Republic of the Philippines

UNIVERSITY OF EASTERN PHILIPPINES

University Town, Northern Samar
Web: http://uep.edu.ph Email: uepnsofficial@gmail.com

COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES

PERFORMANCE EVALUATION CHECKLIST

ASSESSING EARS

ABLE TO ABLE TO UNABLE

PROCEDURE PERFORM PERFORM WITH TO
(2) ASSISTANCE PERFORM
(1) (0)
Nursing Interview Guide to Collect Data from the Client
Current Symptoms
1. Recent changes in hearing (if yes, were all or
just some sounds affected)?
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 in ears?
Past History
1. Previous ear or hearing problem such us
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 work around frequent or continuous loud
noise?
2. Use of ear protection from noise or while in
water?
3. Has hearing loss affected ability to work or
care for self or noise?

PERFORMING PHYSICAL ASSESSMENT OF THE EARS

External Ear Structures
1. Inspect the auricle, tragus, and lobule for size
and shape, position, lesions/ discoloration, and
discharge.
2. Palpate the auricle and mastoid process for
tenderness.
Otoscopic Examination
1. Inspect the external auditory canal with the
otoscope for discharge, color and consistency
of cerumen, color and consistency of canal
walls, and modules.
2. Inspect the tympanic membrane, using the
otoscope, for color and shape, consistency,
and landmarks.
PHYSICAL ASSESSMENT GUIDE TO COLLECT OBJECTIVE CLIENT DATA
3. Have the client perform the Valsalva
maneuver, and observe the center of the
tympanic membrane for a flutter. (Do not do
this procedure on an older client, as it may
interfere with equilibrium and cause dizziness.)
Hearing and Equilibrium Test
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-
2ft) behind the client. Repeat on the other ear.
2. Perform the weber test by using a tuning fork
placed on the center of the head or forehead
and asking whether the client hears the sound
better in one ear or the same in the both ears.
3. Perform the Rinne test by using a tuning fork
and placing the base on the client’s mastoid
process. When the client no longer hears the
sound, note the time interval, and move it in
front of the external ear. When the client no
longer hears a sound, note the time interval.
4. Perform the Romberg test to evaluate
equilibrium. With feet together and arms at the
side, close eyes for 20 seconds. Observe for
the swaying.
Analysis of Data
1. Formulate nursing diagnoses (wellness, risk,
actual)
2. Formulate collaborative problems.
3. Make necessary referrals.

Remarks: ______________________________________________________________________

Grade: ________

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Clinical Instructor Student’s Signature