Posted: December 3rd, 2022

nursing care plan for ear infection essay

Holistic Assessment of an Adult Ear Using an Otoscope (Observation) and Palpation

Assessment or examination of the ear for appropriate and correct diagnosis uses the techniques of inspection or observation as well as palpation. Because there are internal structures in the ear, the inspection aspect is facilitated by the use of an otoscope (Ball et al., 2019). This paper presents some of the findings that may come out of the examination of an adult patient’s ears.

Table 1: Examination of an adult ear

Part/ Procedure Findings
Inspection of the external ear structures (including the auricle, tragus, and lobule) ·       The gross structure of the ears including the lobules of the auricles appears the same in size and shape on both sides.

·       The tragus and antitragus do not appear swollen or inflamed bilaterally.

·       There are no piercings bilaterally on the lobule, the helix, or the tragus.

·       The intertragic notch shows no sign or evidence of otorrhea or ear discharge bilaterally.

·       There are no visible lesions bilaterally on both ears, and the color of the ears is homogeneous with the rest of the body.

·       There is no discoloration on both sides.

Palpation of the external structures of the ear (including the auricle and mastoid process) ·       The auricle, the helix, the tragus, and antitragus all do not show any tenderness or swelling bilaterally.

·       Also, there are no masses that are palpable bilaterally.

·       On palpation of the mastoid process, the patient denies any tenderness on both sides.

·       The auricle feels soft and flexible bilaterally on palpation.

Bilateral inspection of the external auditory canal using the otoscope ·       The patient denies any discomfort when the otoscope is inserted in the external auditory canal on both sides.

·       Inspection of the external auditory canal reveals a clear canal with just a little cerumen that is brown in color.

·       There is no otorrhea visible bilaterally.

·       The canal walls are smooth with no evidence of nodules or inconsistencies bilaterally.

Bilateral inspection of the tympanic membranes ·       The tympanic membrane shows no perforation or sclerosis on both sides.

·       There are also no visible fluid levels behind the tympanic membrane bilaterally.

·       However, there are bubbles that are visible on otoscopy on the right side.

·       There is no cholesteatoma in the attic area of the membrane bilaterally.

·       The tympanic membrane shows a visible bulge and demonstrates reduced mobility on pneumatic otoscopy on the right side too.

·       The tympanic membrane on the left is round, smooth, and has no bulge or any other visible abnormality.

A common ear disorder or abnormal finding discoverable in an ear assessment Acute otitis media (AOM)

·       In this condition, the tympanic membrane shows an opaque reaction to light and may also bulge.

·       Fluid may be demonstrated in the middle ear through otoscopy and visible through the tympanic membrane.

·       There is inflammation shown by redness of the tympanic membrane and the patient may have fever and tenderness on inserting the otoscope.

·       The fluid behind the tympanic membrane may also be pus at times (Hammer & McPhee, 2018).

Nursing Diagnoses for AOM in Adults
A health promotion nursing diagnosis for AOM A risk nursing diagnosis for AOM A collaborative problem or actual nursing diagnosis for AOM
Readiness for enhanced learning on the prevention of acute otitis media Risk for developing intra-temporal abscess if AOM is left untreated Risk for complications of intracranial and intra-temporal conditions

 

 

 

References

Ball, J., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2019). Seidel’s guide to physical examination: An interprofessional approach, 9th ed. Elsevier.

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.

 

