What do you mean by Deafness?

Deafness is defined by partial or complete hearing loss. Hearing loss is a common handicap worldwide. It may be conductive, sensorineural, and mixed hearing loss. Hearing impairment ranges from mild difficulty in understanding word or sound and then total hearing loss. hearing loss are of different types those are conductive hearing loss, sensorineural hearing loss, and mixed hearing loss.

Deafness and Hearing Loss

Hearing Loss

Deafness is defined by partial or complete hearing loss. Hearing loss is a common handicap worldwide. It may be conductive, sensorineural, and mixed hearing loss. Hearing impairment ranges from mild difficulty in understanding word or sound and then total hearing loss.

Conductive Hearing Loss

Conductive hearing loss occurs when a sound wave is blocked from contact with inner ear nerve fiber because of external or middle ear disorder.

Conductive Hearing loss Causes:-

External Ear:- Impacted Cerumen, obstruction of ear canal.

Middle Ear:- Otitis media, Otosclerosis, Damage to ossicle.

Sensorineural Hearing Loss

Sensorineural hearing loss occur when sensory nerve fibres that carry impulse to the cerebral cortex are damage.

This type of Hearing loss can not be reverse.

Causes:-

Damage to cochlea or vestibular nerves.

Mixed Hearing Loss

The client has both conductive and sensorineural hearing loss.

Hearing Loss Risk factors:-

  • Family history of sensorineural impairment.
  • Low birth weight (<1500 gram).
  • Ototoxic medication (Genetomycin).
  • Recurrent ear infection.
  • Bacterial meningitis.
  • Prolong exposure to loud noise.
  • Tympanic membrane perforation.
  • Aging.
  • Acoustic neuroma.
  • Congenital malformation of cranial structure.
Loud Noise

Hearing Loss Clinical Manifestations:-

  • Progressive hearing loss.
  • Tinnitus.
  • Vertigo.
  • Difficulty following conversation.
  • Difficulty in understanding the sound especially background music.
  • Hard to differentiate sound.

Hearing Loss Investigation:-

  • History collection.
  • Physical examination.
  • Weber and Rinne test:- It is used to detect lateralization to unaffected ear.
  • Pure tone audiometry.
  • Psychosocial assessment.
  • Otoscopy.

Hearing Loss Management:-

hearing aids

Treatment is based on the cause of hearing loss.

  1. Ear Irrigation:- The removal of a foreign body from the external canal of the ear.
  2. Myringotomy:- Removal of fluid from the middle ear.
  3. Stapedectomy:- Removal of the footplate of stapes from the oval window.
  4. Tympanoplasty:- Repairing of the perforated tympanic membrane through grafting.
  5. Hearing Aid:- Hearing aid Is an electronic device through which speech and microphone converted to electrical signals, amplified and reconverted to acoustic signals. The hearing aid is consist of the following part:-
  • Microphone:- Receive sound wave and change sound into electrical signals.
  • Amplifier:- To increase the strength of electrical signals.
  • Receiver:- To change electrical signals into acoustic signals.

Hearing Aid can be worn in the following location:-

  • In the ear.
  • In the ear canal.
  • Behind the ear.
  • On the trunk.

What You Don’t Know About Meniere’s Disease

It is the disorder of Inner ear that causes episodes of vertigo, ringing in the ear (Tinnitus), and one-sided sensory hearing loss that causes by increase endolymph fluid pressure inside the inner ear canal system. Exact cause of the meniere’s disease is unknown but there are some risk factor which are allergic reaction, viral or bacterial infection, fluid imbalance, blockage in the endolymphatic duct, head injury, and long term stress. visit for more….

Meniere’s Disease: Causes, Symptoms, Treatment

Meniere’s disease is an abnormal inner ear fluid balance caused by malabsorption in the endolymphatic sac. Evidence indicates that many people with Meniere’s disease may have a blockage in the endolymphatic duct. Regardless of the cause, endolymphatic hydrops, dilation in the endolymphatic space, develops.

