MSN QUESTION BANK- UNIT 1- ENT LONG ESSAY 5M 1) Explain post operative management of Mast is. Mastoiditis is an infection of mastoid process, the portion of the temporal bone of the skull that is behind the ear which contains open, air containing spaces. Surgical management for mastoiditis includes: Myringotomy (a small incision is made in the tympanic membrane which helps to drain the pus from middle ear), Mastoidectomy i.c. simple, radical or modified radical mastoidectomy (removal of diseased tissue or the source of infection) * After surgery on the middle ear: comfort, safety, prevention of infection, and prevention of pressure on the tympanic membrane. * Nausea common ist patient first time out of bed, in case of dizziness. nt should avoid activity that creates pressure on the tympanic membrane(blowing the nose, coughing, sneezing, straining) Medical management: # Inspect the dressing and describe drainage but do not disturb or remove the dressing. * Medications: to prevent like hood of complications © High dose of broad spectrum iv antibiotics for at least 48 hours (© Oral antibiotics may be used after 48 hours if clinically improving © Analgesics © Antipyretics Nursing management: NURSING DIAGNOSIS: Anxiety related to surgical procedure, poter expression, loss of hearing as manifested by facial © Reinforce the information discussed by otologic surgeon. © Explain regarding the anesthesia, location of the ini ‘outcome. mn, and expected surgical isk for infection related to mastaidectomy. © The extemal auditory canal wick or packing may be kept with an antibiotic solution before instillation. Prophylactic antibiotics are administered as prescribed. Instruct the patient to prevent water from entering the extemal auditory canal for 6 weeks. © Place cotton balls or lamb wool covered with petroleum jelly loosely in the ear canal to prevent water contamination. * Report signs and symptoms of infection.Disturbed auditory sensory perception related to surgery ar packing as manifested by presence of surgical dre: fe To improve hearing: Reduce environmental noise. Facing the patient while speaking. Speak clearly and distinct. Provide good lighting if the patient relies on speech reading and use of non verbal clues. Instruct family members about the effective way to communicate with the client. Patient teaching after surgery: Take antibiotics and other medications as prescribed. Blow nose gently onc side at a time for 1 week after surgery. Sneeze and cough with mouth open for few week after surgery. Avoid heavy lifting, straining and bending over for a few week after surgery. Crackling sensations in the operated car are normal for approximately 3 to 5 weeks after surgery. Temporary hearing los: packing in the ear. Report excessive purulent discharge to the physician. Change the cotton balls in the ear as needed. Avoid getting wet in the operated ear for 2 weeks after surgery. Do not shampoo for one week. normal in the operative ear duc to fluid, blood, or (reference: Brunner &Suddarth’s, textbookof Medical-Surgical Nursing; South Asian edition, Vol 1 Walters Kluwer. Page no: 1605 2) List the causes and management of Epitaxis. Epitaxis is a hemorthage from the nose, generally common in all age groups. Causes of epitaxis: Local: © Nose: ic, in the nose or nasopharynx i, Trauma — finger nail trauma, injuries of nose, intranasal surgery, fractures of middle third of face and base of skull, hard blowing of nose, violent sneeze. ii, Infections: Acute: viral rhinitis, nasal diphtheria, acute sinusitis. Chronic: all erust forming dis . atrophic rhinitis, rhinitis sicca, tuberculosis, syphilis, septal perforation, granulomatous lesion of nose. Foreign bodies: nonliving:any neglected foreign body, rhinolith. Living: maggots,lecches. iv. Neoplasm of nose and paranasal sinus Malignant: carcinoma or sarcoma, v. Atmospheric changes: high altitudes, sudden decompression. vi. Deviated nasal septum. © Naspharynx: i. Adenoiditis ii, Juvenile angiofibroma : benign: haemangioma.iii, Malignant tumors + General caus a) Cardiovascular system: hypertension, atherosclerosis, mitral stenosis. b) Disorders of blood and blood vessels: aplastic anaemia, leukemia, thrombocytopenia and vascular purpura, haemophilia, scurvy, vit deficiency, Christmas disease. ¢) Liver diseases: hepatic cirrhosis. d) Kidney disease: chronic nephritis €) Drugs: excessive use of salicyclates and other analgesics, anticoagulant therapy 1) Mediastinal compression g) Acute general infection: influenza, measles, chickenpox, whooping cough, rheumatic fever, typhoid, pneumonia, malaria, dengue fever. Management of epitaxis: Management of epitaxis depends on its cause and the location of the bleeding site. ‘A nasal speculum, penlight, or headlight may be used to identify the site of bleeding in the nasal cavity. Initial treatment may include applying direct pressure. The patient should sits upright with the head tilted forward to prevent swallowing and aspiration of blood © Itis directed to pinch the soft outer portion of the nose against the midline septum for 5 or 10 minutes continuously. * Medical management © Application of decongestants (phenylephrine, one or two sprays) © Visible bleeding sites may be cauterized with silver nitrate or electrocautery. © Asupplemental pateh of Surgicel or Gelfoam may be used. ° ° Cotton tampon may be used to try to stop the bleeding. Ifthe origin of the bleeding cannot be identified, the nose may be packed with gauze impregnated with petrolatrum jelly or antibiotic ointment, © A topical anesthetic spray and decongestant agent may be used before the gauze packing is inserted, or ballon inflated catheter may be used. ¢ Nursing management: NURSING DIAGNOSIS: Risk for bleeding. ‘© Monitor the patients general condition. © Monitor vital signs. # Monitor the amount of bleeding patients. * Monitor the event of anemia. Ineffective airway clearance. ‘Asses the sound or the depth of breathing and chest movement. Note the ability to remove mucous’ coughing effectively. Give fowlers or semi fowlers position. Clear secretions from the mouth and trachea,Acute pain, © Assess the level of pain ‘© Teach relaxation and distraction techniques. © Observe vital signs. Patient education about sclf care: Avoid vigorous exercise for several days. Avoid hot or spicy foods and tobacco. Discharge education includes reviewing ways to prevent pitaxis. Avoid forceful nose blowing, straining, high altitude and nasal trauma. ‘Adequate humidification may prevent drying ofthe nasal passages. Reference: Brunner &Suddarth’s, textbookof Medical-Surgical