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Nurs*150 - Health Assessment Scholarly Assignment

The human ear is an important sensory organ that allows us to hear and
maintain equilibrium. It plays a crucial role both in development and throughout life.
Infants and children tend to have a reoccurrence of ear-related ailments due to the
shorter and wider Eustachian tube and the angle in which is positioned (Jarvis,
2014). This is a concern because the ear plays an important role in an infants
ability to learn how to speak, since they must hear language first. It is also a
concern because the ear affects their ability to stand up and walk by providing them
with the ability to balance themselves. Anytime a nurse is doing an assessment on
an infant/child, whether they have a respiratory infection or a fever, the ears should
always be examined.
For this assignment, an 18 month old infant has been brought in for in for an
assessment. His parents are concerned because he has yet to start walking and his
only form of verbal communication is the occasional mama or dada. In addition,
they have noticed an amber coloured discharge or blood staining on the blanket
some mornings. For this assignment, I have chosen to focus on the following two
aspects for his ear assessment, firstly I would want to do an otoscope exam and
secondly I would want to conduct a hearing test. My concern is that the infants
hearing is affected. I believe that because the infant has only spoken two words, is
unable to communicate verbally and does not respond to his parents when they
speak to him, means his hearing may be impaired. Using the otoscope would allow
me to determine whether there is a potential cause for impaired hearing, and
conducting a hearing test would allow me to determine the extent of the impaired
hearing. The following paragraphs will explain my rationale for why I chose these as
my priority areas for this infants ear assessment and how they can allow me to
determine if his hearing is impaired to some extent.
My first priority of the ear assessment would be to examine the infants ears with
an otoscope. My concern is that the infant may have an infection that is affecting
his ability to hear, since he has a history of being prescribed antibiotics for recurrent
illnesses and because of the discharge. Using an otoscope would allow me to
visualize whether there are any abnormalities or signs of infection within the ear
itself.
I would want to use a pneumatic bulb on the otoscope to assess the infants
eardrum during the inspection. The bulb blows a puff of air into the ear causing the
ear drum to move inwars and then outwards based on the change in pressure. If the
infants ear drum does not vibrate or move I would be concerned that the child
could have otitis media- since it interferes with the mobility of the eardrum (Mosby,
2013). The ear drum is important for sound conduction because it must pass
vibrations to the middle ear in order for vibrations to be converted into electrical
signals which are sent to a nerve in the brain to tell us what we are hearing (Bios
101 lecture on October 1st 2013). If the eardrum is not functioning then the infant

will not be able to convert the sounds to vibrations, therefore affecting his ability to
hear.
While looking in the infants ear, I would also want to take note of any signs of
inflammation. Inflammation could be a sign of infection or a foreign body being
present. Using the otoscope I could see if there are any visible wounds or growths
within his ear canal that could cause inflammation, or whether the inflammation is
more likely to be caused by infection. The otoscope would also allow me to view if
there are any foreign objects stuck in the infants ear that are impeding his hearing
ability. Kids are known to stick objects in their orifices out of curiousity. If the infant
stuck, something in his ear and his parents failed to notice, it could be affecting his
hearing in the ear the object was stuck in. the discharge could be a result of the
bodys attempt to force a foreign object out of the ear. Both inflammation from
infection or a foreign body and an impeding object could impair the infants hearing.
Next, I would look if there is any cerumen and if there is any discharge. The
consistency and abundance of cerumen could impact his ability to hear. If there is
an overabundance of wax or the wax is impacted, hearing can be reduced
dramatically. Conductive hearing loss can be caused by impacted cerumen. Infants
are at a higher risk for occlusion due to the different shape of their Eustachian tube
(Jarvis, 2014). The colour and amount of discharge can indicate what may be wrong.
If the discharge is purulent, it is more likely the ear is infected, because pus
coloured discharge is abnormal and is the bodys defense mechanism to try to
eliminate pathogens. All of the above could lead to pain and interfere with his ability
to hear his parents speaking to him, hence why he may not be responding to them,
and come across as being stubborn.
It is important to note that I would compare all findings bilaterally. Often with ear
ailments, only one ear will be affected or one of the ears could be more severely
affected than the other ear. The otoscope would be one of my priority assessments
because it would be able to provide me with abundance of objective data that will
contribute to the next steps for this patient in terms of treatment or prevention.
My second priority would be to conduct a hearing test. Performing a hearing test
would allow me to determine the extent of the infants hearing impairment and
whether any hearing loss has occurred. The parents stated that the infant is failing
to expand his vocabulary and communicate, in addition to him not responding or
being aware of his parents trying to communicate with him. My concern is that the
child is behind in developmental milestones for his verbal communications and
language abilities, in that he should be able to speak more than two words. By
eighteen months, an infant should be able to speak a dozen words as well as
combine two words together (CDC 2012). It is possible that because he is suffering
from impaired hearing, he is not able to pick up on language and learn what his
parents are saying.

It is important to note that some antibiotics can in fact cause ototoxicity and can
result in hearing loss. Ototoxicity is known to be caused by Aminoglycosides,
therefore I would want to pay close attention to what antibitoics the infant was
prescribed for his previous illness. If the antibitoics prescribed can cause ototoxicity,
then my concern would be that the infants hair cells have been damaged. In which
case, they do not regenerate and the infants ability to hear would be decreased,
therefore affecting their ability to learn how to verbally communicate. Damaged hair
cells results in the vibration in the ear canal not being able to be converted into an
electrical signal as efficiently which can affect how it will travel to the brain through
a nerve.
To perform a hearing test, I would want to use my hands to clap around the
infant, from a safe I would use my hands to clap on all sides of the infant, to
determine where he is having difficulty hearing from. I would also want to determine
whether he needs to see me in order to observe a visual response from him. If the
infant only responds, whether it is with noise or facial expression or by stopping
what he is doing to focus on the noise when I am within his visual field, then I would
worry that his hearing is in fact impaired because it is necessary for him to see me
to acknowledge what I am doing.
In conclusion, my priority for this infants ear assessment would be to determine
if he has impaired hearing based on the data presented and gathered from the
examination. In order to determine both the cause and extent of hearing
impairment, I would first use the otoscope for examination and then use a hearing
test for part of my objective data collection. Hearing is crucial for an infant to reach
the developmental milestones of verbal communication and language, in addition to
their ability to walk, by affecting their balance. It is the nurses responsibility to
obtain a thorough subjective and objective exam assessment, in order to determine
the next steps for the patient while providing client-centred care.

References:
Centre for Disease Control. (July 5th 2012). Important Milestones: Your Child at
Eighteen Months. In Centre for Disease Control and Prevention. Retrieved November
6th 2013 from http://www.cdc.gov/ncbdd/actearly/milestones-18mo.html
Jarvis et al. (2014). Physical Examination and Health Assessment, Canadian Edition
(2nd ed.). Saunders Canada.
Mosby (2013). Mosbys Dictionary of Medicine, Nursing & Health Professions (9 th ed.)
Mosby.
Hirst, S., and Niell, S., (2013). Treatment of acute otitis media in childhood. Practice
Nursing 2013, vol. 24 (8). Retrieved November 6 th 2013 from

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