Either increased pressure in the system or rupture of the inner ear membrane occurs, producing symptoms of Meniere’s disease. It is the disorder of Inner ear that causes episodes of vertigo, ringing in the ear (Tinnitus), and one-sided sensory hearing loss that causes by increase endolymph fluid pressure inside the inner ear canal system.

Meniere’s disease incidence:-

  • Meniere’s disease affects more than 2.4 million people in the United States.
  • More Common in adults, it has an average age of onset in the 40s, with symptoms usually beginning between the ages of 20 and 60 years.
  • The disease has been reported in children as young as age 4 years and in adults up to the 90s.
  • Meniere’s disease appears to be equally common in both genders,
  • The right and left ears are affected with equal frequency.
  • The disease has occurred bilaterally in about 20% of patients.

Meniere’s disease causes:-

Exact cause unknown.

Meniere’s disease Risk factor:-

  • Allergic reaction.
  • Viral or bacterial infection.
  • Fluid imbalance ( Malabsorption in the endolymphatic sac).
  • Blockage in the endolymphatic duct.
  • Head injury.
  • Long term stress.

Meniere’s Disease Pathophysiology:-

  • Increase endolymph fluid pressure.
  • Membranous labyrinth dilated like a balloon when the pressure increase.
  • Distorts the entire inner ear canal system. further, if it causes dilation of the cochlear duct which results in hearing loss. or If it causes damage to the vestibule system which results in Vertigo and tinnitus.

Meniere’s disease Sign and Symptoms:-

Meniere’s disease is characterised by a triad of symptoms:-

  • Episodic, Incapacitating Vertigo.
  • Tinnitus or roaring sound.
  • Sensorineural hearing loss.
  • Pressure in the Ear or fullness of the ear.
  • Headache, Nausea, Vomiting.
  • Nystagmus (rapid involuntary eye movement).

A few clinicians accept that there are two subsets of the disease, known as atypical Ménière’s disease: cochlear and vestibular. Cochlear Ménière’s disease is recognized as a fluctuating, progressive sensorineural hearing misfortune related to tinnitus and aural pressure within the nonattendance of vestibular indications or findings. Vestibular Ménière’s infection is characterized as the event of episodic vertigo related to aural pressure but no cochlear symptoms. In a few patients, cochlear or vestibular Ménière’s disease creates, to begin with. In most patients, be that as it may, all of the symptoms develop in the long run.

Meniere’s Disease Investigation:-

  1. Physical Examination.
  2. Weber test.
  3. Electronystaga gram.
  4. Electrocochleography.
  5. Audiometry test:- Measurement of acuity by the audiologist or audiology technician and trained skilled nurse.
  • Frequency:- Express in Hertz. High frequency means greater the number of vibration per second. Low frequency means fewer the number of vibration per second.
  • The intensity in Decibel (DB):- Intensity table is given below –
Sound Intensity D.B. Safe Exposure
Threshold 0
Whispering 20 db
Average 40 db
Conversation 60 db
Car traffic 70 db 3 hour
Motor cycle 90 db 3 hour
Rock Concert 120 db 3 hour
Jet Engine 140 db Immediately
Danger
Rocket Launching 180 dbImmediately
Danger
Table:- Intensity in decibel(DB).

Meniere’s Disease Management:-

Meniere’s Disease Non Surgical Management:-

  • Teach the patient to e head slowly to prevent worsening of vertigo.
  • Encourage patients to stop smoking.

Nutritional Therapy:-

  • Avoid foods and fluid high in salt and sugar.
  • adequate intake of fluid daily, water, milk, and low sugar fluid juice are recommended.
  • Limit intake of coffee, tea, and soft drinks ( Avoid caffeine because of its diuretics effect).
  • Limiting alcohol intake.
  • Avoid monosodium glutamate ( MSG ), containing food.