Nursing; South Asian edition, Vol | Walters Kluwer. Page no: 1603 3) Explain the rehabilitation of patients with hearing loss. ‘Aural rehabilitation is the process of identifying and diagnosing a hearing loss, providing diferent types of therapies to clients who are hearing impaired and implementing different amplification devices to aid the clients hearing abilities. The purpose ofthe aural {he hearing impaired client's communication skills. rehabilitation is to maxir ‘Aural rehabilitation is multifaceted process that includes auditory taining (listening) speech reading (lp reading) and the use of hearing aids 1. Hearing aid orientation: The process of providing education and therapies to persons (individual or group) and their families about the use and expectations of wearing hearing ads to improve communication. ening strategies: The process of teaching hearing impaired persons common and altemative strategies when listening with of without amplification to improve theit communication 3. Speech reading: The process of using or teaching the understanding communication using visual cues observed from the speakers mouth, facial expressions, and hand movements, 4, Auditory training: The process of teaching an individual with a hearing los the ability to recognise speech sounds, pattems, words, phrases or sentences via audition. 5. Unisensory: Therapy philosophy that centers on extreme development ofa single sense for improving communication, {6 Cued speech: The process of using and teaching manual hand or facial movements used to supplement an auditory-verbal approach tothe development of communication competence. 7. Total communication: The process of using and teaching speech, language and communication skills simultaneously using manual communication, speech and hearing.8. Manual communication: The process of using and teaching communication via finger spelling and with a signed language. Reference: Lewis's Medical -Surgical Nursing, Volume-I,page no; 398 4) Explain the management of common cold. The common cold is a viral infection of the upper respiratory tract usually last approximately 7 days associated with a number of viruses. Eg. Rhinovirus, parainfluenza virus Symptoms © Watery eyes © Head ache © Chills ‘© Dryness and stiffness in the nasopharynx Management © Antihistamines © Decongestant * Pain relievers © Nasal strips ‘© Drinking plenty of fluids © Resting © Saltwater gargle © Using saline nasal drops Nursing diagnosis: ineffective airway clearance related to semithick nasal discharge as evidenced by presence of mucus secretion. Ineffective breathing pattern related to airway spasm as evidenced by abnormal breath sounds wheezes and crackles Nursing interventions © Administer analgesics as indicated © Assisting with or providing balanced dictary intake of foods and fluids. References: www.nandanursingeareplan.com, www Slideshare.mob.com, Nebi 5) Describe the nursing management of sinusitis. Sim an inflammation of the mucus membrane of the paranasal sinuses Medical management© Antipyretics © Analgesics © Mucolyties ‘© Nasal decongestant Nursing management * For the first 24 hours after sinus surgery observe the client for nasal bleeding, respiratory distress, orbital and facial edema. + Explain the client to engage in minimal physical exereise. # Teach the client to sneeze only with the mouth open * Nasal saline spray may be started 3 to 5 days after the surgery to remove the mucosa, Nursing diagnosis * Acute pain related to inflammation of nose © Self concept disturbance related to bad breath and a runny nose ‘Nursing interventions ‘© Monitor vital signs © Assess clients level of pain References htp://nursingeareplan.blogspot.com, www.nandacareplan.com, www SlideShare.mob.com 6) Discuss the meaning, causes and clinical manifestations of pharyngi Acute pharyngitis is a sudden painful inflammation of the pharynx, the back portion of the throat that includes the posterior third of the tongue, soft palate, and tonsils. It is commonly referred to as a sore throat. Causes: > Poorly ventilated rooms > Viral infections: droplets of cough, and sneezes, unhygienic hands. It is high in winter and carly spring. > Bacterial infections: caused mainly by Group A beta-hemolytic streptococcus. Clinical Manifestations: © Fiery-red pharyngeal membrane and tonsils, ‘© Lymphoid follicles are swollen and flecked with white-purple exudate, ‘© Enlarged and tender cervical lymph nodes,No cough, Fever(>38.3°C), Malaise, 0° 0 0 ° Sore throat, Vomiting, Anorexia, 0 0 0 Scarlet fever-scarlatina-form rash with urticarial. Streptococcal pharyngitis produces: ° Painful sore throat Malaise Fever with or without chills Headache Myalgia 0 000 ° Painful cervical adenopathy Nausea Tonsi Petechiae 00 0° Halitosis. Reference: Brunner and Suddharth, Textbook of Medical-Surgical Nursing, South Asian edition, Published by Wolters Kluwer Pvt. Ltd., New Delhi(2018), Page:1561. 7) Explain medical and nursing management of tonsillitis. The tonsils are composed of lymphatic tissue and are situated on cach side of the oropharynx. The palatine tonsils and lingual tonsils are located behind the pillars of the fauces and tongue. The inflammation of these sites are called as tonsillitis. ‘The symptoms include sore throat, fever, snoring, and dysphagia. MEDICAL MANAG: IT: Tonsillitis is treated with supportive measures that include increased fluid intake, analgesics, salt water gargles, and rest. Bacterial infections are treated (first line therapy) or cephalosporins (cefdinir, moxifloxacin). Viral tonsil effectively treated with antibiotic therapy.Y Tonsillectomy continues to be a commonly performed surgical procedure and remains the treatment of choice for patients with chronic tonsillitis. Tonsillectomy is indicated if the patient has had repeated episodes of tonsillitis despite antibiotic therapy. Y The presence of persistent tonsillar asymmetry should prompt an excisional biopsy to rule out lymphoma. NURSING MANAGEMENT: Postoperative cat Y Continuous nursing observation is required in the immediate postoperative and recovery periods because of the risk of hemorthage. Y The most comfortable position is prone, with the patient's head tumed to the side to allow drainage from the mouth and the pharynx. Y The nurse must not remove the oral airway until the patient's gag and swallowing reflexes have returned. The nurse applies an ice collar to the neck, and a basin and tissues are provided for the expectoration of blood and mucus. ¥ The symptoms of complications include fever, pain, and bleeding. Pain can be controlled by