Otoscope Assessment Of A Human Ear and Synthesis Essay

Otoscope Assessment Of A Human Ear and Synthesis Essay

Otoscope Assessment Of A Human Ear and Synthesis Essay

Ear Assessment and Nursing Diagnoses Sample Essay

Part 1: Assessment Template

Current Symptoms: Ears	Struggling to meet your deadline ? Get assistance on Otoscope Assessment Of A Human Ear and Synthesis Essay done on time by medical experts. Don’t wait – ORDER NOW! Meet My Deadline Assessment Findings
Interview Guide
1. Recent changes in hearing (if yes, were all or just some sounds affected)?	The patient reports a recent decrease in hearing acuity, and people must shout for him to hear for the last three days. He can only hear loud sounds.
2. Ear discharge (if yes, amount/odor)?	Yellow discharge that is minimal in amount (noticeable)
3. Ear pain (if yes, is there accompanying sore throat, sinus infection, or problem with teeth or gums)?	The patient is experiencing severe ear pain that came after a runny and congested nose. He denies previous gum or sinus infections. The runny nose, congested nose, and cough subsided and are not concurrent with the ear pain.
4. Ringing or crackling sounds in ears?	The patient reports persistent ringing bilaterally with pain on yawning and swallowing.
Past History
1. Previous ear or hearing problems such as infections, trauma, or earaches (medications, surgery, hearing aids)?	The patient denies a history of ear problems. Denies taking medications or surgery for ear problems. Denies history of ear trauma
Family History
1. Family history of ear problems or hearing loss?	The patient denies any family history of hearing loss or ear problems. The parents (90 and 84 years) have diminished hearing related to old age.
Lifestyle and Health Practices
1. Live or work around frequent or continuous loud noise? Use of earbuds daily?	The patient is a grade 4 teacher who lives in a rural area with no exposure to loud noise or frequent earbud use.
2. Use of ear protection from noise or while in water?	Admits to not using ear protection while in water
3. Has any hearing loss affected the ability to work or care for self or others?	Hearing loss and other symptoms such as pain and discharge have affected his ability to interact with colleagues and teach students effectively.
Physical Assessment: External Ear Structures	(List findings bilaterally)
1. Inspect the auricle, tragus, and lobule for size and shape bilaterally. Describe bilateral position, lesions/discoloration, and discharge.	The auricle, tragus, and lobules are bilaterally symmetrical with swelling, lesions, erythema, or signs of injury. No lesions or discoloration bilaterally. No discharge was noted bilaterally externally.
2. Palpate the auricle and mastoid process bilaterally. Describe findings, including symptomatology or tenderness if they are present.	There is no tenderness, pain, or swellings on palpation of the auricle and mastoid process. The patient guards the ear on palpation of the tragus.
Otoscopic Examination
3. Bilaterally inspect the external auditory canal with the otoscope for discharge, color and consistency of cerumen, color and consistency of canal walls, and any nodules. (Address each of these items bilaterally.)	The patient has a thick yellow discharge bilaterally in the external auditory canal. There is no cerumen impaction on the canal; the canal is erythematous.
4. Inspect and describe the tympanic membranes bilaterally, using the otoscope, for color, shape, and landmarks.	The tympanic is erythematous, edematous, and ruptured bilaterally. The tympanic membrane is opaque, and the umbo and the cone of light are not visible. The malleus is visible on otoscopy.
Hearing and equilibrium tests
1. Perform the whisper test by having the client place a finger on the tragus of one ear. Whisper a two-syllable word 30.4–60.9 cm (1–2 ft) behind the client. Repeat on the other ear.	Diminished ability to hear sounds on both sounds, Inability to hear the syllables (Letter) accurately bilaterally whispered.
2. Perform the Romberg test to evaluate equilibrium. With feet together and arms at the side, close eyes for 20 seconds. Observe for swaying. (Refer to textbook, Chapters 16 and 26.)	The patient maintained a stable gait, with eyes open and closed during the test. The ear problem has not affected his balance and gait; hence, there is no indication of vestibular system involvement.
3. If your “patient” had no pathological findings, then list a common ear disorder or abnormal assessment finding that would be discoverable in an ear or hearing assessment for a hypothetical patient.	Acute bilateral otitis media- The patient reports bilateral ear pain that followed an upper respiratory tract infection. He also reports drainage of thick yellow discharge bilaterally. On physical examination, the ear canal is erythematous with a yellow discharge, and the tympanic membrane is ruptured, erythematous, and edematous. There is also decreased hearing acuity bilaterally.

