RETURN DEMONSTRATION TOOL EVALUATION FOR:

Assessing the Ears and Hearing Acuity

Name: _____________________________________ Grade: _____________
Time started: ____________ Time ended: ____________ Date of RD: ________________________

AREA FOR EVALUATION RATING COMMENTS

SKILLS (35%) 5 4 3 2 1 0
ASSESSMENT /PLANNING
1. Check doctor’s order.
2. Assemble all equipments:
 Otoscope
 Watch with a second
 Tuning Fork
IMPLEMENTATION
3. Identifies client.
4. Explains to the client what you are
going to do, why it is necessary,
and how he or she can cooperate.
5. Washes hands and observes
other appropriate infection control
procedures.
6. Provides for client’s privacy.
7. Determines client’s history of
present health concern of the
following:
 Recent changes in
hearing
 Any ear drainage.
Describe the amount and
odor if any.
 Any ear pain. Use
COLDSPA to explore the
symptoms
 Any ringing, roaring or
crackling in the ears
 Experience like spinning
or the room is spinning.
Feel dizzy or unbalanced.
8. Positions the client comfortably,
seated if possible.
External Ear Structures
9. Inspect the auricle, tragus and
lobule. Note size, shape and
position. Observe for lesions,
discolorations and discharges.
10. Palpate the auricle and mastoid
process.
Internal Ear: Otoscopic Examination
11. Inspect the external auditory
 canal.
 Note any discharge along
with the color and
consistency of cerumen.
 Observe the color and
consistency of the ear
canals and inspect the
character of any nodules.
12. Inspect the tympanic membrane.
Note color, shape, consistency
and landmarks.
Hearing and Equilibrium Test
13. Perform the whisper test.
a.Ask the client to gently occlude
the ear not being tested and
rub the tragus with a finger in
a circular motion.
b.Start with testing the better
hearing ear and then the
poorer one.
c. With your head 2 feet behind
the client (client can’t see
your lips move) whisper a 2
syllable word.
d.Ask the client to repeat it back
to you.
e.If the response is incorrect the
first time, whisper the word
one more time. Identifying the
3 out 6 whispered words is
considered passing the test.
14. Perform Weber’s Test if the client
reports diminished or lost hearing
in one ear.
a. Strike a tuning fork softly with
the back of your hand.
b. Place it at the center of the
client’s head or forehead.
c. Ask whether the client hears the
sound better in one ear or the
same in both ears.
15. Perform the Rinne test.
a.Strike a tuning fork and place
the base of the fork on the
client’s mastoid process.
b.Ask the client to tell you when
the sound is no longer heard.
c. Move the prongs of the tuning
fork to the front of the externsl
auditory canal.
d.Ask the client to tell you if the
sound is audible after the fork
is moved.
16. Perform the Romberg test.
a.Ask the client to stand with feet
 together, arms at sides, and
eyes open, then with the eyes
closed.
EVALUATION/DOCUMENTATION
1. Documents findings in the client’s
record.
KNOWLEDGE: (15%)
1. Gives rationale of the procedure.
2. Explains the elements and
mechanics of the procedure.
3. Knows the elements of nursing
process as applied.
4. States principles applied in the
procedure.
ATTITUDE: (10%)
1. Is well groomed.
2. Wears prescribed, neat, and clean
uniform.
3. Arrives on time for the RD.
4. Speaks to CI and client tactfully.
5. Minimizes use of energy, time, and
effort
6. Utilizes supplies efficiently.
7. Considers client’s safety, privacy, and
comfort.
8. Is well organized.
9. Keeps working area clean at all times.
10. Gives high value for aesthetics.

Comments: _______________________________________________________________
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Clinical Instructor’s signature: ____________________________________