Transcript Indezine Template

Chapter 50
Assessment of the Ear and
Hearing
Marion Kreisel RN, MSN
Adult Health NU230
Fall 2011
Anatomy and Physiology
• Review of the structure of:
• External ear
• Middle ear
• Inner ear
Internal Ear
Internal Ear—
Tympanic
Membrane
Middle
Ear
Otoscope
pressure bulb for injecting air into external cana; to
test mobility of the ear drum
Tympanic Membrane
Hearing
Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Ear and Hearing Changes
Associated with Aging
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Drier, impacted cerumen
Loss of tympanic membrane elasticity
Decreased bony ossicle movement
Degenerative changes of cochlea
Disturbed vestibular function
Diminished hearing acuity
Decreased ability to hear high-frequency
sounds
Assessment Techniques
• Patient history
• Family history and genetic risk
• Current health problems:
• Hyperacusis
• Tinnitus
• Vertigo
Physical Assessment
• External ear and mastoid assessment
• Otoscopic assessment
Auditory Assessment
• Conductive hearing loss resulting from any physical
obstruction of sound wave transmission
• Sensorineural hearing loss resulting from a defect in
the cochlea, the eighth cranial nerve, or the brain
• Mixed conductive-sensorineural hearing loss, a
profound hearing loss
Tests
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Voice test
Watch test
Audioscopy
Weber tuning fork test
Rinne tuning fork test
Weber Tuning Fork Test
Rinne Tuning Fork Test
Diagnostic Assessment
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Laboratory tests
Computed tomography
Magnetic resonance imaging
Auditory brainstem-evoked response
Electronystagmography
Caloric testing
Dix-Hallpike test for vertigo
Audiometry
• Frequency is the highness or lowness of
tones.
• Intensity is expressed in decibels.
• Threshold is the lowest level of intensity at
which pure tones and speech are heard.
• Pure tones are generated by an
audiometer to determine hearing acuity.
Audiogram
Speech Audiometry
• Speech reception threshold
• Speech discrimination testing
• Tympanometry
Chapter 50
NCLEX TIME
Question 1
A history of which of these conditions will
increase the patient’s risk for developing
hearing loss?
A.
B.
C.
D.
Diabetes mellitus
Down syndrome
Cardiac disease
Turner’s syndrome
Question 2
What is the most important measurable
aspect of human hearing?
A. The ability to detect high-frequency
sounds
B. The ability to distinguish highness or
lowness of tones
C. The ability to understand speech
D. The ability to tolerate loud sounds
Question 3
The patient with a long history of heart failure is at risk
for developing hearing loss if:
A. There is a genetic predisposition to develop
hearing loss.
B. Heart failure alters tissue perfusion, which may
affect hearing.
C. The patient uses topical medications, which may
be ototoxic.
D. The patient has received multiple doses of
furosemide.
Question 4
What is a priority nursing intervention when
providing care to a patient with hearing
loss?
A. Provide a safe environment.
B. Provide written information regarding
medications and disease processes.
C. Ensure that the patient can directly
visualize you when you provide
instructions.
D. Have the patient repeat instructions to
evaluate additional teaching needs.
Question 5
During the physical assessment, the nurse
notices that the patient’s right external ear
is deformed. The nurse
should:
A. Ask the patient about hearing deficits.
B. Ask the patient about renal or urinary tract
problems.
C. Speak in a lower-toned voice and ensure
good visual contact with the patient.
D. Ask the patient to provide information
about his hearing.