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Adapted from Weber, Kelly & Sprengel, 2014: Lippincott, with permission.

Part 2 Instructions: Analysis and synthesis exercise:

(See below for your type-in template; an example of this form is given in the Module.)

1.     Problem or Assessment finding you have selected for analysis. Patient problem: Acute bilateral otitis media. Assessment The patient reports bilateral ear pain that followed an upper respiratory tract infection. He also reports drainage of thick yellow discharge bilaterally. On physical examination, the ear canal is erythematous with a yellow discharge, and the tympanic membrane is ruptured, erythematous, and edematous. There is also decreased hearing acuity bilaterally on whisper test administration.
2.     Synthesis: What is the nature, likely etiology, or factor most impacting the abnormal finding you have discovered (or, if your patient had nothing abnormal, discuss the problem you listed)?	3.     Priority: Level of urgency for further action on the part of the nurse or patient. 1.     Emergency—address now! 2.     Urgent—address soon—today or within a few days. 3.     Routine—address at the next clinician visit. 4.     Incidental—no action is necessary. Clue to your answer: What would happen if the finding is not addressed—in a worst-case situation (think physical, social, financial, for example)?   List an in-text citation for your authority source regarding the level of priority, using APA style.   Reference: Reference a textbook, reliable medical website, or journal article using APA format. (It does not need to be within 5 years—some conditions are not currently under investigation and any authoritative source will receive full points regardless of year. Mayo Clinic and Cleveland Clinic websites are good examples of websites that may be cited for this assignment. See the APA website for instructions on citing a website as a reference.)	4.     Implications: What should the nurse recommend, teach, or do based on this knowledge? (Be brief—1 – 3 sentences only should be used here. What is the “big picture” or the main elements to remember? )

Part 2 Template

1.     Problem or Assessment finding you have selected for analysis: (Write in here):  Patient problem: Acute bilateral otitis media. Assessment-The patient reports bilateral ear pain that followed an upper respiratory tract infection. He also reports drainage of thick yellow discharge bilaterally. On physical examination, the ear canal is erythematous with a yellow discharge, and the tympanic membrane is ruptured, erythematous, and edematous. There is also decreased hearing acuity bilaterally on whisper test administration..
2.     Synthesis	3.     Priority	4.     Implications
Several factors, including bacterial and viral infections after eustachian tube dysfunction, cause acute otitis media. Poor fluid clearance from the middle ear creates a conducive medium for infection. Upper respiratory tract infections are also common causes of acute otitis media, where the infective agents ascend the eustachian tube to infect the middle ears (Rijk et al., 2021). The etiology explains the reason for high infection rates in the cold seasons. Other causative factors include child and school settings (high risk for infection through contact) and anatomy (poor fluid drainage by the Eustachian tube)	The priority of the problem’s management is urgent. The patient has moderate symptoms of otitis media and needs medical attention. However, failure to manage the symptoms now cannot lead to death; hence, it does not require emergency treatment. Acute otitis media (AOM) is not a life-threatening problem but requires treatment urgently to prevent complications that arise when AOM is untreated or poorly managed (Harmes et al., 2013). Failure to manage AOM leads to complications such as septicemia, mastoiditis, and otitis internal, which can permanently damage the cochlea, leading to permanent hearing loss. Otitis media can also be managed routinely, where follow-up and relevant interventions are implemented based on the outcomes of the initial interventions (Mayo Clinic, n.d.).   Harmes, K. M., Blackwood, A., Burrows, I., Cooke, J. M., Van Harrison, R., & Passamani, P. P. (2013). Otitis Media: Diagnosis and Treatment. America Family Physician 88(7):435-440. Mayo Clinic. (n.d.) Ear infection, middle ear. Retrieved 2/2/23 from https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616	The nurse can recommend a high dose of amoxicillin or other antibiotics to manage the infection, with culture and sensitivity for more specific management and analgesics for pain and inflammation management. Patient education on the management of the current condition and prevention of subsequent infections, such as avoidance of swimming, thoroughly cleaning water from ears after shower, and avoiding touching ears with dirty hands Management in adults may be complicated, and an evaluation is necessary to rule out other causes, such as mechanical obstruction (Harmes et al., 2013).