OTOSCOPE Assignment
Ear Assessment and appropriate nursing diagnoses (Do assessment on an adult) 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, (auscultation and percussion are not used in ear assessments) and palpation. 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. Many videos are also available to assist you. There is one on Blackboard 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! 
Current Symptoms: Ears Assessment Findings External Ear Structures 1. Inspect the auricle, tragus, and lobule for size and shape, bilaterally. Describe bilateral position, lesions/discoloration, and discharge. Auricle is 6.5 cm vertical dimension, rounded, and light brown flesh-colored bilaterally (in keeping with client's skin color.) No lesions or tenderness bilaterally. Tragus is triangular, non-tender, no lesions, color consistent with auricle, no piercings bilaterally. Lobules are attached, with one piercing bilaterally, nontender without lesions bilaterally.
 2. Palpate the auricle and mastoid process bilaterally. Describe findings, including symptomatology or tenderness if they are present. Auricle and mastoid process are without lesions, and client denies tenderness; auricle is flexible and soft. 
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.) Auditory canals: smooth walls, slightly pink color, no nodules bilaterally. Dark brown cerumen is present in the right canal, left canal has no visible cerumen. 
4. Inspect and describe the tympanic membranes bilaterally, using the otoscope, for color and shape, and The tympanic membranes on the right cannot be visualized due to brown cerumen blocking the ear canal; the left tympanic membrane appears round, smooth, and pearly gray. The cone-shaped reflection of the otoscope light is landmarks. reflected at 7 O'clock. 
5. List a common ear disorder or abnormal assessment finding that would be discoverable in an ear or hearing assessment on a hypothetical patient. (You may include the medical diagnosis, but it is not required. You may select a problem that has not yet been diagnosed since this is a very realistic scenario—often nurses are the one who discover problems first and then refer the client.) The patient has been diagnosed with a basal cell carcinoma on his right auricle, but has not yet been treated. Surgical removal and use of fluorouracil cream are planned by dermatologist beginning next week. Skin lesion is on the very top of the auricle and extends over both the front and back of it. The lesion is rough/uneven, 6 mm at largest diameter, and has a small amount of yellow discharge dried around the edges. The edges of the lesion appear "rolled" and pink. The lesion is non-tender. Patient states he never has used sunscreen. Adapted from Weber, Kelly & Sprengel, 2014: Lippincott, with permission. Using the diagnostic reasoning process described in chapter 5 of your textbook, synthesize one of each of the three types of nursing diagnoses described below for a potential client with the problem you listed in area #5, above. You will use the three of the types of nursing diagnoses (ND) described in Chapter 5 of your Weber and Kelley textbook: 1. A Health Promotion ND 2. A Risk ND and 3. Either a Collaborative Problem OR an Actual ND. You will find a list of possible diagnoses in Appendix C and D in your textbook. Synthesis Instructions/Items to include Nursing Diagnosis List one “Health Promotion” (HP) nursing diagnosis appropriate for your client with the condition you describe in section 5, above. (Do not use “none at this time.”) Health Promotion (HP) nursing diagnoses often begin with “Readiness for enhanced learning” as described in Appendix C of your textbook, under Domain 1. They are also discussed in Table 5-1 and 5-2. (Note to students: you are listing a hypothetical patient, so you can assume a few things if you want to. For instance in Appendix C for a HP ND I could use “Risk-prone health behavior” or “readiness for enhanced self-care”—(my hypothetical client states he never uses sunscreen) a risk factor for skin cancer. I could also use Readiness for enhanced health management because now he has to have surgery and use a topical cream as treatment.) Readiness for enhanced health management re: surgical procedure, use of topical fluorouracil and sun screen. List one “risk for” nursing diagnosis for the condition you listed above in section 5. Risk diagnoses are described in tables 5-1 and 5-2, and in Appendix C in each of the domains, but particularly in Domain 11. They usually begin with the words, “Risk for….” Here I could, for instance, use Risk for impaired skin integrity (he already has current impaired skin integrity, but now he is a risk for extending that, or Risk for delayed surgical recovery— the area is in a place that his hat could rub-- ) Risk for delayed surgical recovery due to location of lesion, on the top of his ear where his hat rubs. List EITHER one “Collaborative Problem” that would be appropriate for a client with the condition described in section 5, above OR list an actual nursing diagnosis from Appendix C. Collaborative problems are describe in table 5-2 and are listed in Appendix D. They begin with “Risk for Complications (RC) of….” Actual nursing diagnoses are scattered through Appendix C Students, I could use something like Risk for Complications of antineoplastic therapy adverse effects due the fluorouracil, or I could list an actual ND like “impaired tissue integrity.” (since the lesion has extended deep into the auricle, I chose it rather than impaired skin integrity. RC of Antineoplastic Therapy due to use of fluorouracil.
PLEASE THE ASSIGNMENT IS IN TABLE FORM. HOPE YOU UNDERSTAND
Current symptoms :Ears
External ears structures(TAB 1)
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.etc till no.5	Assessment findings(TAB 2)

Auricle is 6.5 cm vertical dimension, rounded, and light brown flesh-colored bilaterally (in keeping with client's skin color.) No lesions or tenderness bilaterally. Tragus is triangular, non-tender, no lesions, color consistent with auricle, no piercings bilaterally. Lobules are attached, with one piercing bilaterally, nontender without lesions bilaterally.
Auricle and mastoid process are without lesions, and client denies tenderness; auricle is flexible and soft.

Current Symptoms: Ears >Assessment Findings External Ear Structures >1. Inspect the auricle, tragus, and lobule for size and shape, bilaterally. Describe bilateral position, lesions/discoloration, and discharge. Auricle is 6.5 cm vertical dimension, rounded, and light brown flesh-colored bilaterally (in keeping with client's skin color.) No lesions or tenderness bilaterally. Tragus is triangular, non-tender, no lesions, color consistent with auricle, no piercings bilaterally. Lobules are attached, with one piercing bilaterally, nontender without lesions bilaterally.

