The nurse is gathering a history from a client who is concerned about changes in his hearing. Which of the following require the physician's immediate follow-up? (Select all that apply.)
A. Feeling of fullness in ears, in addition to other manifestations of upper respiratory infection
B. Purulent drainage from ear canal
C. Sudden onset of high fever after ear surgery
D. Acute hearing loss
E. Presence of cerumen obstructing 50% of canal
F. Increasing hearing loss since started on furosemide (Lasix)
B, C, D, F
Rationale: The key word is immediate; purulent drainage and sudden onset of fever after ear surgery suggest a serious infection. In addition to causing ear damage, there is always risk for invasion of an organism into the mastoid or meningeal areas. Acute hearing loss and hearing loss from furosemide (Lasix), which is ototoxic, may cause permanent hearing loss if not addressed quickly. The other manifestations need to be addressed but are not emergent. It is quite common to have fluid behind the tympanic membrane creating pressure sensations when URI is present. Cerumen is 50% is not obstructive, but needs to be addressed.
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