Download Top Rated Exam Guide for HEENT Capstone: Cerumen Impaction and Related Ear Disorders and more Exams Nursing in PDF only on Docsity!
Capstone
Amber Carter
Department of Graduate Nursing, University
of Texas at Arlington College of Nursing and
Health Innovation Attained Grade A+
Top Rated Exam Guide 2024
SOAP Note Form
S/ Identifying Information: (initials, age/DOB, gender, reliability)
Family Hx: Ask patient about family hx as it pertains to current problem. History of family hearing loss.
K.U 85 - year-old Female (^) Personal/Social Hx: Chief Complaint/RFE: Married Hard of hearing Resides in a retirement Hx Present Illness: (7 Variables but do not list as such) community Pt presents with decreased hearing on the right side that began about 2 months ago. The visit was prompted by the patient’s husband observation regarding her trouble hearing. Patient states that everything sounds funny and can hear noises but speech isn’t clear and states that it is worst in her right ear. Patient states she has the most trouble In the dining hall in the evening. Patient states that her husband and best friend have been having to repeat themselves when talking to her lately. Patient reports sounds on the right are hollow. The patient reports that she attempted to treat the problem by using a cotton swab “in case there was some wax in there”, the patient reports that nothing came out on the swab and it did not resolve the problem. The patient says that she watches people’s lips when they talk in noisy restaurants or sometimes just does not listen and that it is frustrating.
Capstone
Amber Carter
Department of Graduate Nursing, University
of Texas at Arlington College of Nursing and
Health Innovation Attained Grade A+
Top Rated Exam Guide 2024
CURRENT HEALTH
Medications: Ask patient of current medications taking at home. Allergies: Ask patients about allergies Last PE & Screenings: Ask patient of last physical and screening and if she gets regular screenings and check-ups Immunization Status: Ask patient if she is up to date on all immunizations? Pneumovax? Flu? Shingles? LMP & Birth Control (if applicable) : Patient is 85 and menopausal PMH Illnesses & Trauma: Ask patient of any recent illnesses, falls? Hospitalizations/Surgeries: Ask patient if she has been hospitalized recently. Ask patient about past surgical history. OB Hx/Sexual Hx: Ask patient about current sexual practices Emotional/Psy Hx: admits to having frustration with current situation of not being able to hear REVIEW OF SYSTEMS General: document and assess if patient appears clear, in good hygiene, note how the patient
Capstone
Amber Carter
Department of Graduate Nursing, University
of Texas at Arlington College of Nursing and
Health Innovation Attained Grade A+
Top Rated Exam Guide 2024
General: record that patient is female if she appears to be in good health, nourished vs. malnourished, and functionality Skin: Perform assessment and include the temperature of the patient’s skin, if skin is intact, if any bruising is present or wounds, if patients’ skin is dry or clammy Head: assessment of the head to include shape of head, and record any trauma or deformities to head EENT: impacted cerumen identified by inspection of ear canal by otoscope. Weber test: sound lateralizes to right side, Rinne test: AC=BC on right side. Perform PERRLA exam and reports if eyes are equal bilaterally if they accommodate and size of pupils. Assessment of symmetry of face and patency of nares, Test facial and trigeminal nerves and document findings. Neck: assessment to include if the trachea is midline or deviating, inspect and palpate to locate masses or swollen lymph nodes Breasts/Chest: assessment of chest wall for deformities/symmetry, observe rise and fall of chest and document symmetry or asymmetry
Capstone
Amber Carter
Department of Graduate Nursing, University
of Texas at Arlington College of Nursing and
Health Innovation Attained Grade A+
Top Rated Exam Guide 2024
Lungs: auscultate lungs and listen for crackles, stridor, wheezing or rubbing. Heart/ perip vascular: assessment of pulses, EKG if warranted, auscultate heart for heart sounds (s1.s2. or s3 or s4, gallops, murmurs or clicks), edema in extremities Abdomen: auscultate abdomen for bowel sounds (normal, hypoactive, hyperactive), assessment of stomach to include flatness, roundness, obese, distention, and palpation to check for tenderness and any masses Genitalia/Rectum: n/a Lymph: palpate lymph nodes and check for tenderness, inflamed nodes or swollen nodes. MSK: check strength and weakness in all extremities, test gait, note if patient uses any devices for ambulation Neuro: test cranial nerves, orientation questions Medical Dx: (2max) Impacted Cerumen
Age related hearing loss
Rule Outs (only if applicable): Health Profile: age/gender/racial risks: n/a
Pertinent Positives:(1DX) Hard of hearing for 2 months personal/family: n/a screening needs: n/a Pertinent Negatives: Impacted cerumen
counseling needs: n/a Immunization/chemo needs: n/a Differential DX:(3-5) Labyrinthitis Meniere’s Disease Mixed hearing loss
Alteration in Health Prevention R/T: Screening deficits: n/a Counseling deficits: n/a
Nursing Dx: Auditory loss due to impacted cerumen secondary to otoscopic exam.
