Hi, I'm Meris. And in this video, I'm going to be talking to you about assessment of the ears and nose. I'm going to be following along using our Health Assessment Flashcards. These are available on our website, leveluprn.com, where you can grab a set for yourself.
Or if you're not interested in hardcopies of the cards like these, you can check out Flashables, which are our digital flashcards available with you on the go. They're the coolest thing. Check them out. All right. Let's get started.
So first up, let's talk about assessing the ears. So as always, we're going to begin by inspecting. We are looking at size, shape, relative position, symmetry. Is there any drainage, erythema, any of the things that we are looking for normally?
Now, when it comes to assessing the ears, what we expect to see is that the top of the auricles, which is right here, this is the very top of the ear, should be in line with the inner canthus of the eye. So the inner canthus being this part right here, that little part right there. Plus or minus, that should be in line with the top of the auricles, top of the ear. So we're going to look for that.
Do we see any sort of low-set ears? Low-set ears can be indicative of different conditions, different findings.
And we're going to see, do we have any kind of swelling, redness, discharge, any concerns for an infection?
And of course, we're going to ask our patients about their hearing. And do they use any sort of assistive devices such as a hearing aid? We need to know about that.
This is one of my biggest pet peeves. This happens all the time. As an ER nurse, I get patients coming to me from their homes and from nursing homes and things of that variety. And very commonly, they will not have their hearing aids in because there's a medical emergency happening, and they don't have the time to put them in. And sometimes, I will see that family members will bring the hearing aids with them, and then they'll just leave them sitting on the table.
And I'm like, I love that you brought these with. That is so important. But my patient can't hear or understand me without them in their ears. So seeing people try to have a conversation with someone who is hard of hearing or capital D deaf and have their hearing aids sitting on the table, it's like, guys, come on. Put those in their ears if you're trying to have a conversation. Let's use their accommodations, right? So please ask about that and ensure that your patient has access to those devices as well.
Now, using an otoscope-- and I will say that this is not something that is a routine part of my assessment process. However, this is within the scope of what you could do when you are assessing.
So you would assess the internal structures of the ear using an otoscope. Oto- meaning ear, -scope meaning to look, so we're looking in the ear. And what we're going to see is the tympanic membrane, we hope. We expect to see the tympanic membrane.
And this is kind of-- it kind of looks like a drum, right? Eardrum. I always think it just looks kind of like a weird, fractured plate or something. I don't know how to describe it, but once you've seen it, you know it.
A tympanic membrane, there's two things that I want you specifically to be aware of. The first is the color of the tympanic membrane. It should be pearly gray in color. Pearly gray. That is not a color that we are often looking for, so it is important that you know that that is the color that you should see here.
The other thing is that when you use an otoscope, there's light that is attached to that scope, and that that light is going to shine into the ear so that you can see. However, some of that is going to bounce back at us, and this is actually called the cone of light. So the cone of light is this area of the tympanic membrane, the eardrum, that appears to have a cone that is brighter than the rest of it. And what you're seeing here is just that light reflecting from the otoscope, but based on the position of the patient's ear. So you need to know where you should expect to see the cone of light on the right versus the left side.
Because this matters, because if I see that the cone of light is in a different place, I know that something is off with the anatomy.
Either just my patient's general setup— their general anatomy—is different, or do we have something like a ruptured eardrum or some swelling or something going on that I need to be aware of?
So we do have a way to remember this for you. I'm going to tell you straight up first that on the right, it's going to be at 5 o'clock. Imagine you're looking at a watch face. It's going to be at 5 o'clock. And on the left, it's going to be at 7 o'clock.
So as you see here, we do have a Cool Chicken Hint here to remind you that 5 o'clock is on the right side of a watch face, right? If you look at your watch, 5 o'clock is on the right side and 7 o'clock is on the left side. So very easy to remember 5:00 and 7:00.
The other way that I remember it, I don't know if this is helpful to you. This is not our official hint, but I like to give these to you is that I think of left and it makes an L. And then if I just rotate it, it turns into a 7. So L, 7. That's the easiest way for me to remember it.
But I like that our Cool Chicken mnemonic gives you the right and the left here with that.
Okay. So another thing that we can assess when we're talking about the ear, again, if indicated for your assessment would be to assess cranial nerve eight vestibulocochlear. This could also be called the acoustic nerve, but cranial nerve 8 can be assessed as part of the ear assessment.
Now, when we're talking about assessing the nose, things are a little bit more straightforward. We're going to be, just like usual, using inspection to look at the size, shape, position, symmetry, lesions, and drainage from the nose, anything like that we want to take note of.
But when it comes to the internal inspection, it's a lot more straightforward. We're just going to use an otoscope to use the light from it to look up into the patient's nares. And when we look into the patient's nares, we're going to be looking at the septum. Want to see if that is straight down the middle, or is it deviated to one side or the other.
And what do those mucous membranes look like? Are they nice and moist and pink, or are they scarred or swollen or anything else going on inside them? And we can also inspect the turbinates at this time.
One of the things that you can do to assess the patency of your patient's nares is to have them occlude one nostril at a time and be able to show that they can inhale and exhale through both nares.
However, I just want to give you a little pro tip that when you, the nurse, are assessing this, you want to have your patient inhale. You do not want to have them forcefully exhale while occluding one nostril or else you may end up covered in mucus, right? So we are going to always have them sniff in like you are smelling the flowers, right? So that's how we're going to assess for patency.
And then if indicated, we can also do an assessment of cranial nerve number 1, which is the olfactory nerve. And we can test this by having our patient identify a familiar scent, such as soap, mint, or coffee.
All right. Now let's test your knowledge of some key facts I provided in this video using some quiz questions.
Where should the cone of light be visualized in the left ear?
In the 7 o'clock position.
What color does the nurse expect the tympanic membrane to be?
Pearly gray.
How can the nurse assess the function of cranial nerve one?
Ask the patient to identify a familiar smell.
All right. That is it for this video. I hope you found it helpful. I would love to hear a comment from you, something you learned, or how many quiz questions you got right.
And I can't wait to see you in the next one. Thanks so much, and happy studying.
