal in which of the following circumstances? A Ear pain B Hearing loss C Otitis externa D Perforated tympanic membrane

D. Irrigation of the ear canal is contraindicated with perforation of the tympanic membrane because the solution entering the inner ear may cause dizziness, nausea, vomiting, and infection.

The nurse is caring for a client who is hearing-impaired and should take which approach to facilitate communication?

Speak in a normal tone.

The nurse is preparing to communicate with an older client who is hearing impaired. Which intervention should be implemented initially?

Stand in front of the client.

The nurse provides dietary instructions to a client with Ménière's disease. The nurse tells the client that which food or fluid item is acceptable to consume?

Sugar-free Jell-O

The nurse provides discharge instructions to the client who was hospitalized for an acute attack of Ménière's disease. Which statement made by the client indicates a need for further teaching?

"It is not necessary to restrict salt in my diet."

Mang Isko, a 68-year-old widower, has been stricken with cataracts about year ago. Which assessment date would the nurse expect when collecting the nursing history from the client? A Blurred vision B Eye pain C Floaters D Eye redness

A. Cataracts lead to progressive worsening and blurring of vision. Eye pain and redness, common with glaucoma, are not present with cataracts. Floaters are characteristics of retinal detachment.

The nurse is reviewing the medication list for an assigned client. Which medication is the only one on the client's prescription sheet that does not have an ototoxic effect?

Acetaminophen

A client was just admitted to the hospital to rule out a gastrointestinal bleed. The client has brought several bottles of medications prescribed by different specialists. During the admission assessment, the client states, "Lately, I have been hearing some roaring sounds in my ears, especially when I am alone." Which medication should the nurse determine to be the cause of the client's complaint?

Acetylsalicylic acid

A client has a diagnosis of presbycusis. The nurse interprets that which behavior indicates that the client has successfully adapted to this disorder?

Agrees to use a prescribed hearing aid especially when home alone

A caloric test is prescribed for a client suspected of having a disease of the labyrinth. The nurse obtains which essential item in preparation for this test?

An otoscope

The nurse is assisting in developing a plan of care for a client following the surgical removal of an acoustic neuroma. Which assessment will be included in the plan of care for this specific intervention?

Assessment of cranial nerve VII (facial)

The nurse is performing a voice test to assess hearing. Which of the following describes the accurate procedure for performing this test? A Stand 4 feet away from the client to ensure that the client can hear at this distance. B Whisper a statement and ask the client to repeat it. C Whisper a statement with the examiners back facing the client. D Whisper a statement while the client blocks both ears.

B The examiner stands 1-2 feet away from the client and asks the client to block one external ear canal. The nurse whispers a statement and asks the client to repeat it. Each ear is tested separately.

Nerve deafness would most likely result from an injury or infection that damaged the: A Vagus nerve B Cochlear nerve C Vestibular nerve D Trigeminal nerve

B. Because the organ of hearing is the organ of Corti, located in the cochlea, nerve deafness would most likely accompany damage to the cochlear nerve.

A client arrives at the emergency room with a foreign body in the left ear that has been determined to be an insect. Which intervention would the nurse anticipate to be prescribed initially? A Irrigation of the ear B Instillation of diluted alcohol C Instillation of antibiotic ear drops D Instillation of corticosteroids ear drops

B. Insects are killed before removal unless they can be coaxed out by a flashlight or a humming noise. Mineral oil or diluted alcohol is instilled into the ear to suffocate the insect, which then is removed by using forceps. When the foreign object is vegetable matter, irrigation is not used because this material expands with hydration and the impaction becomes worse.

A client with Meniere's disease is experiencing severe vertigo. Which instruction would the nurse give to the client to assist in controlling the vertigo? A Increase fluid intake to 3000 ml a day B Avoid sudden head movements C Lie still and watch the television D Increase sodium in the diet

B. The nurse instructs the client to make slow head movements to prevent worsening of the vertigo. Dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid sometimes are prescribed. Lying still and watching television will not control vertigo.

For a client diagnosed with epistaxis, which intervention would be included in the care plan? A Performing several abdominal thrust (Heimlich) maneuvers B Compressing the nares to the septum for 5 to 10 minutes C Applying an ice collar to the neck area D Encouraging warm saline throat gargles

B. When a client experiences epistaxis, the nurse should compress the soft outer portion of the nares against the septum for approximately 5 to 10 minutes. the client should sit upright, breathe through the mouth, and refrain from talking. Performing abdominal thrusts is appropriate for the client with a foreign-body aspiration. Applying an ice collar to the neck is commonly done for a client after a tonsillectomy. Warm saline throat gargles are appropriate for the client with pharyngitis.

The nurse has conducted discharge teaching for a client who had a fenestration procedure for the treatment of otosclerosis. Which of the following, if stated by the client, would indicate that teaching was effective? A "I should drink liquids through a straw for the next 2-3 weeks." B "It's ok to take a shower and wash my hair." C "I will take stool softeners as prescribed by my doctor." D "I can resume my tennis lessons starting next week."