analgesics. Occasionally, suture or ligation of a bleeding vessel is needed. If there is no bleeding, water and ice chips are given to the patient as soon as desired. The patient is instructed to refrain from too much talking and coughing, because these activities can produce throat pain. Educating patient about self-care: Y The patient is sent home from the recovery room once awake, oriented and able to drink liquids and void. Y The nurse instructs the patient about the use of liquid acetaminophen/paracetamol with or without codeine for pain control and explains the pain will subside during the first 3-5 days. Y The nurse should explain to the patient that a sore throat, stiff neck, minor ear pain and vomiting may occur in the first 24 hours. Y The patient should eat an adequate diet with soft foods. The patient should avoid spicy, hot, acidic, or rough foods. Milk and milk products may be restricted. The nurse instructs the patient to maintain good hydration.Y The patient is advised to avoid vigorous tooth brushing or gargling because these can cause bleeding. The nurse encourages the patient to use the cool-mist vaporizer or humidifier in the home. Y The patient should avoid smoking and heavy lifting or exertion for 10 days. Reference: Brunner and Suddharth, Textbook of Medical-Surgical Nursing, South Asian edition, Wolters Kluwer Pvt. Ltd., New Delhi 2018, Pages 1563-1564 8, Explain surgical and nursing management of tonsillitis. Tonsillitis is the inflammation of palatine tonsils commonly caused by viral (HSV , Measles) or bacterial infections ( S. arcus , bacterial pneumonia). Surgical management for tonsillitis is tonsillectomy in which both the palatine tonsils are fully removed from the back of the throat, The procedure is mainly performed for recurrent throat infections and obstructive sleep apnea (OSA). Types of tonsillectomy: 1, Cold Scalpel or Cold Knife Surgery: This is the oldest form of tonsillectomy. Here they don't freeze the instruments and they don’t freeze your tonsils. “Cold” refers to the metal of the scalpel. In this method, the tonsils and/or adenoids are removed completely using a scalpel. The patient is under general anesthesia. There is minimal post-operative bleeding. 2. Ultrasonic or Harmonic Dissection: This method uses the blade of a very special scalpel. scalpel vibrates at high frequency. The energy from the vibration is transferred from the blade to the tissue. The vibration is at such high frequency (55,000 cycles per second) that the multancously cut and coagulated. ENTs like the very precise cutting afforded by this method. The patient is under general anesthesia and there is little post-operative bleeding, 3. Electrocautery Tonsil Removal: This method bums the tonsils away. It simultancously removes the tonsil and cauterizes the area to stop bleeding. This method is safe, effective and fairly common. It does run the risk of injury to the tissue around the tonsil and this can make the post-operative recovery period more uncomfortable. 4. Microdebrider Tonsillectomy: A microdebrider is a rotary device that “shaves” tissue away. When this method is removed, the entire tonsil is not removed. A layer of tonsil tissue is left over the throat muscles. This procedure ean be performed in the ENT’s office under local anesthesia. The recovery period is minimal and there is very little post-operative pain, However, this procedure is not recommended when tonsil removal is due to recurring infection, This procedure is recommended when enlarged tonsils obstruct breathing. 5. Bipolar Radiofrequency Ablation: Bipolar refers to the method in which energy is transferred to tissue. An ionized (or charged) saline layer is charged with radiofrequency waves. This breaks molecular bonds in the tissue and separates it without causing harm to the surrounding tissue. This method can be used to reduce the size of enlarged tonsils or to completely remove the tonsils. This method has very little post-operative pain and the recovery process is much casier.Reference: https://scentmd.com/blog/5-types-of-tonsil-surgery. Nursing management: + Continuous nursing observation is required in the immediate postoperative and recovery periods because of the risk of haemorrhage, which may also compromise the patient's airway. Nursing dingnosis: 1. Pain related to removal of tonsils as evidenced by pain score reading. 2. Ineffective airway clearance related to pain as evidenced by accumulation of secretions 3. Anxicty related to surgical intervention as evidenced by facial expression. 4, Risk for deficient fluid volume related to decreased intake of fluid: isk for infection related to surgery. Interventions: Provide analgesics as prescribed. Provide comfortable position and bed + Promote intake of sips of water * As I signs 4 Look for complications. Prevent any further injury and infections, oe o Reference: (REF: Lewis's medical surgical nursing) 9. Explain care of a patient with tracheostomy. A tracheostomy is a surgically ereated opening in the trachea. A tracheostomy tube is placed in the incision to secure an airway and to prevent it from closing. Tracheostomy care is generally done every eight hours and involves cleaning around the incision, as well as replacing the inner canula of the tracheostomy tube. Afier the site heals, the entire trachoesotomy tube is replaced once or twice per week, depending on the physicians order. Precautions: + Extra precautions should be taken when performing site care during the first few days afler the tracheostomy is surgically created. + The site is prone to bleeding and is sensitive to movement of the tracheostomy tube. + Itis recommended that another healthcare professional securely holds the tube while site care is performed. + Tracheostomy care should not be done while the patient is restless or agitated, since this increases the chances that the tube may be pulled out and the airway lost. Equipments: Clean tray or trolley Sterile dressing pack Sterile gauze swabs (additional) Sterile gallipot (additional) Sterile drape Sterile gloves non sterile gloves Sterile water Sterile suction catheter SAA yee9. Hydrogen peroxide solution 10, Antiseptic solution 11, 2 tracheostomy tapes 12, Receptacle for soiled disposables 13, Suction apparatus Procedure: Explain the procedure to the patient to gain patients confidence and cooperation. Ensure the patients privacy. Wash and dry hands to prevent infection Assist the patient to be in a comfortable position Assess the condition of the stoma prior to conducting the procedure. Note redness, swelling, type of secretions, presence of purulence or bleeding. The presence of skin breakdown or infection must be monitored and reported. Culture of the site may be warranted. 