2. Palpate the auricle and mastoid process bilaterally. Describe findings, including symptomatology or tenderness if they are present. Auricle and mastoid process are without lesions, and client denies tenderness; auricle is flexible and soft. 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.) Auditory canals: smooth walls, slightly pink color, no nodules bilaterally. Dark brown cerumen is present in the right canal, left canal has no visible cerumen. 4. Inspect and describe the tympanic membranes bilaterally, using the otoscope, for color and shape, and The tympanic membranes on the right cannot be visualized due to brown cerumen blocking the ear canal; the left tympanic membrane appears round, smooth, and pearly gray. The cone-shaped reflection of the otoscope light is landmarks. reflected at 7 O'clock. 5. List a common ear disorder or abnormal assessment finding that would be discoverable in an ear or hearing assessment on a hypothetical patient. (You may include the medical diagnosis, but it is not required. You may select a problem that has not yet been diagnosed since this is a very realistic scenario—often nurses are the one who discover problems first and then refer the client.) The patient has been diagnosed with a basal cell carcinoma on his right auricle, but has not yet been treated. Surgical removal and use of fluorouracil cream are planned by dermatologist beginning next week. Skin lesion is on the very top of the auricle and extends over both the front and back of it. The lesion is rough/uneven, 6 mm at largest diameter, and has a small amount of yellow discharge dried around the edges. The edges of the lesion appear "rolled" and pink. The lesion is non-tender. Patient states he never has used sunscreen. Adapted from Weber, Kelly & Sprengel, 2014: Lippincott, with permission. 
Using the diagnostic reasoning process described in chapter 5 of your textbook, synthesize one of each of the three types of nursing diagnoses described below for a potential client with the problem you listed in area #5, above. You will use the three of the types of nursing diagnoses (ND) described in Chapter 5 of your Weber and Kelley textbook: synthesize one of each of the three types of nursing diagnoses described below for a potential client with the problem you listed in area #5, above.
      1. A Health Promotion ND 
      2. A Risk ND and
      3. Either a Collaborative Problem OR an Actual ND. 
You will find a list of possible diagnoses in Appendix C and D in your textbook. 
Synthesis(TAB 1). Instructions/Items to include(TAB 2)Nursing Diagnosis(TAB 3)
List one “Health Promotion” (HP) nursing diagnosis appropriate for your client with the condition you describe in section 5, above. (Do not use “none at this time.”)




n0 2 UNDER  SYNTHESIS: List one “risk for” nursing diagnosis for the condition you listed above in section 5.



N0.3 UNDER SYNTHESIS List EITHER one “Collaborative Problem” that would be appropriate for a client with the condition described in section 5, above OR list an actual nursing diagnosis from Appendix C	Instructions/Items to include
Health Promotion (HP) nursing diagnoses often begin with “Readiness for enhanced learning” as described in Appendix C of your textbook, under Domain 1. They are also discussed in Table 5-1 and 5-2.




Risk diagnoses are described in tables 5-1 and 5-2, and in Appendix C in each of the domains, but particularly in Domain 11. They usually begin with the words, “Risk for….”


Collaborative problems are describe in table 5-2 and are listed in Appendix D. They begin with “Risk for Complications (RC) of….” Actual nursing diagnoses are scattered through Appendix C	Nursing Diagnosis
(Note to students: you are listing a hypothetical patient, so you can assume a few things if you want to. For instance in Appendix C for a HP ND I could use “Risk-prone health behavior” or “readiness for enhanced self-care”—(my hypothetical client states he never uses sunscreen) a risk factor for skin cancer. I could also use Readiness for enhanced health management because now he has to have surgery and use a topical cream as treatment.) Readiness for enhanced health management re: surgical procedure, use of topical fluorouracil and sun screen.

Here I could, for instance, use Risk for impaired skin integrity (he already has current impaired skin integrity, but now he is a risk for extending that, or Risk for delayed surgical recovery— the area is in a place that his hat could rub-- ) Risk for delayed surgical recovery due to location of lesion, on the top of his ear where his hat rubs

Students, I could use something like Risk for Complications of antineoplastic therapy adverse effects due the fluorouracil, or I could list an actual ND like “impaired tissue integrity.” (since the lesion has extended deep into the auricle, I chose it rather than impaired skin integrity. RC of Antineoplastic Therapy due to use of fluorouracil.

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