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When examing the ears, the nurse should first inform the patient reason the ear examination is being conducted. The vestibulocochlear nerve, the 8th cranial nerve is the auditory nerve. The patients ability to hear conversation should first be assessed while in front of the patient. The nurse should then stand behind the patient at arms length away, whisper three words, and have the patient repeat them to confirm hearing. They should stand on the opposite side of the patient and whisper three different words to test for hearing. The external ear structures should be assessed for regularity, color, and piercings. The nurse should show the patient the instrument to be used in the examination and that although it wont be painful, it might feel cold. The nurse will sit beside or in front of the patient. The otoscope covering should be the appropriate size for the ear and the otoscope should fit comfortably into the external opening of the ear canal (Jain, et al., 2019). Once the otoscope is in the ear canal the nurse can turn the light on to illuminate the canal. The pinna should be retracted upwards and backward so the cartilaginous canal is in line with the bony canal (Jain, et al., 2019). The otoscope should enter the external meatus no deeper than 1cm. As the nurse looks into the otoscope, they will be observing for contents such as ear wax, secretions, and foreign bodies. The eardrum should be examined for integrity, i.e., no perforations or signs of infection such as redness or drainage. The eardrum should be pearly grey, shiny, and cone-shaped. The nurse should stand behind the patient, whisper three words, and have the patient repeat them to confirm hearing. They should stand on the opposite side and whisper three different words to assess hearing. If conductive hearing loss is suspected, the nurse can do a Rhine test. The patient is asked to report which is louder as the nurse tests for bone and air conduction using a tuning fork. The instrument is tapped on a table and held with the long axis perpendicularly one inch from each ear. It is held alternatively to the mastoid. If bone conduction is heard better than air conduction, it is strong support for hearing loss in that ear (Sanders, et al., 2010).
Visual assessment includes asking questions such as pain? Assessing for diplopia, double vision, redness, or excessive tearing.
Important areas of examination include:
Inspect for size, shape, and symmetry.
Reactions to light, direct or consensual
Conjunctiva and sclera
Cornea, lens, and pupils
Fundi, including: Optic disc and cup, retina, and retinal vessels
Confrontation testing of the visual elds is a valuable screening technique for detection of lesions in the anterior and posterior visual pathway.
Emergent intervention is to assess the CN IV for trochlear nerve damage, due to the head trauma. There are six such cardinal directions to assess. When a person looks down and to the right, for example, the right inferior rectus (CN III) is principally responsible for moving the right eye, whereas the left superior oblique (CN IV) is principally responsible for moving the left eye. If one of these muscles is paralyzed, the eye will deviate from its normal position in that direction of gaze and the eyes will no longer appear conjugate, or parallel.
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