Health Assessment Chapter 07(midterm)

• Weber


  Health Assessment in Nursing
• MS JOAN F. AKUT, RN

  CLINICAL INSTRUCTOR
• The ear


  • Sense organ of hearing and equilibrium
  • Consists of three distinct parts: external ear, middle ear, and inner ear

  
• Tympanic membrane


  Separates the external ear from the middle ear

  
• External ear and tympanic membrane

  • Can be assessed by direct inspection and using an otoscope
  • Middle and inner ear cannot be directly inspected

  
• External ear


  • Composed of the Auricle or pinna, external auditory canal
  • Auricle (pinna) is the portion visible without tools
  • External auditory canal is S-shaped in the adult
  • Modified sweat glands secrete cerumen, a wax-like substance

  
• Middle ear


  • Small, air-filled chamber in the temporal bone
  • Separated from the external ear by the tympanic membrane
  • Contains three auditory ossicles: malleus, incus, and stapes
  • Air pressure equalized by the eustachian tube

  
• Inner ear


  • Fluid-filled, made up of bony labyrinth and inner membranous labyrinth
  • Bony labyrinth has three parts: cochlea, vestibule, and semicircular canals
  • Cochlear duct contains the spiral organ of Corti, the sensory organ for hearing
  • Sensory receptors in vestibule and semicircular canals sense position and head movements

  
• The inner ear is fluid-filled, not air-filled

  
• Hearing


  1. Sound vibrations collected by external ear, causing eardrum to vibrate

  2. Vibrations transmitted through auditory ossicles

  3. Stapes vibrates at oval window, fluid in inner ear stimulates hair cells of spiral organ of Corti

  4. Nerve impulses travel to brain via acoustic nerve

  
• Conductive hearing


  Something blocks or impairs the passage of vibrations from getting to the inner ear

  
• Sensorineural hearing


  Transmission of sound waves in the inner ear

  
• • Conductive hearing loss relates to external or middle ear dysfunction
  • Sensorineural hearing loss relates to inner ear dysfunction

  
• Bones of the skull also conduct sound waves through bone conduction</b>
• Biological and cultural variations

  • Ears vary in size and shape
  • Earlobes may be freestanding or attached
  • Some ears have a Darwin tubercle
  • Earwax varies between dry and wet based on genetics

  
• Europeans and Africans tend to have wet earwax, East Asians and Native Americans tend to have dry earwax
• Genetic variation leads to women with dry earwax having lower incidence of breast cancer, especially in East Asian women
• Hearing loss may result from genetic causes, birth complications, infectious diseases, chronic ear infections, certain drugs, noise exposure, and aging
• Some indigenous populations have higher rates of otitis media
• Causes of hearing loss at or before birth include birth complications, maternal infections, use of ototoxic drugs, and severe jaundice
• Causes of hearing loss after birth include infectious diseases, ototoxic drugs, head/ear injury, wax/foreign-body blockage, excessive noise, and aging
• Presbycusis often begins with a loss of the ability to hear high-frequency sounds
• Health assessment of hearing


  • Provides important information about client's ability to interact with environment
  • Changes in hearing are often gradual and go unrecognized until severe problem develops
  • Asking specific questions can help detect disorders early
• Collecting subjective data


  1. Gather data from client about current hearing, past/family history

  2. Be alert to signs of hearing loss during data collection

  3. Collect data on environmental influences and how it affects client's ADLs
• Sudden sensorineural hearing loss (SSHL)

  Also known as "inner ear" hearing loss

  
• Types of hearing loss

  • Conductive
  • Sensorineural
  • Mixed
  • Auditory neuropathy spectrum disorder

  
• Sudden sensorineural ("inner ear") hearing loss (SSHL)


  Sudden hearing loss caused by a problem in the inner ear or hearing nerve

  
• Types of hearing loss

  • Conductive hearing loss
  • Sensorineural hearing loss (SNHL)
  • Mixed hearing loss
  • Auditory neuropathy spectrum disorder

  
• Conductive hearing loss


  Caused by something that stops sound getting through the outer or middle ear

  
• Sensorineural hearing loss (SNHL)


  Occurs when there is a problem in the way the inner ear or hearing nerve works

  
• Mixed hearing loss


  Includes both a conductive and a sensorineural loss

  
• Auditory neuropathy spectrum disorder


  Occurs when sound enters the ear normally, but because of damage to the inner ear or the hearing nerve, sound is not organized in a way the brain can understand it

  
• Equipment


  • Watch with a second-hand for Romberg test
  • Tuning fork (512 or 1,024 Hz)
  • Otoscope
• Collecting Subjective Data


  • History of present health concern
  • Past health history
  • Family history
  • Lifestyle and health practices
• Risk Factors for Hearing Loss

  • Genetic predisposition
  • Congenital anomalies
  • Preauricular tag, otitis media
  • Fluid in inner ear, loud noises
  • Micronutrient deficiencies
  • Ototoxic medications, age
  • Trauma to eardrum
  • Otosclerosis
  • Viral infections of inner ear
  • Meniere's disease, impacted cerumen
  • Acoustic neuroma of auditory nerve
  • Brain diseases
  • Child of mother who contracted rubella while pregnant
  • In utero developmental problems

  
• Risk Reduction Tips


  • Avoid loud noises
  • Wear ear protection
  • Treatment for otitis media and recurrent sinusitis
  • Well-balanced diet
  • Regular hearing evaluation
  • Avoid medications associated with ototoxicity
• External Ear Structures


  • Inspect the auricle, tragus, and lobule for size, shape, position, lesions/discoloration, and discharge
  • Palpate the auricle and mastoid process for tenderness

  
• Ear - Inspection and Palpation


  • Angle of attachment and position
  • Size, shape, and symmetry
  • Drainage: clear, blood, or purulent
  • Consistency and tenderness
  • Palpate tragus, mastoid, and helix for tenderness

  
• Ear - Inspection (Otoscope)


  • Use an otoscope
  • Adult - upward and backward, slightly away from the head
  • < 3 yrs old – downward and backward
  • Smooth and pinkish
  • Note any discharge, foreign body, redness, swelling and wax

  
• Abnormalities of the External Ear And Ear Canal

  • Tophi, postauricular cyst
  • Malignant lesion
  • Otitis externa
  • Build-up of cerumen in ear canal
  • Polyp, exostosis