Ear Assessment 1 Running head: MR. CHESTNUT’S EAR ASSESSMENT. Mr. Chestnut’s Ear Assessment Jacqueline Benjamin 28" October, 2014 VE MSmeEar Assessment 2 Mr. Chestnut’s Ear Assessment Scenario: Mr. Chestnut is an 89 years old client who has just had a big gathering of family members at his bedside for a visit. The family members had just brought in drinks and snacks to celebrate Mr. Chestnuts birthday. He is quiet anStaring out the window. His name has to be called out loudly before he hears. His vital sj ‘emperature-38.0C, Respiration-22, Oxygen Saturation-98, and Blood Pressure-138/96mmlHg. He is comfortable in bed and reading his newspaper. In this scenario, Mr. Chestnut is celebrating his 89" birthday and he has a large group of family members around his bed who are having a grand celebration with him, Mr. Chestnut does not show any signs of excitement, agitation, pain, or discomfort. He seems very calm and he is relaxing comfortably in bed while reading the newspapers, but he only responds to loud speech. However, his temperature, respiration, and diastolic blood pressure seem slightly elevated. Mr. Chestnut’s response to only loud speech indicates that his hearing needs to be assessed. The elevation in his diastolic blood pressure above the normal range of 60 - 90 and his temperature approximately 0.70°C above the normal limits are indicators that his vijaf signs need to be rechecked. The two priority areas of ear assessment that would bgocus on for Mr. Chestnut will be (i) An Otoscopic Examination, and (ii) A Hearing Acyity Zest. Choosing to perform an Otoscopic examination and, Mr. Chestnut’s age and his response to loud speech onlf. At his age, he is more likely to experience decrease in hearing due to sound waves being prevented from readily reaching his tympanic membrane (ci is may be due to loss of flexibility of the cilia in the external auditory meatus (ear canal, or excessive amounts of cerumen. Mr. Chestnut’s hearing couldBar Assessment 3 have also been affected by scarring of his tympanic membrane as a result of possible past ear infections. As stated in Physical Examination and Health Assessmght Canadian Edition, 2" Edition, “presbycusis is a type of hearing loss that occurs withy4ging, even in people living in quiet environments. Itis a gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve” (Jarvis, Browne, MacDonild, §/ Luctkar-Flude, 2013). Mr. Chestnut may also be suffering with presbycusis. Mr. Chestnut may also have an infection based on the elevation of his body temperature which is above the normal value. The elevation in his body temperature may be unrelated to an ear infection and needs to be ruled out before satin Se are done for other infections, e.g Urinary Tract Infection (UTI) of Ypfer Respiratory ‘Tract Infection (URTI). Using an Otoscope, Mr. Chestnut will be given an external ear canal assessment where ok +. documentation will be made of any unusual colour, swelling, lesions, or discharge from the ear ee @7 canal, or an accumulation of cerumen in the canal. A tympanic membrane inspection will also be Sy OAS Deanit out to ensure there is no damage to the i the membrane looks normal, Xp shiny, translucent and pearl grey in colour (Jarvis, et @J/S013). This will rule out any middle ear y \ ree which can cause an elevation in temperature, but he has no observable discomfort so he may not have a middle car infection (otitis media). ‘The Hearing Acuity Test will involve assessing Mr. Chestnut’s response to whispered voice, and using a tuning fork assesses his response to the Rinne’s test and the Weber's test. In performing the Whisper Voice test, Mr. Chestnut will block one ear while any two-syllable word will be whispered into his unblocked ear. He will be asked to repeat the whispered word to verify that he heard is the word that was whispered to him, he Rinne’s test will also be performed on ‘Mr. Chestnut using a 512 or 128Hz tuning forlsThis tuning fork will be hit to the palm of theEar Assessment 4 nurse’s hand then placed on the patient's mastoid process and the patient will be ask to say when he is no longer feeling the vibration of the tuning fork. When he no longer feels the vibration, the tuning fork will then be placed close to the external auditory meatus. Mr. Chestnut is again asked to say whether he hears the sound of the tuning fork, If he hears the sound, this indicates that air conduction is greater than bone conduction which means that the Rinne’s test is normal for the tested ear. The same procedure is repeated on the other ear. The Weber test will be carried out on Mr. Chestnut using a tuning fork. The tuning fork will be struck in the nurse’s palm and placed on the superior area of Mr. Chestnyt“s forehead. He will be asked to say if he hears the sound of the tuning fork, and if therg6 any difference in the volume on either side. If there is no difference, then the test is normgf. Any lateralization of the sound indicates that an abnormality exist in his hearing, In this scenario, Mr. Chestnut will probably have lateralization to one ear indicating that he may be experiencing conductive or sensgzifieural deafness. The patient’s assessment will be documented and he will be referred tga Audiologist for further evaluation of the hearing disorder. The Audiologist will diagnose the level of Mr. Chestnut’s hearing disorder and prescribe treatment accordingly. Ifthe findings from the ear assessment does not have any connection to the elevation temperature then additional i for Mr. Chestnut in order to find the under lying cays€. If Mr. Chestnut is not on medication for his blood pressure (BP) then he needs to be evaluated by his attending physician for further management. Based on Debbie Tolson (1997), nurses have af important role to play in helping to identify hearing deficits in the elderly and be able yo’assist in having these patient properly ©. — nth es ed anhigott MS managed and treated by the appropriate NeEar Assessment 5 References Agitation. (n.d). In Dictionary.com online. Retrieved from http://dictionary.reference.com/browse/agitation Jarvis, C., Browne, A., MacDonald-Jenkins, J., & Luctkar-Flude, M. (2013). Physical Examination and health assessment, Canadian edition, 2" edition. Toronto, ON: Elsevier Saunders. Tolson, D. (1997). Age-related hearing loss: a case for nursing intervention. 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