Meniere’s Disease Surgical Management:-

  1. Endolymphatic Sac Decompression. Endolymphatic sac decompression, or shunting, theoretically equalizes the pressure in the endolymphatic space. A shunt or drain is inserted in the endolymphatic sac to drain fluid from the membranous labyrinth. Equalizes the pressure in the endolymphatic space. This procedure is favored by many otolaryngologists as a first-line surgical approach to treat the vertigo of Meniere’s disease because it is relatively simple and safe and can be performed on an outpatient basis.
  2. Vestibular Nerve Sectioning. (Cutting the nerve prevents the brain from receiving input from the semi-circular canals and eliminating the attacks of vertigo). Vestibular nerve section provides the greatest rate of approximately 98% in eliminating the attacks of vertigo. It can be performed by a trans labyrinthine approach that is through the hearing mechanism or in a manner that can conserve hearing i.e. suboccipital or middle cranial fossa, depending on the degree of hearing loss. Most patients with incapacitating Meniere’s disease have little or no effective hearing. Cutting the nerve prevents the brain from receiving input from the semicircular canals. This procedure requires a brief hospital stay.
  3. Labyrinthectomy.
  4. Middle and Inner ear perfusion. Ototoxic medications, such as streptomycin or gentamicin, can be given to patients by infusion into the middle and inner ear. These medicines are used to decrease vestibular function and decrease vertigo. The success rate for killing vertigo is high, almost 85%, but the chance of critical hearing loss is additionally high. This method of inner ear perfusion ordinarily requires an overnight remain within the clinic. After the procedure, numerous patients have a period of awkwardness that lasts several weeks.

Meniere’s Disease Nursing Management:-

  1. The risk of injury related to altered mobility because of vertigo and Gait disturbance.
  2. Altered communication related to impaired hearing.
  3. Impaired adjustment related to disability requiring a change in lifestyle due to unpredictability of vertigo.
  4. The risk for deficient fluid volume related to increased fluid output, altered intake, and medications.
  5. Anxiety-related to the threat of, or change in, health status and disability effects of vertigo.
  6. Ineffective coping is related to personal vulnerability and disabling effects of vertigo.

Reference:-

  1. Brunner and Suddarth’s, Textbook of Medical-Surgical nursing, 10th edition, chapter-59, assessment and management of patient with hearing and balance disorder.

The varicose vein or Varicosity

The varicose vein or varicosity is an abnormally dilated, tortuous superficial vein caused by an incompetent venous valve.
varicose veins are permanently distended veins that develop from the loss of valvular competence faulty valves elevated venous pressure causing distention and tortuosity of superficial veins.

Introduction | Etiology or Risk factor | Clinical Manifestation | Diagnostic Evaluation | Management |

 

Introduction:-

  • The varicose vein or varicosity is an abnormally dilated, tortuous superficial vein caused by an incompetent venous valve.
  • varicose veins are permanently distended veins that develop from the loss of valvular competence faulty valves elevated venous pressure causing distention and tortuosity of superficial veins.
  • a varicose vein is divided into two types according to cause:-
  1. Primary
  2. Secondary

1. Primary varicose vein:-  vein after resting from congenital, genetic, or familial predisposition that leads to loss of elasticity of the veins valve.

2. Secondary varicose vein:- it occurs when trauma, obstruction deep vein thrombosis, or inflammation cause damage of valves.

Etiology and Risk factor of Varicose vein or Varicosity:-

  • Prolong standing
  • Genetic predisposing factor
  • A weakness of vein valves
  • Congenital deformities
  • Pregnancy

Clinical manifestation of Varicose vein or Varicosity:-

  • Dull-ache
  • weakness
  • moderate swelling
  • malaise
  • fever
  • nocturnal cramps
  • edema
  • Pigmentation
  • Ulceration
  • susceptibility to injection
  • The unsightly appearance of legs

Diagnostic evaluation of Varicose vein or Varicosity:-

  • Duplex scan:- to assess or find out anatomy of veins
  • Venous blood pressure
  • Venography

Management of Varicose vein or Varicosity:-

  1. General management:-

  • the patient is instructed to avoid activity that causes venous stasis such as wearing light shocks or constructive griddles crossing. the legs at the thigh or sitting or standing in a long period. Instruct the client for changing the position frequently, elevating the legs which feel tired & getting up to walk for several minutes of every hour to promote circulation.
  • the patient should be encouraged to walk 1-2 miles per day.
  • The elastic wrap needs to be wrapped twice daily so that the greatest pressure is at the ankle with lessor pressure gradually applied at the level of the knee.

