NR325 Adult health 2 Exam #2 ROK

NR325 Adult health 2 Exam #2 ROK 1 NR325 Adult health 2Exam #2 ROKHearing Impaired – Ch. 22, pg. 432Gerontologic considerations – pg. 432Presbycusis, hearing loss of high-pitched sounds associated with aging; decline in word recognition abilityNoise exposure, vascular or systemic diseases, poor or inadequate nutrition, ototoxic drugs and pollution during the life span can damage delicate hair cells of the organ or Corti or atrophy lymph producing cellsAbility to understand spoken word is greatly affectedVowels are heard but some consonants fall into the high frequency range and cannot be differentiated.Noise exposure is a factor related to presbycusisThe loss associated with presbycusis is usually greater for high pitched soundsReluctant to use a hearing aid due to cost, appearance, insufficient knowledge about hearing aids, amplification of competing noise, unrealistic expectations, accept their losses as part of getting older & believe there is no need for improvementMeniere’s disease-client education – pg. 428Define: is characterized by symptoms caused by inner ear disease, including episodic vertigo, tinnitus, fluctuating sensorineural hearing loss and aural fullnessResults in a excessive accumulation of endolymph in the membranous labyrinth; cause unknownAttacks: preceded by a sense of fullness in the ear, increase tinnitus, muffled hearing, feeling of being pulled to the ground (“drop attack”), whirling in space; can last hrs or daysKeep patient in a quiet, darkened room in a comfortable positionPatient needs to be taught to avoid sudden head movements or position changesFluorescent or flickering lights or watching television may exacerbate symptoms and should be avoidedAn emesis basin should be available for vomiting; antiemeticsKeep side rails up and bed in lowest positionPatient should be instructed to call for assistance when getting out of bed; assist with ambulation when attack is over tooMedications and fluids are administered parenterally and intake and output are monitoredWhen attack subsides, assist the patient with ambulation because unsteadiness may remainRestriction of Na, caffeine, nicotine, alcohol, & foods w/MSGClient teaching for eardrops – pg. 426Hands should be washed before and after administering eardropsAdminister drops at room temperature (cold drops can cause vertigo and heated drops can burn the tympanum)The tip of the dropper should not touch the ear to prevent contaminationThe ear is positioned so the drops can run into the canal. This position should be maintained for two minutes.1 Client teaching to protect hearing loss – pg. 430Amplified music should be locked in not to exceed 50% of maximum volume Ear protection should be worn when firing a gun and during other recreational pursuits with high noise levelsHealth teaching regarding avoidance of continue exposure to noise levels greater than 85 to 95 dBis essentialWork environments known to have high noise levels >85 dB need to wear ear protection Periodic audiometric screening should be part of the health maintenance policies of industryEmployees should participate in hearing conservation programs in work environmentYoung adults should be encouraged to keep amplified music at a reasonable level & limit their exposure timeExternal otitis – pg. 424inflammation or infection of the epithelium of the auricle and ear canalExample: swimmer’s ear, trauma from picking earClient care: oMoist heat, mild analgesics, anesthetic dropsoWash hands before/after eardropsoTip of dropper should not touch earoPosition ear so drops can run into canal; stay this position for 2 minsOtitis media – inflammation of middle ear Fever PainEnlarged lymph nodesDischarge from earNausea/vomitingHearing lossClient care:oAdminister antibiotics (oral, otic)oReduce feveroEar irrigationsoMonitor for hearing lossNursing care for tympanoplastyAfter surgery pt will be positioned flat and side lying with operative side up.Instruct pt to change cotton packing and dressing dailyMonitor tightness of dressing to prevent tissue necrosis and assess amount and type of drainagePostoperative Teaching After Ear Surgery – Table 22-14, pg. 426Avoid sudden head movementsDo not try to get out of bed w/o assistanceTake drugs to reduce dizzinessChange positions slowlyAvoid getting the head wetReport fever pain and increase in hearing loss or drainage from the earDo not cough or blow the nose because this causes increased pressure in the Eustachian tube and middle ear cavityIf need to cough or sneeze, leave the mouth open to help reduce pressureAvoid crowds where respiratory infections may be contracted2