nursing care plan for ear infection essay
Holistic Assessment of an Adult Ear Using an Otoscope (Observation) and Palpation
Assessment or examination of the ear for appropriate and correct diagnosis uses the techniques of inspection or observation as well as palpation. Because there are internal structures in the ear, the inspection aspect is facilitated by the use of an otoscope (Ball et al., 2019). This paper presents some of the findings that may come out of the examination of an adult patient’s ears.
Table 1: Examination of an adult ear

Part/ Procedure
Findings

Inspection of the external ear structures (including the auricle, tragus, and lobule)
·       The gross structure of the ears including the lobules of the auricles appears the same in size and shape on both sides.
·       The tragus and antitragus do not appear swollen or inflamed bilaterally.
·       There are no piercings bilaterally on the lobule, the helix, or the tragus.
·       The intertragic notch shows no sign or evidence of otorrhea or ear discharge bilaterally.
·       There are no visible lesions bilaterally on both ears, and the color of the ears is homogeneous with the rest of the body.
·       There is no discoloration on both sides.

Palpation of the external structures of the ear (including the auricle and mastoid process)
·       The auricle, the helix, the tragus, and antitragus all do not show any tenderness or swelling bilaterally.
·       Also, there are no masses that are palpable bilaterally.
·       On palpation of the mastoid process, the patient denies any tenderness on both sides.
·       The auricle feels soft and flexible bilaterally on palpation.

Bilateral inspection of the external auditory canal using the otoscope
·       The patient denies any discomfort when the otoscope is inserted in the external auditory canal on both sides.
·       Inspection of the external auditory canal reveals a clear canal with just a little cerumen that is brown in color.
·       There is no otorrhea visible bilaterally.
·       The canal walls are smooth with no evidence of nodules or inconsistencies bilaterally.

Bilateral inspection of the tympanic membranes
·       The tympanic membrane shows no perforation or sclerosis on both sides.
·       There are also no visible fluid levels behind the tympanic membrane bilaterally.
·       However, there are bubbles that are visible on otoscopy on the right side.
·       There is no cholesteatoma in the attic area of the membrane bilaterally.
·       The tympanic membrane shows a visible bulge and demonstrates reduced mobility on pneumatic otoscopy on the right side too.
·       The tympanic membrane on the left is round, smooth, and has no bulge or any other visible abnormality.

A common ear disorder or abnormal finding discoverable in an ear assessment
Acute otitis media (AOM)
·       In this condition, the tympanic membrane shows an opaque reaction to light and may also bulge.
·       Fluid may be demonstrated in the middle ear through otoscopy and visible through the tympanic membrane.
·       There is inflammation shown by redness of the tympanic membrane and the patient may have fever and tenderness on inserting the otoscope.
·       The fluid behind the tympanic membrane may also be pus at times (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 on the prevention of acute otitis media
Risk for developing intra-temporal abscess if AOM is left untreated
Risk for complications of 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.
 
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. Auricle is 6.5 cm vertical dimension, rounded, and light brown flesh-colored bilaterally (in keeping with client’s skin color.) No lesions or tenderness bilaterally. Tragus is triangular, non-tender, no lesions, color consistent with auricle, no piercings bilaterally. Lobules are attached, with one piercing bilaterally, nontender without lesions bilaterally.
2. Palpate the auricle and mastoid process bilaterally. Describe findings, including symptomatology or tenderness if they are present. Auricle and mastoid process are without lesions, and client denies tenderness; 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.) Auditory canals: smooth walls, slightly pink color, no nodules bilaterally. Dark brown cerumen is present in the right canal, left canal has no visible cerumen.
4. Inspect and describe the tympanic membranes bilaterally, using the otoscope, for color and shape, and 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. The cone-shaped reflection of the otoscope light is landmarks. reflected 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 one 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 use of fluorouracil cream are planned by dermatologist beginning next week. 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, 6 mm at 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. Patient states he never has used sunscreen. Adapted from Weber