Immunization/chemo deficits: n/a
Capstone
Amber Carter
Department of Graduate Nursing, University
of Texas at Arlington College of Nursing and
Health Innovation Attained Grade A+
Top Rated Exam Guide 2024
are to only be used on the outside of the ears. If cerumen build up is severe enough that it needs to be removed by a health care professional more than once a year, then another alternative for prevention needs to be discussed.
II. Rationale: (Max 2 pages) According to Horton et al., (2020), patients with cerumen impaction typically present with these symptoms, including aural fullness, hearing loss, ear pain, itching, and tinnitus. Cerumen impaction can occur through regular use of cotton tipped swabs, digital manipulation of the ear canal, or use of hearing aids, all of which pack the cerumen deeper into the ear canal (Horton et al., 2020).
The patient presented to clinic with complaints hearing loss for 2 months with things sounding “hollow” and more significant in the right ear than the left. The patient states that she can hear noises but speech is unclear. The patient made an attempt to use a cotton swab to try and resolve the issue but was unsuccessful. The patient mentioned that she has trouble in the main dining hall in the evenings and that her Husband and friends have had to repeat themselves constantly but have not needed to shout at her. The patient said that she has to read lips in noisy restaurants but sometimes she just doesn’t listen and that she is frustrated with not being able to hear. During the ear assessment impacted cerumen was found blocking the visual of the eardrum. Mineral oil and hydrogen peroxide were used to remove the cerumen resulting in an instant increase in hearing. The patient was referred to a specialist and was instructed to follow up with the clinic in a couple of weeks to make sure there’s no build up occurring again. The patient’s otoscopic exam confirmed cerumen impaction and the patient presents with symptoms consistent with a diagnosis of cerumen impaction such as things sounding “hollow” and hearing loss and the patient also reported the use of cotton swabs with further impacted the cerumen into the ear canal.
Capstone
Amber Carter
Department of Graduate Nursing, University
of Texas at Arlington College of Nursing and
Health Innovation Attained Grade A+
Top Rated Exam Guide 2024
III. Patho: (Max 2 pages)
Cerumen, also known as, earwax, is waxy substance that provides mechanical and microbial protection to the lining of the external auditory canal. Cerumen is normally carried out of the ear canal via migration aided by jaw movement and cerumen accumulates when this clearing process is compromised. This can occur through regular use of cotton tipped swabs, digital manipulation of the ear canal, or use of hearing aids, all of which can pack cerumen deep into the ear canal. Cerumen impaction is defined as the accumulation of cerumen with symptoms or cerumen build up that prevents an accurate diagnostic assessment (Horton et al., 2020).
Capstone
Amber Carter
Department of Graduate Nursing, University
of Texas at Arlington College of Nursing and
Health Innovation Attained Grade A+
Top Rated Exam Guide 2024
Medical Diagnosis (2 primary)
Impacted Cerumen
- Pathophysiology o Cerumen, also known as, earwax, is waxy substance that provides mechanical and microbial protection to the lining of the external auditory canal. Cerumen is normally carried out of the ear canal via migration aided by jaw movement and cerumen accumulates when this clearing process is compromised. This can occur through regular use of cotton tipped swabs, digital manipulation of the ear canal,
Capstone
Amber Carter
Department of Graduate Nursing, University
of Texas at Arlington College of Nursing and
Health Innovation Attained Grade A+
Top Rated Exam Guide 2024
or use of hearing aids, all of which can pack cerumen deep into the ear canal. Cerumen impaction is defined as the accumulation of cerumen with symptoms or cerumen build up that prevents an accurate diagnostic assessment (Horton et al., 2020).
o According to Horton et al., (2020), patients with cerumen impaction typically present with these symptoms, including aural fullness, hearing loss, ear pain, itching, and tinnitus. Cerumen impaction can occur through regular use of cotton tipped swabs, digital manipulation of the ear canal, or use of hearing aids, all of which pack the cerumen deeper into the ear canal (Horton et al., 2020).