References

Harmes, K. M., Blackwood, A., Burrows, I., Cooke, J. M., Van Harrison, R., & Passamani, P. P. (2013). Otitis Media: Diagnosis and Treatment. America Family Physician 88(7):435-440. Retrieved September 1, 2023, from https://www.aafp.org/pubs/afp/issues/2013/1001/p435.html#

Mayo Clinic. (n.d.) Ear infection, middle ear. Retrieved 2/2/23 from https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616

Rijk, M. H., Hullegie, S., Schilder, A. G., Kortekaas, M. F., Damoiseaux, R. A., Verheij, T. J., & Venekamp, R. P. (2021). Incidence and management of acute otitis media in adults: a primary care-based cohort study. Family Practice, 38(4), 448-453. https://doi.org/10.1093/fampra/cmaa150

Ear Assessment and nursing diagnoses (Do assessment on an adult using an otoscope)

Part 1 Instructions:  In the boxes, describe your findings.  Do not use the word “Normal” or approximations of it, such as N/A, expected, etc.  State what you found using terminology appropriate for the area.  See the textbook for appropriate wording.  If there are no signs or symptoms of any problems, for instance, it would be appropriate to write:  Denies tenderness, pain, and paresthesia; no lesions or breakdown observed.  No evidence of pathology noted. Then proceed to describe what you assess in terms of observation and palpation (auscultation and percussion are not used in ear assessment).  Weber and Kelley’s textbook has a helpful guide with pictures and verbiage you may find helpful:  Assessment Guide 17-1, in the chapter on ear assessment (note especially the textbook verbiage in the center and right columns.)  You may use textbook terminology in this class because it is expected.  Do not use the findings of other students since the plagiarism detection program will flag the duplicate wording you use as plagiarism.  Many videos are also available to assist you.  There is one on Canvas in the current module, and YouTube has a number of them as well.

Do not use the work of other students.  That is plagiarism, and our detection program will flag it. If confirmed it will mean the grade of F in the class:  It isn’t worth it!

Part 1: Assessment template

Current Symptoms: Ears	Assessment Findings
Interview Guide
1. Recent changes in hearing (if yes, were all or just some sounds affected)?	If yes, describe, if no, then state “denies changes in hearing.”
2. Ear discharge (if yes, amount/odor)?
3. Ear pain (if yes, is there accompanying sore throat, sinus infection, or problem with teeth or gums)?
4. Ringing or crackling sounds in ears?
Past History
1. Previous ear or hearing problems such as infections, trauma, or earaches (medications, surgery, hearing aids)?
Family History
1. Family history of ear problems or hearing loss?
Lifestyle and Health Practices
1. Live or work around frequent or continuous loud noise?  Use of ear buds daily?
2. Use of ear protection from noise or while in water?
3. Has any hearing loss affected ability to work or care for self or others?
Physical Assessment: External Ear Structures	(List findings bilaterally)
1. Inspect the auricle, tragus, and lobule for size and shape, bilaterally.  Describe bilateral position, lesions/discoloration, and discharge.
2. Palpate the auricle and mastoid process bilaterally.  Describe findings, including symptomatology or tenderness if they are present.
Otoscopic Examination
3. Bilaterally inspect the external auditory canal with the otoscope for discharge, color and consistency of cerumen, color and consistency of canal walls, and any nodules. (Address each of these items bilaterally.)
4. Inspect and describe the tympanic membranes bilaterally, using the otoscope, for color and shape, and landmarks.
Hearing and equilibrium tests
1. Perform the whisper test by having the client place a finger on the tragus of one ear. Whisper a two-syllable word 30.4–60.9 cm (1–2 ft) behind the client. Repeat on the other ear.
2. Perform the Romberg test to evaluate equilibrium. With feet together and arms at the side, close eyes for 20 seconds. Observe for swaying. (Refer to textbook, Chapters 16 and 26.)
3. If your “patient” had no pathological findings, then list a common ear disorder or abnormal assessment finding that would be discoverable in an ear or hearing assessment for a hypothetical patient.	(Copy this disorder into the blank below in the orange section)

Adapted from Weber, Kelly & Sprengel, 2014: Lippincott, with permission.

