Otoscope Assignment With ND

Ear Assessment and appropriate nursing diagnoses (Do assessment on an adult)
In the boxes, describe your findings. Do not use the word “Normal” or approximations of it,
such as N/A, expected, etc. State what you found using terminology appropriate for the area.
See the textbook for appropriate wording. If there are no signs or symptoms of any problems,
for instance, it would be appropriate to write: Denies tenderness, pain, and paresthesia; no
lesions or breakdown observed. No evidence of pathology noted. Then proceed to describe what
you assess in terms of observation, (auscultation and percussion are not used in ear assessments)
and palpation. Weber and Kelley’s textbook has a helpful guide with pictures and verbiage you
may find helpful: Assessment Guide 17-1, in the chapter on ear assessment (note especially the
textbook verbiage in the center and right columns.)
You may use textbook terminology in this class because it is expected. Many videos are also
available to assist you. There is one on Blackboard in the current module, and YouTube has a
number of them as well.
Do not use the work of other students. That is plagiarism, and our detection program will
flag it. If confirmed it will mean the grade of F in the class: It isn’t worth it!
Assessment Findings
Current Symptoms: Ears
External Ear Structures

Ears appear symmetrical bilaterally. Skin is
1. Inspect the auricle, tragus, and intact bilaterally with no tenderness. The right
lobule for size and shape, pinna measures 6.1cm. The left pinna measures
bilaterally. Describe bilateral 6.2cm. Tragus is triangular in shape bilaterally
position, lesions/discoloration, and with no skin discoloration noted. No piercings.
discharge. Auricles show no skin discoloration bilaterally.
Lobules are detached bilaterally with no
piercings and no tenderness.
Auricles are nontender bilaterally. The skin is
2. Palpate the auricle and mastoid intact bilaterally with no discolorations or lesions
process bilaterally. Describe noted. Mastoid if nontender bilaterally. Skin
findings, including intact bilaterally with no discolorations or lesions
symptomatology or tenderness if noted.
they are present.
Otoscopic Examination
The right ear canal is pink in color with a small
3. Bilaterally inspect the external amount of yellow cerumen noted. No nodules or
auditory canal with the otoscope drainage noted.
for discharge, color and The left ear canal shows some redness to canal
consistency of cerumen, color and wall with small amount of yellow cerumen noted.
consistency of canal walls, and any No nodules or drainage noted.
nodules. (Address each of these
items bilaterally.)
The right tympanic membrane is pearly gray and
4. Inspect and describe the tympanic is translucent with no bulging or retracting
membranes bilaterally, using the noted. Cone is noted at 5 o'clock.
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The left tympanic membrane is pearly gray and
otoscope, for color and shape, and is translucent with no bulging or retracting
landmarks. noted. Cone is noted at 7 o'clock.
If the tympanic membrane appears to have a

5. List a common ear disorder or blue or dark red color to it, this is indicative of a
abnormal assessment finding that head/skull injury that has caused blood to pool
would be discoverable in an ear or behind the tympanic membrane.
hearing assessment.
Adapted from Weber, Kelly & Sprengel, 2014: Lippincott, with permission.
Using the diagnostic reasoning process described in chapter 5 of your textbook,

synthesize one of each of the three types of nursing diagnoses described below for
a potential client with the problem you listed in area #5, above.
You will use the three of the types of nursing diagnoses (ND) described in Chapter
5 of your Weber and Kelley textbook:
1. A Health Promotion ND
2. A Risk ND and
3. A Collaborative Problem or Actual ND.
You will find a list of possible diagnoses in Appendix C and D in your textbook.
Synthesis Instructions/Items to include Nursing Diagnosis

List one “Health Health Promotion nursing diagnoses Readiness for enhanced health
Promotion” nursing often begin with “Readiness for management r/t head trauma.
diagnosis appropriate for enhanced learning” as described in
your client with the Appendix C of your textbook, under
condition you describe in Domain 1. They are also discussed
section 5, above. in Table 5-1 and 5-2.
List one “risk for” nursing Risk diagnoses are described in Risk for injury to tympanic
diagnosis for the condition tables 5-1 and 5-2, and in Appendix membrane due to blood
you listed above in section C in each of the domains, but collecting behind tympanic
5. particularly in Domain 11. They membrane, caused by possible
usually begin with the words, “Risk head injury.
for….”
List EITHER one Collaborative problems are describe Impaired comfort
“Collaborative Problem” in table 5-2 and are listed in
that would be appropriate Appendix D. They begin with “Risk
for a client with the for Complications (RC) of….”
condition described in
section 5, above OR list an Actual nursing diagnoses are
actual nursing diagnosis scattered through Appendix C
from Appendix C.
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Ear Assessment and appropriate nursing diagnoses (Do assessment on an adult)

External Ear Structures

If the tympanic membrane appears to have a

Using the diagnostic reasoning process described in chapter 5 of your textbook,

Synthesis Instructions/Items to include Nursing Diagnosis

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