6. Cleaning of the fresh stoma should be performed every 8 hours or more frequently if required. To prevent infection To prevent irritation yaepe Preparatory phase: 1. Suction the trachea and pharynx thoroughly prior to tracheostomy care, Removal of secretions prior to care keeps the site clean for a longer period. Place sterile drape on patient's chest under tracheostomy site. It provides sterile field. Open dressing pack. Pour antiseptic, hydrogen peroxide (diluted strength) and water into 3 separate sterile containers. Antiseptic solution may be applied to fresh stoma or infected stoma. Hydrogen peroxide is used for the removal of mucus and crust. The presence of which promotes infection. 5. Place sterile tapes on sterile field. 6. Don sterile gloves. Bey Performance phase: 1. Clean the external end of the tracheostomy tube with 2 gauze swabs soaked with hydrogen peroxide. 2. Clean the stoma with 2 gauze swabs with hydrogen peroxide. Make only a single sweep with each swab then discard. 3. Loosen and remove any crusting with sterile cotton swabs. 4. Repeat step 2 using sterile water soaked gauze sponges to ensure that hydrogen peroxide is removed. 5. Repeat the procedure using 2 dry swabs to ensure dryness of the area because moisture promotes infection 6. An infected wound may be cleaned using gauze with antiseptic solution and then dried. Use one swab one wipe technique, Apply antibiotic if prescribed, using cotton swabs. 7. Change the tracheostomy tie tapes. Tape should be changed every 24 hours or when soiled or wet.Cut soiled tape while holding the tube secured/ in place with the other hand (two nurses may be required for this procedure step) to prevent accidental dislodgement. + Remove old tape carefully. % Take one tape and iscrt through slit in trachcostomy tube wing. Pull through to half the lenghth to form a loop. To assist in the prevention of irritation and coughing due to the manipulation of the tube. % Repeat procedure on second wi Tie the tape sat the side of thencck in a square knot. Alternate knot from side to side cach time tapes are changed to prevent irritation and to rotate pressure tc. % Tapes should be tight enough to secure the tube in the stoma while facilitating the access of two fingers between the tape and neck, Tightness of tape will cause discomfort to the patient, Excessive tightness will compress the jugular veins as well as decrease the blood circulation to the skin beneath the tapes. 8. Dressing to the stoma site is dependent upon the decision of practitioner. 9. Leave patient in a comfortable position 10, Clean and lear equipment 11, Wash and dry hands 12, Document procedure including observation of stoma as well as character of secretion. 10, Briefly describe the causes, signs and symptoms of Otitis media Otitis media is defined as the inflammation of the middle car characterized by the accumulation of infected fluid in the middle car, the arca just behind the car drum. ‘Causes: + Bacteria: Streptococcus pneumonia, Hemophilus influenzae, Moraxella catarrhalis, Group A Streptococcus, Staphylococcus aureus “Virus: Adenovirus, Rhinovirus, Influenza virus Viral infection of Upper respiratory tract + Anatomic obstruction caused by adenoids and nasopharyngeal tumors + Infections of nose and throat “Forcible blowing of nose ++ Swimming + Bottle feeding in supine or horizontal position “Middle ear trauma ** Barotrauma + Palatal disorders: cleft palate “Nasal allergies Signs and symptoms: “> Fullness in the ear+ Earache > Deafness + Tinnitus: is the perception of noise or ringing in the ears. “> Fever (102-103°F) + Ottorhoea: it is a serous, serosanguincous or purulent discharge from the ear “Malaise: a general feeling of discomfort or illness Headache * Vertigo: A sudden internal or external spinning sensation often triggered by moving your head too quickly Reference: Lewis's Medical -Surgical Nursing, Volume-Ipage no; 395 11. Cli I manifestation and nursing management of patient with otitis media. Otitis media is defined as the inflammation of the middle ear characterized by the accumulation of infected fluid in the middle car, the area just behind the ear drum. Clinical manifestation: Fullness in the ear Earache Deafness Tinnitus: is the perception of noise or ringing in the ears. Fever ( 102-103°F) Ottorhoca: it is a scrous, serosanguincous or purulent discharge from the car Malaise: a gencral feeling of discomfort or illness Headache Vertigo: A sudden internal or external spinning sensation often triggered by moving your head too quickly. Co a Nursing management: 1. Acute car pain related to infection, inflammation, swollen tympanic membrane as evidenced by pain score reading. 2. Disturbed auditory sensory perception related to obstruction in car as evidenced by hearing, loss. 3. Hyperthermia related to infection as evidenced by thermometer reading. 4, Anxiety related to progressive hearing loss as evidenced by facial expression. 5. Disturbed sleep related to pain as evidenced by drowsiness during the day. Interventions: + Check vital signs frequently Advice bed restReport signs of infection Give medications as per physicians order Instruct patient to prevent water entering the ear for 6 weeks. Avoid any heavy lifting and blowing for 2-3 weeks. Reduce loud noise to improve hearing and communication + Cold compress to reduce temperature ( take precautions so that water doesn’t enter ear) Reference: Lewis's Medical -Surgical Nursing, Volume-L,page no; 395 12, Discuss causes and signs and symptoms of speech disorders. A speech disorder is a condition in which a person has problems creating or forming the speech sounds needed to communicate with others > Causes of speech disorders ; Brain damage due to a stroke or head injury muscle weakness damaged vocal cords a degenerative disease, such as Huntington's disease, Parkinson’s disease, or amyotrophic lateral sclerosis dementia cancer that affects the mouth or throat autism Down syndrome hearing loss > Signs and symptoms : Bibliography: repeating or prolonging sounds distorting sounds adding sounds or syllables to words rearranging syllables having difficulty pronouncing words correctly struggling to say the correct word or sound speaking with a hoarse or raspy voice speaking very softly : [/weww medicalnewstoday.com/articles/324764itsym, 13. Explain the care and maintenance of hearing aids. > Cleanin; Keep in mind that the ear mold is the only part of the hearing aid that may be washed frequently. Wash the ear mold daily with soup and water. Allow the ear mold to dry completely before it is snapped into the receiver. Clean the cannula with a small pipe cleaner-like device.