Introduction to Medical-Surgical Nursing, 6th ed.
54
Lesson Plans for
Ear and Hearing Disorders
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 54.1:
2. Describe the tests and procedures used to diagnose disorders of the ear, hearing, or balance.
4. Explain the nursing care for patients receiving common therapeutic measures for disorders of the ear,
hearing, or balance.
Lesson 54.2:
5. Describe the pathophysiology, signs and symptoms, complications, and medical or surgical treatment
for selected disorders.
7. Assist in the development of a nursing care plan for a patient with a disorder of the ear, hearing, or
balance.
CHAPTER TEACHING FOCUS
• In this chapter, students will be introduced to the data to be collected and the tests and procedures,
including nursing considerations, for patients with disorders of the ear, hearing, and balance.
• Students will have the opportunity to review the pathophysiology, signs and symptoms, complications,
and medical and surgical treatment for selected disorders.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Protection and Movement
• Concept: Sensory Perception
• Exemplar: Conductive Hearing Loss, p. 1260
THEME: Protection and Movement
• Concept: Infection
• Exemplar: Otitis Media, p. 1264
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Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Which of the following is the best description of the external auditory canal?
a) A canal extending between the middle ear and the nasopharynx
b) A tubelike structure bridging outside sounds with the tympanic membrane
c) The chamber housing the semicircular canals and cochlea
d) The fibrous structure joining the bones of the middle ear
2) Weber’s test is used to diagnose what type of disorder?
a) Conductive dysfunction
b) Cerumen blockage
c) Ménière syndrome
d) Nystagmus
3) The malleus, incus, and stapes reside in which part(s) of the ear?
a) External ear
b) External and middle ear
c) Middle ear
d) Middle and inner ear
4) Which of the following describes the four major categories of hearing loss?
a) Infectious, occlusal, ambulatory, cochlear
b) Endemic, systemic, localized, sonorous
c) Conductive, sensorineural, mixed, central
d) Confined, auscultatory, general, occlusal
5) When working with a hearing-impaired person, you may need to do which of the following?
a) Gently touch the patient before stepping into their line of vision.
b) Try to stay out of direct lighting.
c) Elevate the pitch of your voice.
d) Irrigate the ears daily to remove cerumen.
6) Which of the following is a boil in the external auditory canal?
a) Furuncle
b) Mastoiditis
c) Cholesteatoma
d) Otitis externa
7) Which of the following statements best describes Ménière disease?
a) A painful pressure buildup in the middle ear caused by a blocked eustachian tube
b) A specific equilibrium disturbance caused by certain ototoxic substances such as neomycin
c) A type of viral rhinitis, which may cause hearing impairment
d) A disease of the inner ear causing dizziness and hearing loss
8) A disease of the inner ear causing dizziness and hearing loss.
a) Presbycusis
b) Agenesis
c) Alalia
d) Agnosia
9) Which term means inflammation of the inner ear?
a) Labyrinthitis
b) Otitis lateralis
c) Otosclerosis
d) Otalgia
10) Which of the following drug classes can be ototoxic and cause permanent hearing loss?
a) Diuretics
b) Anticoagulants
c) Antiarrhythmics
d) Aminoglycosides
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What is otosclerosis, how is it diagnosed, and how is it treated?
Question: What are some age-related conditions that might affect hearing or balance?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.1
Instructor Preparation
Textbook Objectives Covered
1. Identify the data to be collected when assessing a patient with a disorder affecting the ear,
hearing, or balance.