2.  Surgical management:-

  • Sclerotherapy:- (using a fine therapy):-  Sclerotherapy is the injection of a sclerosis agent into a varicose vein. The agent damage the vein and endothelial causing to swell the blood to clot. the vein turns into sear tissue that many eventually fade from view. It is used for spider veins of varicose veins up to 15 millimeters in diameter and has been treated successfully.
  • Vein ligation and Stripping:-surgical management of varicose vein consists of ligation of a greater saphenous vein with its tributaries at the saphenofemoral junction. Combined with the removal of the saphenous vein (stripping) & ligation of incompetent performance vein. Removal of a vein is performed through multiple short incisions. An increase made at the ankle over the saphenous vein and a nylon wire is threaded up vein to the groin.
  • Saphenofemoral ligation:- some client requires only typing of the junction of the saphenous  & femoral vein at the groin. this involves one short incision often local anesthesia & no hospital stay.

Nursing management of Varicose vein or Varicosity:-

  • Maintain firm elastic pressure over the whole limb.
  • Promote regular movement &exercise of legs.
  • Elevate the foot to bed 6-9 inches so the legs are above the heart level which the client is in bed rest.
  • Instruct the client to walk rather than stand or sit.
  • Assess for any signs of complications such as infection, hemorrhage, nerve damage, etc.

Leukemia: Also known as Blood Cancer.

It is the malignant disease of the blood-forming cells especially the neoplastic proliferation of immature leukocytes. 
It is a group of malignant disorders affecting the blood and blood-forming tissues of bone marrow, lymph system a spleen. Leukemia is a malignancy ( cancer ) of blood cells. In leukemia abnormal blood cells are produced in the bone marrow usually leukemia involves the production of abnormal WBC. 

Introduction | Definition | Classification | Myeloid Leukemia | Lymphoid Leukemia | Risk factor | Sign Symptoms | Diagnosis | Management |

Introduction:-

It is a group of malignant disorders affecting the blood and blood-forming tissues of bone marrow, lymph system a spleen. Leukemia is a malignancy ( cancer ) of blood cells. In leukemia abnormal blood cells are produced in the bone marrow usually leukemia involves the production of abnormal WBC.

Definition:-

It is the malignant disease of the blood-forming cells especially the neoplastic proliferation of immature leukocytes.

Classification:-

Classification according to time duration –

  1. Acute Leukemia:- In acute leukemia the abnormal cell production is quick. A large number of leukemia cells accumulate very quickly in the blood and bone marrow. Acute leukemia requires fast and immediate treatment.
  2. Chronic Leukemia:– It develops slowly over time. This leukemia may not cause specific symptoms at the beginning of their cause. If it left untested the cells make eventually grow to a high number.

Classification Based on Cells:-

(1.) Myeloid Leukemia:-

Myeloid Leukemia further divided into two types:-

  • Acute Myeloid Leukemia:- It is also called Acute Myelogenous Leukemia. It involves the rapid growth of myeloid cells. It occi=ur in both adults and children.
  • Chronic Myeloid Leukemia:- It is also called Chronic Myelogenous Leukemia. It develops slowly and mainly affects adults.

(2.) Lymphoid Leukemia:- 

It also further divided into two types:-

  • Acute Lymphoid Leukemia:- It is also known as Lymphocytic Leukemia or Lymphoblastic Leukemia. It is the most common type of leukemia in young children, but it can also affect adults.
  • Chronic Lymphoid Leukemia:– It is a slow-growing cancer of lymphoid cells. That usually affects people of 55 years of age.

Etiology And Risk Factor:-

The exact cause of leukemia is unknown:-

Risk factors:-

  • Radiation.
  • Chemical Exposure.
  • Cigarette Smoking.
  • Heredity ( Down Syndrome ).
  • Drugs and Dyes.

Sign And Symptoms:-

  • The most symptoms in children are easy bruising, pale skin, fever, and enlarge spleen or liver.
  • Excessive frequent infections.
  • Dyspnoea.
  • Feeling of fatigue and tiredness.
  • Night sweats.
  • Unintentional weight loss.
  • Abdominal pain and swelling.

