Nursing management for ear problems and care during ear surgeries

Nursing diagnosis Anxiety related to potential loss of hearing, potential taste disturbance, and potential loss of facial movement Acute pain related to mastoid surgery Risk for infection related to mastoidectomy, placement of grafts, prostheses Disturbed auditory sensory perception related to ear disorder or surgery Risk for trauma related to impaired balance or vertigo during the immediate post operative period Disturbed sensory perception related to potential damage to facial nerve Deficient knowledge about disease condition and surgery

Nausea related to inflammation of labyrinth of ear Hyperthermia related to inflamed ear Disturbed sensory perception related to altered sensory reception secondary to inflammatory response Risk for deficient fluid volume related to nausea and vomiting Risk for injury related to dizziness Insomnia, disturbed sleep pattern Impaired physical mobility related to vertigo Activity intolerance related to dizziness Acute pain related to inflammation of ear Impaired verbal communication related to deafness Deficient knowledge related to disease condition or self management of ear disorder Hopelessness related to impaired hearing Disturbed personal identity Low self esteem

Planning and goals The major goals of caring for a patient undergoing surgery are Reduction of anxiety Reducing pain Prevention of infection Improving hearing and communication Preventing injury Preventing altered sensory perception Promoting home and community based care

Reducing anxiety Explain information's regarding anesthesia, the location of the incision, expected surgical results Encourage the patient to discuss any anxieties and concerns about the surgery Provide psychological support

Relieving pain Aural fullness or pressure after surgery is common Analgesic may be taken for the first 24 hours. External auditory canal packing is used if tympanoplasty was performed. Constant throbbing pain accompanied by fever may indicate infection – report to doctor.

Preventing infection External auditory canal packing with an antibiotic solution Prophylactic antibiotics Prevent water from entering the auditory canal for atleast 6 weeks Cotton ball with a water insoluble substance (petroleum jelly) The post auricular incision should be kept dry for the first 2 days

Improving hearing and communication Hearing in the operated ear may be reduced for several weeks because of edema, accumulation of blood and tissue fluid in the middle ear and dressings or packing Reducing environmental noise Facing the patient when speaking Speak clearly without shouting Provide good lighting

Preventing injury Vertigo may occur Antiemetic or antihistamines medications – for balance disturbances Assisted ambulation Avoid heavy lifting, straining, exertion and nose blowing fro 2 to 3 weeks after surgery

Preventing altered sensory perception Report immediately if any evidence of facial nerve weakness, drooping of mouth, slurred speech, decreased sensation and difficulty swallowing Promoting home and community based care Teaching patients self care (refer previous notes) Follow up