OTOSCOPE Assignment

OTOSCOPE Assignment

Ear Assessment and appropriate nursing diagnoses (Do assessment on an adult) In the boxes, describe your findings. Do not use the word “Normal” or approximations of it, such as N/A, expected, etc. State what you found using terminology appropriate for the area. See the textbook for appropriate wording. If there are no signs or symptoms of any problems, for instance, it would be appropriate to write: Denies tenderness, pain, and paresthesia; no lesions or breakdown observed. No evidence of pathology noted. Then proceed to describe what you assess in terms of observation, (auscultation and percussion are not used in ear assessments) and palpation.

Weber and Kelley’s textbook has a helpful guide with pictures and verbiage you may find helpful:

Assessment Guide 17-1, in the chapter on ear assessment (note especially the textbook verbiage in the center and right columns.) You may use textbook terminology in this class because it is expected. Many videos are also available to assist you. There is one on Blackboard in the current module, and YouTube has a number of them as well. Do not use the work of other students. That is plagiarism, and our detection program will flag it.

If confirmed it will mean the grade of F in the class: It isn’t worth it!

Current Symptoms: Ears Assessment Findings
External Ear Structures
1. Inspect the auricle, tragus, and lobule for size and shape, bilaterally. Describe bilateral position, lesions/discoloration, and discharge.
– The auricle measures 6.5 cm in the vertical dimension, is rounded, and displays a light brown flesh-colored appearance bilaterally (consistent with the client’s skin color.) No lesions or tenderness are observed bilaterally. The tragus is triangular, non-tender, without lesions, and its color is consistent with the auricle; no piercings are seen bilaterally. The lobules are attached, with one piercing bilaterally, and they are nontender without lesions bilaterally.

2. Palpate the auricle and mastoid process bilaterally. Describe findings, including symptomatology or tenderness if they are present.
– Both the auricle and mastoid process are without lesions, and the client denies tenderness. The auricle is flexible and soft.

Otoscopic Examination
3. Bilaterally inspect the external auditory canal with the otoscope for discharge, color, and consistency of cerumen, color and consistency of canal walls, and any nodules. (Address each of these items bilaterally.)
– The auditory canals exhibit smooth walls with a slightly pink color and no nodules bilaterally. Dark brown cerumen is present in the right canal, while the left canal has no visible cerumen.

4. Inspect and describe the tympanic membranes bilaterally, using the otoscope, for color and shape, and landmarks.
– The tympanic membranes on the right cannot be visualized due to brown cerumen blocking the ear canal. The left tympanic membrane appears round, smooth, and pearly gray, with the cone-shaped reflection of the otoscope light at 7 O’clock.

5. List a common ear disorder or abnormal assessment finding that would be discoverable in an ear or hearing assessment on a hypothetical patient. (You may include the medical diagnosis, but it is not required. You may select a problem that has not yet been diagnosed since this is a very realistic scenario—often nurses are the ones who discover problems first and then refer the client.)
– The patient has been diagnosed with a basal cell carcinoma on his right auricle, but has not yet been treated. Surgical removal and the use of fluorouracil cream are planned by the dermatologist beginning next week. The skin lesion is on the very top of the auricle and extends over both the front and back of it. The lesion is rough/uneven, measuring 6 mm at the largest diameter, and has a small amount of yellow discharge dried around the edges. The edges of the lesion appear “rolled” and pink. The lesion is non-tender, and the patient states he never has used sunscreen.

Diana Wiseman iHuman Case Summary

Synthesis Instructions/Items to include
Nursing Diagnosis List one “Health Promotion” (HP) nursing diagnosis appropriate for your client with the condition you describe in section 5, above. (Do not use “none at this time.”)
– Health Promotion (HP) nursing diagnosis: Readiness for enhanced health management regarding surgical procedure, use of topical fluorouracil, and sunscreen.

List one “risk for” nursing diagnosis for the condition you listed above in section 5.
– Risk for delayed surgical recovery due to the location of the lesion, on the top of his ear where his hat rubs.

List EITHER one “Collaborative Problem” that would be appropriate for a client with the condition described in section 5, above OR list an actual nursing diagnosis from Appendix C.
– Collaborative Problem: Risk for Complications (RC) of antineoplastic therapy due to the use of fluorouracil.

Comprehensive Evaluation of an Adult Ear Using an Otoscope (Visual Inspection) and Palpation

The examination and assessment of the ear to establish an accurate diagnosis involve the utilization of inspection, specifically visual observation, in addition to palpation techniques. Given the presence of internal ear structures, the visual aspect of this assessment is effectively facilitated through the application of an otoscope, as outlined by Ball et al. (2019). This paper outlines the findings that can be derived from the evaluation of an adult patient’s ears.

Table 1: Examination of an Adult Ear
Part/ Procedure Findings
Inspection of External Ear Structures (Including the Auricle, Tragus, and Lobule) · The overall size and shape of the ears, including the lobules of the auricles, exhibit uniformity bilaterally.

· Neither the tragus nor the antitragus displays any signs of swelling or inflammation on both sides.

· Bilaterally, there are no piercings evident on the lobule, helix, or tragus.

· The intertragic notch shows no indications of otorrhea or ear discharge on both sides.

· No visible lesions are present bilaterally on either ear, and the ear color harmonizes with the patient’s overall skin tone.

· There is no discoloration observed on both sides.
Palpation of the External Ear Structures (Including the Auricle and Mastoid Process) · Bilaterally, there is no tenderness or swelling apparent in the auricle, helix, tragus, or antitragus.

· Additionally, there are no palpable masses on both sides.

· Upon palpation of the mastoid process, the patient reports no tenderness on either side.

· Bilateral palpation reveals that the auricle feels soft and flexible.
Bilateral Visual Inspection of the External Auditory Canal Using the Otoscope · The patient experiences no discomfort during otoscope insertion into the external auditory canal on both sides.

· Examination of the external auditory canal reveals a clear canal with minimal brown cerumen observed bilaterally.

· There is no visible otorrhea bilaterally.

· The canal walls are smooth, devoid of nodules, and display consistency on both sides.
Bilateral Visual Inspection of the Tympanic Membranes · On both sides, the tympanic membranes show no signs of perforation or sclerosis.

· Additionally, there are no visible fluid levels behind the tympanic membrane bilaterally.

· Nevertheless, bubbles are noticeable on otoscopy on the right side.

· No cholesteatoma is present in the attic area of the membrane bilaterally.

· Pneumatic otoscopy reveals a visible bulge and reduced mobility of the tympanic membrane on the right side.

· On the left side, the tympanic membrane is round, smooth, and devoid of bulges or any other observable abnormalities.
Common Ear Disorder or Abnormal Finding Identifiable During Ear Assessment Acute Otitis Media (AOM)

· In this condition, the tympanic membrane exhibits an opaque reaction to light and may appear bulged.

· Middle ear fluid may be detected through otoscopy and visualized through the tympanic membrane.

· Redness of the tympanic membrane indicates inflammation, and the patient may experience fever and tenderness during otoscope insertion.

· At times, the fluid behind the tympanic membrane may manifest as pus (Hammer & McPhee, 2018).
Nursing Diagnoses for AOM in Adults
A Health Promotion Nursing Diagnosis for AOM A Risk Nursing Diagnosis for AOM A Collaborative Problem or Actual Nursing Diagnosis for AOM
Readiness for enhanced learning about the prevention of acute otitis media Risk for the development of intra-temporal abscess if AOM remains untreated Risk for complications related to intracranial and intra-temporal conditions

References

Ball, J., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2019). Seidel’s guide to physical examination: An interprofessional approach, 9th ed. Elsevier.

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.