If leukemia cells have infiltrated the brain, symptoms such as headache, confusion, seizures, and loss of muscle tone.

Diagnosis:-

  • Medical history.
  • Physical examination.
  • Blood test.
  • Bone marrow aspiration.
  • Lumbar Puncture.
  • Chest x-ray.

Management:-

  • Chemotherapy.
  • Radiation therapy.
  • Biological Therapy.
  • Target therapy.
  • Stemcells Transplantation.

Nursing Management:-

  • Risk of infection or ineffective protection related to leukemia ( Leukemia 2nd degree).
  • Imbalance nutrition is less than body requirements related to anorexia, pain, or fatigue.
  • Disturb body image resulting from alopecia, weight loss related to chemotherapy.

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Hiatus Hernia: Causes, Types, Diagnosis, Treatment, Management

A type of hernia in which part of the stomach protrudes up through the esophageal opening of the Diaphragm. Hiatus hernia is an anatomical abnormality in which the part of the stomach protrudes up through the diaphragm into the chest. The exact cause is unknown. It may be due to, Increased pressure within the abdominal cavity. It may be due to – Heavy lifting, Pregnancy, Ascites, Frequent or hard coughing, Boilent vomiting, Starving etc…

Definition | Causes | Types of Hiatus Hernia | Clinical Feature | Diagnosis | Complication | Nursing Management | Management|

Hiatus Hernia: Symptoms and causes, Treatment

Definition:-

A type of hernia in which part of the stomach protrudes up through the esophageal opening of the Diaphragm. Hiatus hernia is an anatomical abnormality in which the part of the stomach protrudes up through the diaphragm into the chest.

Causes:-

   The exact cause is unknown. It may be due to,

  • Increased pressure within the abdominal cavity. It may be due to – Heavy lifting, Pregnancy, Ascites, Frequent or hard coughing, Boilent vomiting, Starving.
  • Weak LES.
  • Obesity.
  • Aging.

Types:-

  1. type 1st:- Sliding Hiatus Hernia:-

  • Herniation of both the stomach and gastroesophageal junction in the thorax.
  • The most common type of hiatus hernia (90%).

      2.Type 2nd :- Paraesophageal Hiatus Hernia:-

  • It is also known as rolling hiatus hernia.
  • Herniation of all or part of stomach through the esophagus into the thorax,with an undisplaced G.E.junction.
  • It is less common (10%).

Clinical Features:-

  1. In most of the cases, hiatus hernia remains asymptomatic,the disease discovers accidentally.
  2. the clinical feature are :-
  • Heartburn.
  • Dull chest pain.
  • Shortness of breath.
  • Regurgitation.
  • Dysphagia.
  • Palpitaion.
  • Reteosternal chest pain.

Diagnosis:-

  • Endoscopy.
  • Barium swallow X-ray.
  • Chest X-ray.
  • C.T. scan.

Complications:-

  • GERD (most common).
  • Esophagitis.
  • Esophageal ulcer.
  • Aspiration pneumonia.
  • Perforation (cutting of mucus membrane).

Management:-

General Management:-

General Management includes:-

  • Weight Loss.
  • Stop smoking.
  • Maintaining an upright position after taking food.
  • Elevate the head of the bed (20 to 35 cm.).
  • Small and frequent meals.
  • Not lying down or bending over after taking a meal.
  • Avoid tea, coffee, alcohol.

Pharmacological Management:-

  • Antacid.
  • H2- blocker drug.
  • Proton pump inhibitors.

Surgical Management:-

surgical management includes Nissen fundoplication surgery.

Nursing Management:-

  • Prepare the patient for diagnostic tests as needed.
  • Administration Prescribed antacids and other medications.
  • To reduce intra-abdominal pressure and prevent aspiration have the patient sleep in a reverse Trendelenburg position with the head of the bed elevated.
  • Assess the patient’s response to treatment.
  • Observe for complications especially significant bleeding, pulmonary aspiration.
  • Often endoscopy watches for signs of perforation such as falling blood pressure rapid pulse, shock, and sudden pain caused by the endoscope.
  • review prescribed medications, explaining their desired actions and possible adverse effect.
  • Teach the client dietary changes to reduce reflex.
  • Encourage the client to delay lying down for 2 hours after eating.