© Note that properly caring for the ear device and keeping the ear canal clean and dry can prevent complications. > Checking for Malfunctions © Be aware that inadequate amplification, a whistling noise, or pain from the mold ean occur when a hearing aid is not functioning properly. * Check for malfunctions; 4 Is the switch on properly”? 4 Are the batteries charged and positioned correctly? + Is the ear mold clogged with cerumen? Ear wax can be easily removed with the pin, pipe cleaner, or wax loop. + Notify the hearing aid dealer if the hearing aid is still not working properly. * Keep in mind that if the unit requires extended time for repairs the dealer mat lend you a hearing aid until the repair can be accomplished. Bibliography: Brunner &Suddarth’s, textbookof Medical-Surgical Nursing; South Asian edition, Vol 1 Walters Kluwer. Page no: 1606 14, Explain the role of nurse in communicating with heat 12 impaired patients. +> For the person who is hearing impaired whose speech is difficult to understand: Consider how the person refers to communicate with others do not assume that writing gestures on other means are the best or preferred technique. Consider is the person uses sign language interpreters are available from the ‘American sign language. Inc.,interpreting service (ASLI). These specialists provide the best means of communication providing accurate professional services. Devote full attention to what the person is saying look and listen do not try to attend to another task while listening Engage the speaker in conversation when it is possible for you to anticipate the replies this enables you to become accustomed to any peculiarities in speech pattems. Try to determine the essential context of what is being said you can often feel in the details from context. Do not try to appear to appear as if you understand if you do not. If you cannot understand at all or have serious doubt about your ability to understand what is being said, have the person write the message rather than risk misunderstanding having the person repeat the message in speech after you know its content also age u in becoming a custom to the persons patter of speech. Written communication is an excellent research written material should be written at the third grade level so that the maturity of people can understand it. + For the person who is hearing-impaired who speech reads:- When speaking , always face the person as directly as possible. make sure your face is as clearly visible as possible. Locateyourself so that your face is well lighted; avoid being silhouetted against light.Do not obscure the person's veiw of your mouth in any way; avoid talking with any object held in your mouth. Be sure that patient knows the topic or subject before going ahead with what you plan to say this enables the person to use contextual clues in speech reading - Speak slowly and distinctly passing more frequently than you would normally.‘¢ Ifyou question some important direction or instruction has been understood check to be certain that the patient has the full meaning of your message . ‘If for any reason your mouth must be covered (as with the mask ) and you must direct or instruct the patient write the message. Reference:Brunner and sudharth textbook of medical surgical nursing 11" edition volume 2 spage number 2104, SHORT ESSAYS-DK 1) Explain the nursing management of patients with Menicres disease Meniere disease is a chronic disorder of the inner ear involving sensory neural hearing loss senior vertigo and tinnitus. Nursing diagnosis # Risk for injury related to altered mobility because of get disturbed and vertigo . # Adjustment related to disability requiring change in lifestyle because of unpredictability of vertigo, ‘© Risk for fluid volume imbalance and deficit related to increase fMuid output altered intake and medications . ‘© Anxiety related to threat of or change in health status and disabling effects of vertigo . # Ineffective coping related to personal vulnerability and unmet expectations stemming from vertigo. ‘* Feeding, bathing, hygicne, dressing and toileting self care deficit related to labyrinth dysfunction and episodes of vertigo . Nursing management Provide nursing care by during acute attack provide a safe, quiet, dimly lit environment and enforce bed rest . provide emotional support and assurance to elevate anxiety administer prescribed medications which may include anti antiemetic and possibly mild diuretic Instruct the client on self care instructions to control the number of acute attacks . Discuss the nature of the disorder. Discuss the nced for a law salt diet Explain the importance of avoiding stimulants and vasoconstrictions(example:- caffeine decongestants and alcohols ) © discuss medications that may be prescribed to prevent attacks or self administration of appropriate medications during an attacks, which may include anticholinergies,vasodilation, antihistamines and possibly Diuretics or nicotinic acid. Discuss prepare and assist the client with su eo o0°0 istamines and oco°0 ° ical options© A labyrinthectomy is the most radical procedure and involves resection of the vestibular nerve or total removal of labyrinth performed by the transcanal route which results indeafness in that ear. ‘© An Endolymphatic decompression consists of draining the endolymphatic sac and inserting a shunt to enhance the fluid drainage. jical-nursing- Reference: https:/Avww.mpedia,com/nursing-notes/medical-su notes/menieres-disease-nursing-management/ SHORT ANSWERS: 1. List four causes of deafness. Deafness refers to complete or partial loss of ability to hear from one or both cars. The evel of impairment can be mild, moderate, severe or profound. # Extemal ear: Impacted ccrumen, foreign bodies, external otitis. = Middle ear: otitis media, serous otitis, otosclerosis. = Inner car: Meniere's disease, noise exposure, presbycusis(age related hearing loss), ototoxicity. (REF: Lewis's medical surgical nursing) 2) List down the classification of hearing loss. recorded on the Hearing loss can be classified by the decibel (dB) level or loss audiogram. Normal hearing loss is in the 0-15 dB range. * Mild: between 25 and 40 dB ‘© Moderate: between 41 and 55 dB ‘© Moderately severe: between 56 and 70 Db ‘© Severe: between 71 and 90 dB © Profound: 91 dB or greater (REF: Lewis's medical surgical nursing) 3) List four causes of speech disorders. Speech defect is any condition that interferes with the mental formation of words or their physical production. ‘© Secondary to paralysis, deafness, retardation or other mental disorders, and larynx cancer. © Organic defects include deafness, cleft palate, dental abnoormlities and brain damage. * Functional problems which are basically pycological.