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When providing corrective counseling with a student, it is first important to do so privately and away from the patient. Students that are corrected within the presence of a patient will encourage distrust and uncomfortable feeling. Once the student is in a private setting, the instructor would review the ear exam that the student conducted. If the student is able to identify their own mistakes, then the instructor will simply provide a brief review of examining the ear. If the student is unable to identify any mistakes with their own exam, then the instructor would need to provide more in dept instruction.
When first approaching the patient to inspect the ear, questions regarding hearing loss or trouble with the ears should be asked. If the patient is experiencing difficulties with hearing loss or possibly pain then the student would pay attention to what may cause the hearing loss or pain. Explaining the procedure to the patient is the next appropriate step as a way of preparing the patient to hold their head still and to expect that the student will be in close proximity for a brief period. The outer ear would then be inspected for abnormalities to the skin. The student will then use an otoscope with an appropriately sized speculum attached (larger size for an adult and smaller size for a child) which is held in one hand. The other hand will straighten the ear canal by gently pulling the top of the auricle upward, backward, and away from the head. The otoscope speculum will then be inserted into the ear canal with a downward angle. At this point the ear canal is visible. The student should take note to any discharge, redness, swelling, amount of cerumen, or foreign bodies. The eardrum will also be visible and should appear light gray or shiny pearly white in color. The light from the otoscope should reflect off of the surface.
After explaining the proper procedure of conducting an ear exam, I would then have the student redemonstrate an ear exam to ensure that the information was processed and received appropriately.
With any head trauma, it is important to ensure the airway remains patent and oxygen levels remain above 95%. The immediate concern in head injury is intracerebral hemorrhage. Assess for any period of loss of consciousness post head injury. Assess the level of consciousness using the Glasgow Coma Scale which should be 15. Assess the patients level of orientation, identity, knowledge of their location, situation, able to recall the event. Assess for signs of confusion, amnesia, agitation, dizziness, or drowsiness. Assess for signs of intracranial bleeding; nausea, vomiting, slurred speech, seizures. Check for PERRLA: pupillary dilation, equality, roundness, reaction, light sensitivity and reaction of pupils, accommodation of pupils with closeness and distance. Alterations in PERRLA can indicate intracranial swelling. Blindness indicates damage to cranial nerve 2, possible optic nerve avulsion, and possible orbital fracture with globe rupture (Chou, et al., 2016). Drainage from the nose and ears can indicate a cranial fracture.
The patient is at risk for neck trauma and needs to be placed in a cervical collar to immobilize the neck. Assess for a neck injury, palpate neck structures for tenderness or deviations. If the patient is stable, assess for the ability to walk, steady gait, dizziness upon standing. Assess grips and pronator drift. Ask the patient to touch finger to nose and finger to finger. If the patient is alert and oriented, assess vision using the Snellen chart and six cardinal directions of gaze.
Emergent care is maintaining the airway and immobilizing the neck. Keep the head above the level of the heart to reduce intracranial pressure. Protect the patient from injury secondary to right-sided vision loss, possible intracranial bleed, possible confusion, possible neck injury. The patient needs a CT of the head and neck, a possible MRI, and a thorough ophthalmic examination (Chou, et al., 2016).