Aneurysm: Causes, Symptoms, Diagnosis, and Treatment

The aneurysm is defined as a permanent localized dilation, stretching, and ballooning of an artery or blood vessels to around 50% increases in the size. The exact cause of aneurysm is unknown. Aneurysm is classified into 7 types according to location, Etiological factor, appearance, saccular, fusiform, dissecting, and false aneurysm.

Introduction | Risk Factor | Classification of Aneurysm | Pathophysiology | Clinical Manifestation | Diagnostic Evaluation | Complication Of Aneurysm | Management |

Aneurysm: Causes, Risk factor, Diagnosis and Treatment

Introduction:-

The aneurysm is defined as a permanent localized dilation, stretching, and ballooning of an artery or blood vessels to around 50% increases in the size.

Etiology of Aneurysm:-

The exact cause is unknown.

The risk factor of Aneurysm:-

  • Atherosclerosis.
  • a congenital defect is an arterial wall.
  • Genetically weakness of the wall.
  • Hypertension.
  • Trauma or injury.
  • Micro-tic infection.
  • Elevated cholesterol level.
  • Impaired nutrition.

Classification of Aneurysm:-

  1. According to the location:- They are described according to specific vessels in which they develop. Example: Aortic aneurysm, iliac aneurysm, thoracic aneurysm, lastly more preciously according to the area of vessels they affect.
  2. According to Etiological factor:- Aneurysm is classified according to cause such as atherosclerotic aneurysm, microtia, aneurysm, hypertension aneurysm, traumatic aneurysm.
  3. According to Appearance: Classification of the aneurysm is sometimes based on the shape and anatomic feature or size.
  4. Saccular Aneurysm:- Saccular aneurysm involves all three layers of the artery. An outpouching of an artery at the point where the media is thin.
  5. Fusiform Aneurysm:- Fusiform aneurysm involves the entire circumference of the vessels. It is a localized uniform dilation of an artery.
  6. Dissecting Aneurysm:- In dissecting aneurysm hematoma is present in the arterial wall that separates the layers of the arterial wall.
  7. False Aneurysm:- False aneurysm results from the development of a sac around a hematoma that maintain communication with the lumen of an artery where the wall has been ruptured or penetrated.

Pathophysiology of Aneurysm:-

Abdominal aortic aneurysm four types more often than the thoracic aneurysm. the Natural cause of an untreated aneurysm is to expand or rupture. The aorta is under greater stress than the rest of the arterial system because of its large diameter and its exposure to the high pressure during each systolic ejection of blood.

Clinical Manifestation of Aneurysm:-

  • Awareness of pulsation mask in the abdomen.
  • Abdominal pain and back pain.
  • Pain in lower abdomen, groin, and genitalia.
  • Decrease hemoglobin.
  • Sign of hemorrhage.
  • Shock.
  • Abdominal Distension.

Diagnostic Evaluation of Aneurysm:-

  • Physical Examination.
  • USG.
  • CT Scan.
  • Abdominal Aortography.

The complication of Aneurysm:-

  • Coronary artery disease.
  • Pulmonary obstructive disease.
  • Pre-renal failure.
  • Spinal cord ischemia.
  • Change in sexual function.
  • Severe bleeding.

Management of Aneurysm:-

  1. Surgical Management:- Surgery is usually not performed on clients with a less symptomatic abdominal aortic aneurysm smaller than 4-5 cm. Every six months a USG is indicated to determine whether any change in the size occurred.
  • Endovascular Procedure:- It is a newer method for lower emergency treatment to repair abdominal aneurysms. small incisions are made in the groin and avascular into the aorta. deflated balloon and tightly wrapped polyester cloth graft are placed, when properly position the graft is securely place by inflation the balloon and opening the graft of the diameter needed to prevent a blood clot in the aneurysm then the balloon is deflated and removed along with the catheter at each end of the graft hooks are present that help secures it to the inner walls of the aorta.
  • Aneurysm Repair:- Surgical repair is usually recommended for all aneurysm greater than 6 cm. find.