Paper Example on Preparing for an Ear Examination: Questions to Ask

Usually, no serious preparation is required before an ear examination. However, it is essential to keep the patient's head still because of the sensitive nature of the eardrum and ear canal. Before starting the test, the nurse is expected to assess the patient's condition by asking them some questions for instance whether they experience dizziness, have an earache, difficulty in breathing or ringing in the ears (Ely, Hansen, & Clark, 2008). Any genetic background on hearing problems within the family should also be revealed.

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The first thing the nurse ought to do is check the inside of the ear using an otoscope (Dull & Haines, 2003). Other kinds of tests might follow if necessary, and these include:

• Subjective hearing test, which entails a patient giving feedback of what they can hear, for instance, spoken voice and whispered tests, audiometry tests, and tuning fork tests.
• Objective hearing test, which does not rely on a patient's feedback on what they can hear. Here, the hearing is measured with the help of special devices, for example, the OAE tests, auditory brainstem response tests, and tympanometry.
• Otoscopy. The otoscope is used to look into the ear. For smooth insertion of the instrument, the nurse straightens out the ear canal by gently pulling the ear upward and backward. Earwax might be removed during the test. A healthy eardrum is often smooth with shiny gray colour. An abnormal eardrum is usually red, injured, scarred, or has a bulge; this denotes an ear infection.
• Whispered and spoken voice test. The nurse speaks at a distance of about six meters from the patient, by beginning with whispering followed by talking at a standard volume. If the patient fails to grasp what is being spoken, then the nurse moves closer. All the speaking is done while covering one's lips to avoid any lip reading.
• Tuning fork test. The nurse grasps a vibrating tuning fork at the entrance of the ear canal and subsequently places it against a patient's head. If the hearing is smooth when the fork is placed on the head, then the problem is with the ear canal. If the patient fails to hear the tuning fork when placed in both positions, then that is a problem called sensorineural hearing loss.
• Audiometry. Involves using loudspeakers or headphones which play tones at different pitches while varying the volume. The patient is expected to give a sign upon hearing the sound. In most cases, the sound comprises of spoken syllables as well as numbers.
• Tympanometry. Entails measuring the degree at which an eardrum can vibrate. The nurse performs this test by first inserting a bung in the patient's ear canal in an attempt to seal that part of the ear. The instrument alters the pressure in the ear while a tone is played. The sound waves of the tone make the eardrum vibrate. Consequently, it changes the pressure in the ear canal. Such a pressure gradient is measured and recorded.

Eye Examination

In the case of a physical injury occurring to a patient's eye, the initial priority involves managing the anxiety and the pain (Committee on Practice and Ambulatory Medicine, 2003). The patient first needs to be reassured that the health department will do its very best to help the patient. Even for severe cases, the nurse should not indicate the start. The nurse is expected to administer oral analgesics wherever possible.

It is of importance to note that if the nurse suspects the presence of an open globe injury, then they should stop immediately. This is because the continued focus on such an eye would make things worse, thereby resulting in increased prolapse of ocular contents. Such a patient needs to be referred to the theatre for further assessment under anaesthesia. The patient can be assessed in an upright posture if it can be done, but where that is impossible; the patient can be laid down to make it easier. Cases, where the patient cannot open the eye at all, topical anaesthetic drops, can be used as it helps in lessening the pain.

The assessment would include routine vital signs and routine questions asked to every patient. After this visual acuity, external exam, visual fields, EOM assessment, and pupil reflex should all be done (Pieramici, Sternberg, Aaberg, Bridges, Capone, A., Cardillo, & Olsen, 1997). A funduscopic exam can be performed if indicated. Differential diagnosis includes orbital blowout, retinal detachment, and hyphema. This is why the external exam is important because an orbital blow out and hyphema can be seen grossly. A retinal detachment may be the culprit because as mentioned earlier, hyphema and orbital blow out both occur in the anterior chamber and can be seen grossly. If retinal detachment is suspected, this can be confirmed with a CT, or someone proficient in ultrasound can also see a retinal detachment. Either way, with loss of vision, an ophthalmologist should be consulted by the ER physician (Glaser,1999).

References

Committee on Practice and Ambulatory Medicine. (2003). Eye examination in infants, children, and young adults by paediatricians. Paediatrics, 111(4 Pt. 1), 902. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12671132

Dull, P., & Haines, D. J. (2003). Methods for teaching physical examination skills to medical students. FAMILY MEDICINE-KANSAS CITY-, 35(5), 343-348. Retrieved from https://pdfs.semanticscholar.org/914d/b0ccc660ebf4a5cda0d1e55b41d6a2e45e96.pdf

Ely, J. W., Hansen, M. R., & Clark, E. C. (2008). Diagnosis of ear pain. Young (i.e., younger than 40 years), 100(1), 5. Retrieved from https://www.researchgate.net/profile/Elizabeth_Clark3/publication/5501195_Diagnosis_of_ear_pain/links/0fcfd5097d4769ee8b000000/Diagnosis-of-ear-pain.pdf

Glaser, J. S. (Ed.). (1999). Neuro-ophthalmology. Lippincott Williams & Wilkins. Retrieved from https://books.google.com/books?hl=en&lr=&id=eVU2CODGj98C&oi=fnd&pg=PR7&dq=eye+examination+ophthalmologist&ots=dSjR0YPJs3&sig=6B7wc0Cb-aQi6wPS4CNqomoGvok

Pieramici, D. J., Sternberg Jr, P., Aaberg Sr, T. M., Bridges Jr, W. Z., Capone Jr, A., Cardillo, J. A., ... & Olsen, T. W. (1997). A system for classifying mechanical injuries of the eye (globe). American journal of ophthalmology, 123(6), 820-831. Retrieved from https://www.sciencedirect.com/science/article/pii/S0002939414711328