Introduction

As a part of my hospital posting I was posted on “Ent” ward of RIMS hospital,

there I selected Mr. Vinod Kumar of 21 year old. He was elimitted on 5/2/2017
with the complain of Excessive ear ache and hearing impairment .the doctor
diagnosed the condition is “External otitis.’’
Identification data

Name of the patient _ Mr .Vinod kumar

Age/sex _ 20years/Male
Education _ Intermediate
Occupation _ Student
Religion _ Hindu
Marital status _ Unmarried
Address _ Bariatu, Ranchi
Date of admission _ 5/2/17
Date of discharge _ 7/2/17
Registration on _ Icd-550
Ward no _ Ent
Bed no _ 07
Diagnosis _ External otitis
Present medical histor
Mr. Vinod kumar come to the Rims hospital on 05/02/20
with complain of encessive ear ache, and hearing
impairment.

Past medical history

Mr.Vinod kumar has no any medical history since last 2
year.

Present surgical history

Mr. Vinod kumar has not undergone through any kind of
surgery in present.

Past surgical history

Mr.Vinod kumar has not undergone through any kind of
surgery in past.

Family history
S.No Name Age/sex Relationship Education Occupation Health
with patient status

1. Mr. 78/M Grandfather Healthy

Dinesh
Ram
- -
2. Mr. 60/M Father Graduate Teacher Healthy
Vivek
kumar
3. Mrs. 50/F Mother Matic House wife Healthy
Rasham
Devi
4. Miss. 17/F Sister 10th std Student Healthy
Kavya
kumara
5. Miss .Su 10/F Sister 4th std Student Healthy
ma
kumari
6. Mr. 21/M Self Intermediate Student Healthy
Vinod
Kumar

FAMILY TREE
 Sushmita Devi
Nilesh Prasad 62 Years
70 Years

Nikita Devi
Vinod Prasad 34 Years
35 Years

Ritika Kumari Reena Kumari

10 Years 8 Years

Keywords:-
Male
Female

Female Patient
 Socio-economic history
Mr.Vinod kumar belongs to middle class family his
father is only the earning member of his family that
consist of total 6 members.
Personal history
Personal hygiene
Oral hygiene once a day
Agent - Colgate
Bath - once a day
Agent –soap
Breakfast- yes
Lunch-yes
Dinner-yes
Sleep and rest
Mr. Vinod kumar takes rest far about 6-7 hours a
day during night.
Elimination
Bowel elimnation frequency: - once a day
Urine output frequency: - 3-time a day

Housing
Type - pakka
No of room - 4 rooms
Water supply - supply water
Electricity - available

Physical examination
Vital sign : -
Temperature- 99 degree f
Pulse - 80 beats/mins
Respiration -20 breaths/mins
Blood pressure – 130/80 mmhg

General appearance and behaviour

Gender – male
Body built – thin
Nourishment - wel nourished
Activity - decreased
Appearance - dull
Height - 5.8 inc
Weight - 65kg

Integumentary system
Skin – normal, no lesion found
Moisture – dry
Colour-fail
Tenture-normal
Tone- well toned

Eye
Colour- black
Eye ball-oval
Conjunctiva-normal
Pupil-reaction time is normal

Ear
External ears -discharg is come out
Hearing - impaited

Nose
External nares - no inflammation

Nostril- no dioscharges found

Mouth
Lip-pink

Odour- no bad odour

Teeth-white

Gums-pink

Neck
Lymph node- no enlargement

Thyroid gland-no enlargement

Chest
Auscultion-s1 s2 sound heared

Polpation-normal

Abdomen
Inspection-no any lesion

Auscultation-heared bowe sound

Polpation- no tederness found

Percussion- normal

Extermities: -
Movement of joints- normal movement
Ankles- normal

Genital
Discharge-no any discharged
Sexual transmitted disease – absent

Rectum
Discharge- no any discharge
Haeorrhoid-absent
Anatomy and
physiology
 Anatomy of ear : external ear
The external ear include the auricle and the external auditory
canal . The external ear is seperated firm the middle ear by a
disk – seperated from the middle ear by a disk – shaped
structure called the tymponic membrane.

1 .auricle:-

The auricle attached to te side of the head by skin, is composed mainly

of cartilage except for th fat and subcrtaneous tissue in the earlobe.
The auricle collects the sounds waves and directs vibration into the
external auditory canal.

2.external auditory canal:-

The enternal auditory canal is opproximately 2-3 cm long.the lateral
thiral is an elastic cartilaginous and dense fibrous framework to whish
thin skin is attached .the medium two thirds is bone lived with thin skin.
 Anatomy of middle ear:
The middle ear, an air filled cavity, includes the tympanic
membrane laterelly and the otic capsule medially . The middle
ear cleft lies betweet the two.

Tympanic membrane:-
The tympanic membrane (eardrum),about 1 cm in diameter and very
thin is normally pearly gray and translucet t consist of three layers of
tissues:-

1. An outer layer
2. Inner mocosal layer
3. A fibrous middle layer

Ossicles:-
The middle ear contains the three smallest bones (the ossicles) of the
body:the malleus the incus and the stapes .the ossicle which are held in
pluceby joints muscles and ligaments, assist in the transmssion of
sound.
Anatomy of the inner ears:-
The inner ear is housed deep within the tempared bone. The argans for
hearing (cochlea) and balance (semicircular) canals, as well as cranial
nerves vii (facial nerve) and viii (vertibile cochlear nerve) are all part of
this complan anatomy.