(REF: Lewis's medical surgical nursing) 4) List any two indications of speech therapy Speech therapy mainly includes the components like biofeedback, music therapy and meditation, Deafness Hoarsenes Laryngea Speech disorders © Otorhinolaryngologic disease neoplasms Lewis's medical surgical nursing) References: (REF: lar abscess. + Peritonsillar abscess also known as qquincey is a recognized complication of tonsillitis and consists of pus beside the tonsil ic. peritonsilar space mainly caused by group A beta haemolytic streptococcus. 6) Define periton: Reference: Lewis's Medical -Surgical Nursing, Volume-Ipage no; 398 + Accomplication of tonsillitis in which the infections spreads behind the tonsills. A peritonsilar abscess occurs when a collection of pus forms and infection spreads beyond the tonsills. Reference: https://en.m.wikipedia.org/wiki/peritonsillar_abscess 6 Define laryny Inflammation of the larynx , typically resulting in huskiness or loss of the voice, harsh breathing and painful cough. laryngitis is swelling and inflammation of the vocal cords it can be acute or chronic. Reference © SlideShare.mob.in © Wikipedia * Www.Myoclonic.com 7) Define adenoiditis. ¥ The adenoids or pharyngeal tonsils consist of lymphatic tissue near the center of the posterior wall of the nasopharynx, Infection or the inflammation of the adenoids is called as the adenoiditis. The bacterial pathogens include GABHS.‘The most common viral pathogens are Epstein-Barr virus, cytomegalovirus, Reference: Brunner and Suddharth, Textbook of Medical-Surgical Nursing, South Asian Edition, Wolters Kluwer Pvt. Ltd. 2018, Page 1563. > Adenoiditis is an inflammation of the adenoids caused by the infection.Adenoids are the first line of defense against viruses and bacterias, besides tonsils. Symptoms include dry throat, snoring, runny nose, breathing through nose becomes difficult. Adenoiditis can be caused by bacterial infection such as streptococcus and also by a number of viruses like Epstein-Barr viruses, adenovirus, rhinovirus. Refrence: Steve Kim, Brindles Lee Macon, healthline.com, January 6, 2016. 8) What is oral cancer? > There are two types of oral cancers: oral cavity cancers and oropharyngeal cancers. Most oral cancer lesions occur on the lower lip. Other sites include lateral border and undersurface of tongue, labial commissure, and buccal mucosa. Clinical Manifestations: Leukoplakia = smokers patch, a white patch on the mucosa. Exythroplakia Ulcer Soreness or pain red velvety patch on the mouth Slurred speech Dysphagia Increased salivation. Toothache CLERKS Earache Refrence:Sharon L. Lewis, Medical- Surgical Nursing, Third South Asian Edition, RELX India Put. Ltd. 2018, Page:853. > Cancer is defined as the uncontrollable growth of the cells that invade and cause the damage of the surrounding cells. Oral cancer appear as a growth or sore in the mouth that does not go away.Risk Factors: Smoking Tobacco users Family history of cancer Excess consumption of alcohol HPV SRS Reference: Michael Friedman, WebMD Medical Reference, October 10, 2019. 9) Define paroti > Itis the inflammation of the parotid gland. This is caused by streptococcus, staphylococcus species and also due to poor oral hygiene Clinical Manifestations: Y Pain ¥ Absence of salivation Y Purulent exudate Treatment: Antibiotics Warm compress Mouthwashes Fluid intake Topical medications Sofi, bland diet KEK KS Refrence:Sharon L. Lewis, Medical- Surgical Nursing, Third South Asian Edition, RELX India Pvt. Ltd. 2018, Page:852. > Itis defined as the swelling in one or both of the parotid glands. This can be acute and chronic parotitis. Causes: Y Bacterial Y Viral Y Blockage of the saliva ‘Symptoms:Pain and swelling Redness Pus: Dry mouth Milky discharge in the mouth=chronic SAK 6 Risk Factors: Dehydration Recent surgery Tumor Salivary stone Eating disorders Depression Diabetes © HIV infection 0000000 Refrence:Winchesterhospital.org, health library. 10. Wha s audiometry? © Itis the measurement of the range and sensitivity ofa person's sense of hearing, Itis the measurement of hearing. Reference: htps:/www.medisinenet.com * Ibis the single most important diagnostic instrument. Audiometric testing is of two types: a) Pure tone audiometry b) Speech audiometry Reference: (Brunner and Suddhant's 2119.) textbook of medical surgical nursing 11" edition volume 2.page number 11. List two types of audiometry? Pure tone audiometry The sound stimulus consist of a pureor musical tone.The louder the tone before patient perceives it,the greater the hearing loss. Speech audiometry The spoken word is used to determine the ability to hear and discriminate sounds and words. Other types: Suprathreshold Audiometry Self recording Audiometry Impedance AudiometryComputer administered Audiometry 12, What are hearing aids? ‘© Hearing aid is a device through which speech and environmental sounds are received by a microphone, converted to electrical signals, amplified and reconverted to acoustic signals. Reference: (Brunner and Suddharth's textbook of medical surgical nursing 11 edition volume 2,page number 2119) © Assmall amplifying device which fits on the car worn by a partially deaf person Reference: Oxford + Ahearing aid is a device designed to improve hearing by making sound audible toa person with hearing loss. Reference: Lewis's Medical -Surgical Nursing, Volume-Ipage no; 398 13.Define tympanic membrane perforation? “Ans:A hole in the tissue that separates the ear canal from the middle ear. A perforated eardrum may be caused by the loud sounds.a foreign object in the ear head trauma,a middle ear infections or rapid pressure changes. Link: hups://g.co/kgs/rkvWDq_ 14. List the etiological factors of tympanic membrane? Ans: Infection is the main cause of tympanic membrane. Others like direct force to the ‘ear,air pressure head trauma, foreign objects in the middle car,car surgeries. Link: hups://www.bem.edu ical manifestations of tympanic membrane? 15. List the eli Ans: -otalgia -fullness, discomfort -blood tinged discharge from ear -hearing loss vertigo tinnitus hups://www.mayoclinic.org 16, Define otosclerosis?