N104: Essentials of Nursing Care - Health Safety

N104: Essentials of Nursing Care – Health Safety Study Guide able to sit or stand during the exam. Equipment needed for the ear and hearing exam includes an otoscope and ear speculae. Information and abnormal findings provided by unlicensed personnel should be verified during this exam. Implementation • Wear gloves and any other appropriate infection control gear (mask, protective eyewear, gown, etc.). • Wash hands before starting the exam, any time the hands or gloves become soiled, and upon completion of the exam. • Provide a quiet, well-lit, and private place for theexam. • Ensure that the examination room is warm since the patient will be exposed during different parts of the assessment. • Explain each step of the exam: what will happen, why the exam is being done, andhow the patient can help during the exam. • Explain how the results of the exam will be used. • Ask about presence or history of: o Hearing problems or deafness o Signs or symptoms of ear or hearing problems (ringing in ears, drainage fromears) o Use of hearing aids • Assess the outer ears (auricles). o Normal: Color is same as facial skin, ears are symmetrical and aligned with the outer canthus of the eye, ears are mobile, firm, and non-tender, and the pinna springs back to a normal position when folded down o Deviations from normal: Bluish or reddish color or pallor, ears asymmetrical, ears lower than normal, lesions, flaky skin, and tenderness • Assess the ear canal and tympanic membrane: Use an otoscope to examine the ear. Individuals older than 12 months can sit with their head tilted slightly towards the opposite shoulder. Select the largest speculum that will fit easily into the ear canal and attach it to the otoscope. If the person is only having problems with one ear, examining the other ear first may make it easier to determine what is different about the affected ear. When checking the ear of an individual older than 12 months, hold the otoscope in one hand and use your free hand to pull the outer ear gently up and back to straighten the ear canal and improve visualization. In babies younger than 12 months, gently pull the outer ear down and back. Slowly insert the pointed end of the speculum into the ear canal while looking into the otoscope; try not to put pressure on the ear canal. Steady your hand on the person's face so your hand moves along with their head in case they move quickly. Do not move the otoscope forward without looking into it. Make sure you can see the path through the ear canal. Angle the tip of the speculum slightly toward the person's nose to follow the normal angle of the canal. While looking through the otoscope, move it gently at different angles so that you can see the canal walls and eardrum. Stop at any sign of increased pain. o Normal: Hair follicles and cerumen in the ear canal; tympanic membrane (TM) pearly gray and semitransparent

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