Membranous labyrinth
The mambranous labyrinth is composed of the utricle the sacule the
cochlear duct the semicircular canal and te organ of corti all of which
are surround by a fluid called endolymph.

Organo of carti
The organ of carti is housed in the cochlea, a snail shaped bony
tube about 3.5 cm long with two and a half spiral turns.
Membranes seperated the cochlear duct (scal media) form the
scala vestibili and the scala tympani form the basilar
mambrane.
Dissase
Condition
 External otitis
Introduction:-
External otitis is the infection and inflammation of the external
ear. There are various causes that leads to otitis media.

Definition
External otitis refers to an inflammation of the external
audotory canal.

Etiology
Water in the ear canal (swimmers ear)
Traccma
Vitamin deficiency
Bacterical /fungal infections
(staphylococcus aureus and pseudomonas species aspergillus)
Dermatosis- psariasis ,eczema,seorrhcic
Dermatitis.
 Clinical mainfestation

Book Picture Patient Picture

Pain Pain
Discharge from the external Present
auditory canal
Aural Occasionally fever
Occasionally fever

Cellulitis Pruritis
Lymhodenopathy

Pruritis
Feeling of fullness
Hearing Loss
Hearing Impairment
Feeling of fullness

Hearing Impairment
 Dianostic Evaluation
Book picture Patient Picture
History collection History collected
Physical examination Physical Examination
CT-scan and MRI --
Radionuclide Scan Radionuclide scan

Madical Management
Book Picture Patient picture
Ear irrigation Ear irritation
Antibiotic therapy Antibiotic therapy
Analgesics Analgesic
Acidifying
 Nursing Diagnosis
1) Acute pain related to ear infection as
evidenced by folial expression.
2) Disturbed sensory perception related to
obstruction infection of the external ear
as evidenced by verbalization.
3) Impaired verbal communication related
to the effects of hearing loss.
4) Social Isolation related to pain foul
smelling otorrhoea.
5) Knowledge deficit related to cognitive
limitations and lack of interest in
learning.
 Day to day prognosis Note
1st day
General Condition
Temperature-99 degree

Respiration- 24 breath/min

Pulse-82 beat/min

Spo2-96%

Patient complain
I am having problem in sleeping at night.

I am not able to eat anything.

I am suffering form pain.

Doctor advice
Take medication as per time.

Proper eating is maintained.

NURSING MANAGEMENT
Give to the patient soft diet.

Help him to clean the infected ear.

Provide calm environment to improve sleep.

Give analgesic as per docter order.

2nd day
General condition
Temprature - 98degree F

Pulse – 80 beat / min.

Respiration- 24breath/min

Blood presser-120/80mmHg

SPo2-96%

Patient complain
Weakness
Fullness felling

Hearing impairment

Not able to eat

Doctor’s advice
Take rest properly

Clean ear properly

Take all the medication.

Nursing management
Give nutries died.

Give medication as per docer order.

Help him to clean the infeeted area.

Adviced to take proper sleep and rest.

HEALTH EDUCATION
Personal hygienes
 Adviced the patient to maintain personal hygiene like bathing,
hair care, brushing and not poring water in ear during bathing.
Change dress daily and clean body with the shop and antiseptic
solution.
NUTRITION
Encourage the patient to eat small amount of protein rich diet for
improve health.
Adviced the patient to maintain adequate amount (6 glass) fluid
intake.
Adviced the patient nat to scape any male.
Avoid sicy and oily food.

Rest and sleep

 Adviced the patient to sleep daily at lest 6-7 hour per night.
Adviced the patient to avoid day time sleep
So that at night no problem of insommia .
Adviced the atient to maintain regular sleep chedules and avoid
anxiety.
 Exercise
Adviced the patient for passive and active exercise.
Adivice the patient to maintain the body movement.
Adviced the atient to walk daily for 30min if he is able to walk.

Medication and follow up

 Adviced the patient to take medicine according to doctors
order.
 Adviced the patient to take medicine in correct time,
 Adviced the atiet do not scape medication in any how.
 Adviced the patient come regularly for follow up check up
and proper explore if any side effect and sign and symptoms show
during medicine taking.
 Summary
Mr.Vinod kumar come to hospital RIMS with the
complain of encessive ear ache and hearing impairment .
After investigation the disease was diagnosed as external
otitis by the physician .External otitis the infection and
inflammation of the external ear that causes ain and
hearing impairment which was similar to the Vinod
kumar complain.
 Conclusion
This medical case study is an “External otitis”. While completing
this case study I practically come to know about the disease
condition as well as the management of external otitis and the
patient was very Co-operative.
 Bibliography
1) Brunner and suddhartha : A textbook of
Medical surgical nursing publication,12th
Edition, Page No -189-182.
2) Sr.Nancy: Principle and Practice of Nursing 1 st
volume, age No:-174-175.
3) Javed Ansari : A textbook of medical surgical
Nursing – Page No- 22 – 24.