Most people you will have access to for the assessment are likely to be symptom-free with no pathologic findings.  If you do assess someone with a nursing problem, you can complete the last part of this assignment using that problem.  If the person you assessed had no pathological findings, select a common disorder or pathologic finding and complete the remainder of the assignment for a disorder you select.

As you know, hospitals are not using Nursing Diagnoses anymore, and they are not testing this content on the NCLEX.   The National Council of the State Boards of Nursing has revised their listing of the elements of the Nursing Process to be: Assessment, Analysis, Planning, Implementation, and Evaluation (see https://ncsbn.org/clinical-judgment-measurement-model).

This is an assessment class and therefore the focus is on assessment and analysis as the key elements. We are not addressing the entire nursing process and the medical-surgical outcomes in the course, but our goals are help nurses to become more proficient at assessing, analyzing, and synthesizing the significance of nursing assessment findings.

Once a nurse has assessed and identified an abnormality, the next step is to  decide how the assessment finding is impacting or could impact the patient (analysis). Is the problem serious enough to warrant a call to the clinician, or is it merely an incidental finding?   What might happen, in a worst case scenario, if the patient does nothing about it?   What teaching is needed about this finding?

Part 2 Instructions: Analysis and synthesis exercise:

(See below for your type-in template; an example of this form is given in the Module)

(Derived from the NCSBN Clinical Judgement Model)

 

1.      Problem or assessment finding you have selected for analysis   List here:
2.      Synthesis: What is the nature, likely etiology, or factor most impacting the abnormal finding you have discovered (or, if your patient had nothing abnormal, discuss the problem you listed).	3.      Priority: Level of urgency for further action on the part of the nurse or patient. 1.      Emergency—address now! 2.      Urgent—address soon—today or within a few days. 3.      Routine—address at the next clinician visit. 4.      Incidental—no action is necessary. Clue to your answer: What would happen if the finding is not addressed—in a worst-case situation (think physical, social, financial, for example).   List an in-text citation for your authority source regarding the level of priority, using APA style.   Reference: Reference a textbook, reliable medical website, or journal article using APA format.  (It does not need to be within 5 years—some conditions are not currently under investigation and any authoritative source will receive full points regardless of year.  Mayo Clinic or Cleveland clinic websites are good examples of websites that may be cited for this assignment.  See the APA website for instructions on citing a website as a reference.)	4.      Implications: What should the nurse recommend, teach, or do based on this knowledge? (Be brief—1 – 3 sentences only should be used here. What is the “big picture” or the main elements to remember? )

Part 2 Template

1.      Problem or Assessment finding you have selected for analysis:   (Write in here): ________________________________________________
2.      Synthesis	3.      Priority (with APA in-text citation and reference at bottom of box)             Reference	4.      Implications

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Instructions for APA use in this assignment:

In-text citation:

List an in-text citation for your authority source regarding the level of priority, using APA style.  For example, if you obtained your information from an article with several authors having Morgan as first author:  (Morgan, 2020).

If the sources has no author and no date and was from the Mayo Clinic website, it might look like this, for example:  (Mayo Clinic, n.d.)

Reference:

Reference a textbook, reliable medical website, or journal article using APA format.  (It does not need to be within 5 years—some conditions are not currently under investigation and any authoritative source will receive full points regardless of year.  Mayo Clinic or Cleveland clinic websites are good examples of websites that may be cited for this assignment.  See the APA website for instructions on citing a website as a reference.) For example, when no author is listed and no date is given for a website:

 

Reference (example:)

Mayo Clinic. (n.d.) Ear infection, middle ear. Retrieved 2/2/23 from https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616