© Otosclerosis involves the stapes and is thought to result from the formation of new, abnormal spongy bone, especially around the oval window, with resulting fixation of the stapes. The efficient transmission of sound is prevented because the stapes cannot vibrate and carry the sound as conducted from the malleus and incus to the inner cut. Otosclerosis is more common in women, is a familial condition and can progress to complete deafness Bibliography: Brunner &Suddarth’s, textbook of Medical-Surgical Nursing; South Asian edition, Vol | Walters Kluwer. Page no: 1599 © The abnormal formation of new bone in the middle car that gradually immobilizes the stapes (stirrup bone) and prevents it from vibrating in response to sound, causing a progressive conductive loss of hearing. Otosclerosis usually affects both cars. It is a common disorder, especially among young women, Pregnancy may trigger it. Bibliography:hitps:// www medicinenet.com/seripmain/art asp?articlekey=25696 © Otosclerosis is a rare condition that causes hearing loss. It happens when a small bone in your middle gar -- usually the one ealled the stapes -- gets stuck in place. Most of the time, this happens when bone tissue in your middle ear grows around the stapes in a way it shouldn't, izziness or balance problems or ringing, roaring, or hissing Bibliography: https://www.webmd.conycold-and-flwear-infection/otosclerasis-facts# | © Otosclerosis is a form of hearing los s duc to abnormal bone growth in your middle ear. The presence of this srupts the complex series of energy transformations that ultimately allow us to hear. ‘Symptoms: ¥ Common symptoms of otosclerosis are gradual hearing loss as well as tinnitus (or ringing in the ears), As well, people with the condition may experience dizziness or the sensation of vertigo Bibliography:https://ww.healthyhearing.com/report/53072-Otosclerosis 17. Define Meniere's discase? > Meniere's discase is an abnormality in an inner car fluied balance caused by malabsorbtion in the endolymphatic sac or a blockage in the endolmphatic duct Endolymphatic hydrops develops, and cither increased pressure in the system or rupture of the inner ear membrane occurs, producing symptoms of Meniere disease, Clinical Manifestationsisodic vertigo, tinnitus(unwanted noises in the head or car), and fluctuating sensormeural hearing loss. Bibliography: Brunner &Suddarth's, textbook of Medical-Surgical Nursing; South Asian edition, Vol | Walters Kluwer. Page no: 1600 > Meniere's disease is a disorder of the inner ear that can lead to dizzy spells (vertigo) and hearing loss. In most cases, Meniere's disease affects only one ear. Menicre’s disease can occur at any age, but it usually starts between young and middle-aged adulthood. It's considered a chronic condition, but various treatments can help relieve symptoms and minimize the long-term impact on your life. Symptoms: © Ringing in the ear (tinnitus). © Feeling of fullness in the car Bibliography:hutps://www.mavoclinic.org/discases-conditions/menieres-disease/symptoms- > Meniere's disease is a disorder that affects the inner car. The inner ear is responsible for hearing and balance, The condition causes vertigo, the sensation of spinning. It also leads to hearing problems and a ringing sound in the car. Menicre’s disease usually affects only one ear. ‘Symptoms: ertigo, with attacks lasting anywhere from a few minutes to 24 hours loss of hearing in the affected car tinnitus, or the sensation of ringing, in the affected car aural fullness, or the feeling that the ear is full or plugged loss of balance headaches nausea, vomiting, and sweating caused by severe vertigo Bibliography:https://www.healthline.convhealth/menicres-disease#causes © 000000 2 MARKS (MK) 1.Define otalgia. > Otalgia is defined as car pain, Two separate and distinct types of otalgia exist. Pain that originates within the car is primary otalgia; pain that originates outsidethe ear is referred otalgia. Typical sources of primary otalgia are external otitis, otitis media, mastoiditis, and auricular infections. Reference: https://emedicine.medscape.com/article/845173-overview > Itis the pain in the car due to lesions in the ear itself or duc to the conditions in the surrounding areas, * Types of otelgia 1. Primary orelgia is car pain caused by a problem directly associated to the ear, such as an ear infection. 2. Refferedotelgia is from pain that originates from outside the ear. Reference: :Lewis's Medical -Surgical Nursing, Volume-I,page no; 2) Write the method of foreign body removal from the throat? 1. Common removal methods include use of Forceps, water irrigation and suction catheters. 2. Pharyngeal/ tracheal fore! consultations, Refrence:hitps:/www.aafp.org/afp/2007/101 5/p1185.html 3) what are the clinical manifestations of foreign body in the ear? sn bodies are medical emergencies requiring surgical ¥ Pain or bleeding:-If object abrade the car can rupture of the tympanic ‘member,or from the patient's attempt to remove the object. Later stage := Erythema and swelling of the canal and a foul smelling discharge may be present. Y Live insects may cause a buzzing in the car. Y The appearance will vary according to the object and length of the time it has been in theear. .(https://www.medicinenet.com/abjects_or_insects_in_ear/article.htm#what_types, xet_stuck_in, car_caus It is a pain in the ear due to lesions in the ear itself? due to the condition in the surrounding, area. Types- Primary Otalgia- pain caused by a problem directly associated to the ear, such as ear infection. Referred Otalgia-Is the pain that originates from outside the car.Pain that has referred to the car from another source of the body. (huips://www slideshare.net/mobile/mamoon90 l/otalgiacarache) 5) Enumurate the causes of nasal obstruction.Ans. Most common conditions t Septal deviation Nasal valve collapse Lateral wall collapse Equal or even exceed septal deviation as the prime cause of nasal airway obstruction. Reference © Wikipedia © SlideShare.mob.in ‘© Medical news 6)list the complication of supportive otitismedia. Otitis media with effusion or suppurative OM is an inflammation of the middle ear with a collection of fluid in the middle ear space. The fluid may be thin, mucoid, or purulent. It is common to have otitis media with effusion for weeks to months after an cpisode of acute otitis media. It usually resolves without treatment but may recur. Complications are: * Chronic otitis media © Postauricular abscess + Facial nerve paresis © Labyrinthitis © Labyrinthine fistula © Mastoiditis © Temporal abscess * Petrositis * Otitic hydrocephalous Reference: https://www.slideshare.net/mobile/sidranav otitis-media 7) List surgical interventions of suppurative otitis media. Otitis media with effusion or suppurative OM is an inflammation of the middle ear collection of fluid in the middle ear space. The fluid may be thin, mucoid, or purulent.common to have otitis media with effusion for weeks to months after an episode of acute otitis media. It usually resolves without treatment but may recur. Surgical Management: > The goals of the treatment are to clear the middle ear off the infection, any perforations, and preserve hearing. > Tympanoplasty (my plasty) involves reconstruction of the TM and the ossicles. > A mastoidectomy is often performed with a tympanoplasty to remove the infected portions of the mastoid bone. REFERENCE: Sharon L. Lewis, Medical-Surgical Nursing, Third South Asia edition, RELX India Pvt. Ltd. 2018, Pages 339-340. 