C. Following ear surgery, the client needs to avoid straining while having a bowel movement. The client needs to be instructed to avoid drinking through a straw for 2-3 weeks, air travel, and coughing excessively. The client needs to avoid getting his or her hair wet, washing hair, showering for 1 week, and rapidly moving the head, bouncing, and bending over for 3 weeks.

The ear bones that transmit vibrations to the oval window of the cochlea are found in the: A Inner ear B Outer ear C Middle ear D Eustachian tube

C. The bones in the middle ear transmit and amplify air pressure waves from the tympanic membrane to the oval window of the cochlea, which is the inner ear. The tympanic membrane separates the other from the middle ear.

Chad, a 5-year-old preschooler, is brought to the clinic due to an ear problem. Which assessment data would cause the nurse to suspect serous otitis media? A Bright red, bulging or retracted tympanic membrane and fever. B Inflammation of the external ear and crust formation on the auditory canal C Sensorineural hearing loss and complaints of tinnitus D Plugged feeling in the ear and reverberation of the client's own voice.

D. Serous otitis media is manifested by a plugged feeling in the ear, reverberation of the client's own voice, and hearing loss. A bright red, bulging or retracted tympanic membrane and fever suggest suppurative otitis media. Inflammation of the external ear and crust formation on the auditory canal suggest external otitis media. Sensorineural hearing loss and tinnitus indicate otosclerosis.

The nurse assigned to care for a hearing-impaired client should use which approach to communication in order to enhance communication and preserve the client's self-esteem? Select all that apply.

2.Speaking slowly and clearly 3.Standing directly in front of the client while speaking 5.Turning down the volume on the radio or TV when talking

The primary health care provider will perform a caloric test. Which is the priority order of the actions to perform this test? Arrange the actions in the order that they should be performed. All options must be used.

1.Explain the purpose and procedure to the client 2.Note if the client has had central nervous system depressants, alcohol, or barbiturates 3. Check for the presence of nystagmus, postural deviation (Romberg sign), and past-pointing 4. Examine and clean the ear canal. 5. Place emesis basin under ear to be tested then irrigate the suspected ear with hot or cold water 6. Irrigate until the client complains of nausea and dizziness or nystagmus is observed

The nurse is preparing to instill an otic solution into the adult client's right ear. The nurse should include which action while performing this procedure? Select all that apply.

1.Pulling the auricle of the right ear upward 2.Pulling the auricle of the right ear backward 3.Warming the solution to room temperature 4.Placing the client in a left side-lying position

The nurse is observing an unlicensed assistive personnel (UAP) talk to a client who is hearing impaired. The nurse should intervene if which actions are performed by the UAP during communication with the client? Select all that apply.

1.The UAP speaks in a very loud voice.3.The UAP speaks while cleaning the room. 4.The UAP speaks directly into the impaired ear.

The nurse has notes that the physician has a diagnosis of presbycusis on the client's chart. The nurse plans care knowing the condition is: A sensorineural hearing loss that occurs with aging B A conductive hearing loss that occurs with aging. C Tinnitus that occurs with aging D Nystagmus that occurs with aging

A. Presbycusis is a type of hearing loss that occurs with aging. Presbycusis is a gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve.

The nurse is reviewing the health care record of a client suspected of having mastoiditis. Which documented findings should the nurse expect to note if this disorder is present? Select all that apply.

1.Headache 3.Elevated white blood cell count 5.Swelling behind the ear on affected ear

A client has sought treatment in the ambulatory care clinic after an insect has become trapped in the external ear canal. The nurse prepares to assist the primary health care provider to instill which acceptable solutions into the ear to remove the insect? Select all that apply.

1.Lidocaine 2.Mineral oil 3.Ether solution

A person that has serous otitis media will be on a long, low dose of what kind of medication? Why are we giving this?

antibiotics so if the fluid does stay behind the ear drum for a long period of time... it will not become infectious

What is the cause of serous otitis media?

blocked eustachian tube due to *allergies*

What is the main symptom of stasis tube dysfunction?

dull hearing

Who typically gets malignant otitis externa? How do we treat it?

elderly diabetic/immunosuppressed; iv meds

What does the myringotomy tubes/buttons help the patient with that has serous otitis media?

equalize pressure

If the fluid gets behind the ear drum and stays there for a long period of time it can get _______

infected

What happens in malignant otitis externa?

infx progresses into bone

What surgery can be done to help serous otitis media?

myringotomy tubes or buttons

What should we be cautious with with otitis externa?

otomycosis

What can a patient do (lifestyle factor) that can cause them to have stasis tube dysfunction?

smoke

The patient with serous otitis media that undergoes myringotomy has _______ ______ dysfunction

stasis tube

What are 3 defense mechanisms of the ear canal?

tragus and cartilage cover opening, cerumen, hair follicles/narrowing

How does otitis externa present?

wet, hurts, macerated, itchy