o The patient presented to clinic with complaints hearing loss for 2 months with things sounding “hollow” and more significant in the right ear than the left. The patient states that she can hear noises but speech is unclear. The patient made an attempt to use a cotton swab to try and resolve the issue but was unsuccessful. The patient mentioned that she has trouble in the main dining hall in the evenings and that her Husband and friends have had to repeat themselves constantly but have not needed to shout at her. The patient said that she has to read lips in noisy restaurants but sometimes she just doesn’t listen and that she is frustrated with not being able to hear. During the ear assessment impacted cerumen was found blocking the visual of the eardrum. Mineral oil and hydrogen peroxide were used to remove the cerumen resulting in an instant increase in hearing. The patient was referred to a specialist and was instructed to follow up with the clinic in a couple of weeks to make sure there’s no build up occurring again. The patient’s otoscopic exam confirmed cerumen impaction and the patient presents with symptoms consistent with a diagnosis of cerumen impaction such as things sounding “hollow” and hearing loss and the patient also reported the use of cotton swabs
Capstone
Amber Carter
Department of Graduate Nursing, University
of Texas at Arlington College of Nursing and
Health Innovation Attained Grade A+
Top Rated Exam Guide 2024
Age Related Hearing Loss
- Pathophysiology o Age-related hearing loss, presbycusis, is bilateral symmetric hearing loss resulting from aging process. Presbycusis is a complex phenomenon characterized by audiometric threshold shift, deterioration in understanding speech and speech- perception difficulties in a noisy environment (Lee, 2013). According to research by Lee (2020), factors that contribute to presbycusis include mitochondria DNA mutation, genetic disorders such as Ahl , hypertension, diabetes, metabolic disease and other systemic diseases, Extrinsic factors include noise, ototoxic medication and diet. Strial or metabolic presbycusis is the most common cause of presbycusis and it shows hearing loss across all frequency range in audiogram. It is caused by the atrophy of the stria vascularis which results in a decrease in hearing threshold. The loss of strial tissue causes K+^ recycling disorder, resulting in a decrease in endolymphatic potential (Lee, 2013).
- Plan o According to the study by Lee (2013) there is no clinical way to predict the onset of presbycusis and there is neither medical prevention nor treatment that can restore hearing loss at this time. Those with age related hearing loss need to continue to follow up with their PCP and possibly an ENT to monitor further progression of hearing loss.
- Rationale o The patient is an 85-year-old and fits into the age range for age related hearing loss. However, with further investigation into the onset, characteristics and symptoms the patient does not fit this clinical picture. As the patient presented with unilateral hearing loss, and age-related hearing loss presents bilaterally and
Capstone
Amber Carter
Department of Graduate Nursing, University
of Texas at Arlington College of Nursing and
Health Innovation Attained Grade A+
Top Rated Exam Guide 2024
the physical and otoscopic examination showed cerumen in the ear canal. This diagnosis can be ruled out.
Differential Diagnosis (3-5)
Labyrinthitis
Capstone
Amber Carter
Department of Graduate Nursing, University
of Texas at Arlington College of Nursing and
Health Innovation Attained Grade A+
Top Rated Exam Guide 2024
spontaneously without complications but can result in hearing loss. Otitis Media can be of bacterial or viral origin; viruses can ascend through the Eustachian tube to the middle ear and pave the way for bacterial pathogens that reside in the nasopharynx (Schilder et al., 2016).
Capstone
Amber Carter
Department of Graduate Nursing, University
of Texas at Arlington College of Nursing and
Health Innovation Attained Grade A+
Top Rated Exam Guide 2024
References
Horton, G. A., Simpson, M. T. W., Beyea, M. M., Beyea, J. A. (2020). Cerumen Management:
An Updated Clinical Review and Evidence- Based Approach for Primary Care
Physicians. Journal of Primary Care & Community Health, 10 , N. PAG. https://doi-
org.ezproxy.uta.edu
Capstone
Amber Carter
Department of Graduate Nursing, University
of Texas at Arlington College of Nursing and
Health Innovation Attained Grade A+
Top Rated Exam Guide 2024
Gurkov, R., Pyyko, I., Zou, J., & Kentala, E. (2016). What is Meniere’s disease? A contemporary
re-evaluation of endolymphatic hydrops. Journal of Neurology, 1 , 71-81. https://doi-
org.ezproxy.uta.edu
Schilder, A. G., Chonmaitree, T., Cripps, A. W., Rosenfeld, R. M., Casselbrant, M. L., Haggard,
M. P., & Venekamp, R. P. (2016). Otitis Media. Nature Reviews. Disease Primers., 2 (1).
https://doi-org.ezproxy.uta.edu