8) Enumerate the indications for Otoscopic examination, The tympanic membrane is inspected with an otoscope and indirect palpation with a pneumatic otoscope. Indications: External auditory canal: ° charge ©. Inflammation © A foreign body Middle ear: © Fluid © Airbubbles © Blood © Masses Refrence; Brunner and Suddharth, Textbook of Medical-Surgical Nursing, South Asian Edition, Wolters Kluwer Pvt. Ltd. 2018, Page 1586. 9. List indications for ear irrigation?a routine procedure used to remove excess ear wax and foreign material from the ear. Indication: + Difficulty in examining the full tympanic membrane. + Otitis externa + Wax occlusion of the extemal ear canal. + As part of the workup for conductive hearing loss. + Prior to taking the impression for hearing aid fitting. «Suspected external car canal or middle car cholesteatoma. Reference: hitps://www.google.com/search?q=indications+fortear+irrigation&erlz 10. Define Quinsy? © Peritonsillar abscess, also known as a quinsy is recognised complication of tonsillitis and consists of a collection of pus beside the tonsil ic. peritonsillar space. It is mainly caused by group A beta-hemolytic streptococcus. Brunner and Suddharth's textbook of me Reference: al surgical nursing 11" edition volume 2 © Quinsy is also known as peritonsillar abscess is a recognised complication of recurrent untreated tonsillitis and consists of collection of pus inside the tonsils commonly caused by group A beta haemolytic streptococcus. Reference: Sharon L. Lewis, Medical- Surgical Nursing, Third South Asian Edition, RELX India Pvt. Ltd. 2018, Page:852 11) What impacted wax? Ear wax is the waxy ,yellowish substance that lines the inside of your car canal. This wax helps to protect your canal from water, infection, injury and foreign body. But too much wax buildup can cause problems. This buildup called impacted earwax. Reference: https://www.cedars-sinai.org/health-library/diseases-and-conditions/i/impacted- + Ear wax is a natural protective oily substance which is produced in the outer third of the car canal, Excessive collection of thick car wax is known as impacted wax. Reference: https://slideshare net/mobile/sanilmlore/impacted-wax 12) what is tympanoplasty?+ Tympanoplasty is a surgical operation performed for the reconstruction of the eardrum and/or the small bones of the middle car. Reference: https://en.m.wikipedia.org/wiki/tympanoplast + Tympanoplasty also called eardrum repair, refer to surgery performe to reconstruct a perforated tympanic membrane of the middle ear. Referens 9s: //www surgeryencyclopedia.com/st-wr/tympanoplasty.htm| 13, What is nasal septal deviation? ‘* Nasal septal deviation is a deflection of the normally straight nasal septum.lt is most commonly caused by trauma to the nose or congenital disproportion. Reference: Lewis medical surgical nursing 9c page no $32 Sideways displacement of the wall between the nostrils is known as nasal septal deviation, Deviation of the nasal septum may be congenital or occur later from trauma. The major problem that it tends to cause is airway obstruction.Can be treated by surgery Reference: Otorhinolaryngology, Head and Neck Surgeryedited by Matti Anniko, Manuel Bemal-Sprekelsen, Victor Bonkowsky, Patrick Bradley, Salvatore luratopg; 191 sounds reaching the car Types of hearing aids are: Conduction Hearing Aid. In this, the amplifiedsound is transmitted via the car canal to the tympaniemembrane Bone Conduction Hearing Aid, Instead of a receiver has a bone ‘on the mastoidand directly stimulates the cochlea ‘Most of the aids are air conduction type. They can be 1.Body-worn types. Most common typemicrophone and amplifier along with the battery are © inone case wor at the chest level while receiver issituated at the ear level. © 2.Behind-the-ear (ISTE) types. Here microphone, amplifier,receiver and battery are all in one unit whichis worn behind the ear © 3.Spectacle types. It is a modification of the “behindthe-car” type and the unit is housed in the auricularpart of the spectacle frame. It is useful to persons who * need both eye glasses for vision and a hearing aid © 4.An-the-ear (ITE) types. The entire hearing aid ishoused in an earmould which can be won in the ear. © 5.Canal types (ITC and CIC). The hearing aid is so smallthat the entire aid can be wom in the ear canal withoutprojecting into the concha ator which snugly fitsReference: Diseases of Ear, Nose and Throat & Head and Neck Surgery P L Dhingra, Shruti Dhingra Ze pg no; 135 15) What # Ototoxicity can result in temporary/ permanent disturbances of hearing balance or both, Glycoside are the most common cause of ototoxicity and they destroy the hair cells in the organ of Corti. Reference:Brunner and Suddharth’s textbook of medical surgical nursing 11"* edition volume 2,page number 2119. * Ototoxicity is duc to drugs or chemicals that damage inner ear or vestibulo-cochlear nerve, which sends balance and hearing information rom the inner ear to the brain. (© Major locations of ototoxic effects: * Cochlea-“cochleotoxicity” produces hearing loss. * Vestibule: “vestibulotoxic” manifests as balance-related problems\ Reference: Sharon L. Lewis, Medical- Surgical Nursing, Third South Asian Edition, RELX India Pvt, Ltd. 2018, Page:851 16)List any four ototoxicity drugs. © Aminoglycoside antibiotics: Gentamicin, streptomycin, kanamycin, Neomyein,Amicacin. + Antizneoplasties(a ncer drugs)-Cisplatin, Carboplatin-cause hearing loss that is massive and permanent. ¢ Loop diuretics- Bumetimide,fursemide (Lasix), Torsemide (Demadex ) These drugs cause ringing in the cars! decreased hearing that reverses when the drug is stopped. ‘© Antiepileptic drugs- Phenytoin over dose may be associated with vestibular disorder. Reference: Lewis's Medical -Surgical Nursing, Volume-I.page no-395