3. Explain the nursing considerations for each of the tests and procedures.
4. Explain the nursing care for patients receiving common therapeutic measures for disorders of
the ear, hearing, or balance.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying ear and hearing disorders, including:
• Diagnostic tests and procedures
• Pathophysiology, signs and symptoms, and complications
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• cerumen (p. 1250)
• tinnitus (p. 1253)
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 1250-1253)
REVIEW
• Figure 54-1: Anatomic structure of the ear (p. 1251)
• Figure 54-2: The eustachian tube (p. 1252)
ANSWER – Text
• Review Questions for the NCLEX Examination: 3, 5 (pp. 1270-1271)
ANSWER – Study Guide
• Part IA: 1-4, 7-9 (p. 371)
• Part ID: A-L (p. 372)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.1
2
READ – Textbook (pp. 1253-1256)
REVIEW
• Table 54-1: Diagnostic Tests and Procedures: Disorders of the Ear, Hearing, and Balance
(pp. 1254-1255)
• Figure 54-4: Correct technique for using an otoscope (p. 1255)
• Figure 54-5: Normal appearance of the tympanic membrane (p. 1256)
ANSWER – Text
ANSWER – Study Guide
• Part IF: 1-6 (p. 373)
• Part IIG: 36 (p. 376)
3
READ – Textbook (pp. 1253-1256)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1 (p. 1270)
ANSWER – Study Guide
• Part IIG: 32 (p. 375)
4
READ – Textbook (pp. 1256-1258)
REVIEW
• Table 54-2: Drug Therapy: Otic Medications (p. 1257)
ANSWER – Text
• Review Questions for the NCLEX Examination: 6, 8 (p. 1271)
ANSWER – Study Guide
• Part IA: 5, 6 (p. 371)
• Part IIG: 9-17, 41, 42 (pp. 374-376)
• Part IIIH: 3, 8, 9 (pp. 377, 378)
6 Chapter 54Ear and Hearing Disorders _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.1
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 54
Ear and Hearing Disorders
1
Slide 2
Anatomy of the Ear
• External ear
• Auricle
• Innervation
• Lymph drainage
• External auditory canal
• Tympanic membrane
TALKING POINTS:
• What is the tympanic membrane commonly called?
Slide 3
Anatomy of the Ear (cont.)
• Middle ear
• Bones: malleus, incus, and stapes
• Inner ear
• Membranous labyrinth
• Bony labyrinth
TALKING POINTS:
• What fluid is contained in the membranous labyrinth?
Slide 4
Physiology of Hearing
• Perception and interpretation of sound depend on a complex series of steps
• A malfunction at any step can result in some type of hearing impairment
Slide 5
Age-Related Changes
• Skin of the auricle may become dry and wrinkled
• Cerumen production declines; protective wax is drier
• Hairs in canal coarser/longer, especially in men
TALKING POINTS:
• Dryness of the external canal causes itching.
• What may cause hearing loss and balance problems in the older adult?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.1
Slide 6
Health History
• History of present illness
• Changes in hearing acuity, pain, tinnitus, dizziness, vertigo, nausea, vomiting, and
problems with balance
• Medical history
• Acute conditions: sinus infections, dental problems, allergies, upper respiratory
infections
• Chronic conditions: hypertension, DM, hypothyroidism
TALKING POINTS:
• What is otalgia?
• The patient is asked to describe the nature of the pain (e.g., sharp, throbbing, dull) and
when it occurs.
• Hearing impairments are often congenital (present at birth).
• One cause of hearing loss in an infant is rubella during the mother’s pregnancy.
• What does ototoxic mean?
Slide 7
Health History (cont.)
• Functional assessment
• Exposure to excessively loud noise, such as amplified music, firearms, or noisy machinery
• The use of any assistive hearing devices
Physical Examination
• Observe how patient responds to a normal voice
Slide 9
Physical Examination (cont.)
• External ear
• Position of the auricles is significant
• Auricles examined for shape, lesions, nodules
• Palpate auricles and mastoid process for tenderness
• Palpation in front of, below, and behind the ear may locate enlarged lymph nodes
Slide 10
Physical Examination (cont.)
• External auditory canal
• Inspect outer portion of the external auditory canal for any obvious obstructions or
drainage
TALKING POINTS:
• What is the only normal secretion in the canal?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.1
2
&
3
Slide 11
Diagnostic Tests and Procedures
• Otoscopic examination
• Audiometry
• Caloric test
• Electronystagmography
• Hearing acuity tests
• Tuning fork tests
• Rinne test
• Weber test
• Posturography
• Rotary chair testing
TALKING POINTS:
• Radiographic examinations, especially the computed tomographic (CT) scan, may be
used to study the mastoid bone, middle ear, and inner ear.
• What is the difference between an otologist and audiologist?
4
Slide 12
hearing aids.
• Patients with conductive hearing loss may benefit from a temporal bone stimulator.
Therapeutic Measures
• Ear drops
• Irrigation
• Hearing aids
• Cochlear implants
• Temporal bone stimulators
• Surgery
TALKING POINTS:
• Medications intended to be placed directly into the external ear canal are called otic
drops, or simply ear drops.
Slide 13
Nursing Care of the Patient Having Ear Surgery
• Preoperative
• Deficient Knowledge: Supply needed information about the procedure and surgical
routine
• Anxiety: Address specific concerns, patient teaching and reassurance; notify provider
if very anxious
• Notify operating staff of hearing impairment; ask if patient can wear the hearing aid to
the surgical suite
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.1
Slide 14
Nursing Care of the Patient Having Ear Surgery (cont.)
• Postoperative
• Assessment: pain, nausea, dizziness, fever, wound drainage
• Interventions:
• Acute pain
Slide 15
Question 1
• Which of the following is not an age-related change in the ear?
A. Cerumen production increases.
B. The protective wax is drier.
C. The eardrum thickens.
D. Bony joints in the middle ear degenerate.
Slide 16
Question 2
• Which is a contraindication to ear irrigation?
• A. Loose, waxy earwax
• B. Dried, hard earwax
• C. Ruptured tympanic membrane
• D. Impacted cerumen
10 Chapter 54Ear and Hearing Disorders _________________________________________________________
LESSON 54.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the anatomy of the ear and the
physiology of hearing.
• Discuss the implications of age-related
changes in the inner ear.
PRACTICE
• Divide the class into two groups. Assign one
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Consider the
changes in the ear and hearing associated
with aging. Comment on how these changes
would affect everyday function. Ask students
to provide constructive comments on each
2
DISCUSS
• Discuss the distinction between audiometry
and vestibular tests.
PRACTICE
• Divide the class into two groups. Assign one
group audiometry and the other group
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Conduct an
online search of the costs of testing for ear
disorders. Which costs are typically covered
by third-party payers, such as Medicare, and
which are not? Ask students to post their
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.1
3
DISCUSS
• Discuss the information that should be
relayed to the examiner before a caloric test
PRACTICE
• Divide the class into groups. Have each
group discuss the nurse’s role for the
following procedures:
• Otoscopic examination
• Audiometry
• Vestibular tests
class.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Provide patient
teaching information suitable for online
publishing on assigned diagnostic tests. Ask
students to provide constructive comments
on each other’s posts.
4
DISCUSS
• Discuss the nurse’s role in patient education
and monitoring during drug therapy (p.
1257).
PRACTICE
• Divide the class into two groups. Have one
group discuss nursing interventions and
instructions for patients who are treated for
hearing loss, and have the other group
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to prepare and post a video explaining the
correct method for placement of ear drops,
and ear irrigation for both children and
adults. Ask students to provide constructive
comments on each other’s posts.
Critical Thinking Question
Why do some people experience inner ear pain during airplane descent? What are some
relief measures?
Discussion Guidelines: The eardrum (tympanic membrane) separates the outside world from the
12 Chapter 54Ear and Hearing Disorders _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.1
Instructor Notes/Student Feedback
________________________________________________________ Chapter 54Ear and Hearing Disorders 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.2
Textbook Objectives Covered
6. Identify measures the nurse can take to reduce the risk of hearing impairment and to detect
problems early.
7. Assist in the development of a nursing care plan for a patient with a disorder of the ear, hearing,
or balance.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying ear and hearing disorders, including:
• Diagnostic tests and procedures
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• cerumen (p. 1250)
• dizziness (p. 1260)
• equilibrium (p. 1250)
• otalgia (p. 1252)
• tinnitus (p. 1253)
• tympanic membrane (p. 1250)
• vertigo (p. 1260)
Assignments 2 hours
5
READ – Textbook (pp. 1260-1269)
REVIEW
• Figure 54-8: Otosclerosis (p. 1265)