Question

The nurse is assessing a client following a stapedectomy. Which finding suggests damage to cranial nerve VII? A. Changes in taste B. Changes in hearing C. Changes in voice quality D. Changes in oral sensation

Short answer

A. Changes in taste B. Changes in hearing C. Changes in voice quality D. Changes in oral sensation Answer: A. Changes in taste

Step-by-step solution

Understand the function of cranial nerve VII

Firstly, let's understand what cranial nerve VII (the facial nerve) is responsible for. It controls the muscles of facial expression, the secretion of tears and saliva, and the sense of taste in the anterior two-thirds of the tongue.

Learn about a stapedectomy

A stapedectomy is a surgical procedure performed to improve hearing by removing the stapes bone (one of the bones in the middle ear) and replacing it with a prosthesis. During the surgery, there is a chance that, if not performed correctly, the facial nerve may be damaged.

Evaluate option A (Changes in taste)

As mentioned before, cranial nerve VII is responsible for the sense of taste in the anterior two-thirds of the tongue. Therefore, any damage to this nerve may result in changes in taste. This option is a possible sign of damage to cranial nerve VII.

Evaluate option B (Changes in hearing)

Changes in hearing are not related to the facial nerve, but rather to the nerves and structures in and around the ear, like the auditory nerve (cranial nerve VIII) and the cochlea. This option is not a sign of damage to cranial nerve VII.

Evaluate option C (Changes in voice quality)

Changes in voice quality can be related to the larynx, vocal cords, and the nerves that control them, especially cranial nerve X, known as the vagus nerve. This option is not a sign of damage to cranial nerve VII.

Evaluate option D (Changes in oral sensation)

Changes in oral sensation are related to the trigeminal nerve (cranial nerve V), which is responsible for the sensation in the face, mouth, and the anterior two-thirds of the tongue. This option is not a sign of damage to cranial nerve VII.

Conclusion

Based on our evaluation of each option, we can conclude that the finding that suggests damage to cranial nerve VII (facial nerve) after a stapedectomy is A. Changes in taste.

Key concepts

Stapedectomy

A stapedectomy is a delicate surgical procedure aimed at improving hearing. This surgery involves removing the stapes bone, the smallest bone in the human body located in the middle ear, and replacing it with an artificial device or prosthesis. The stapes bone plays a pivotal role in the transmission of sound vibrations to the inner ear, and its dysfunction can lead to conductive hearing loss.

Since the facial nerve, also known as cranial nerve VII, runs close to the stapes bone, there's a risk of nerve damage during this procedure. The facial nerve's proximity to the surgical field necessitates a careful and precise surgical technique to prevent any iatrogenic injury. Patients undergoing a stapedectomy are usually under close observation post-surgery to monitor for any complications, including nerve damage.

Facial Nerve Functions

The facial nerve, or cranial nerve VII, is a critical nerve with both sensory and motor functions. It innervates the muscles of facial expression, enabling us to smile, frown, and show a range of emotions. Additionally, it has parasympathetic fibers that control the secretion of tears and saliva, which explains why facial nerve damage can affect tear production and salivation.

The nerve also carries taste sensations from the anterior two-thirds of the tongue. Thus, damage to this nerve can result in a loss or alteration of taste, known as dysgeusia. Understanding these functions is crucial when assessing potential nerve damage following procedures like stapedectomies, where the facial nerve's intricate pathway makes it susceptible to injury.

Nursing Assessment Post-Surgery

After a patient undergoes a stapedectomy, diligent nursing assessment is essential to ensure a successful recovery and promptly address any complications. Nurses play a vital role in monitoring the patient's vitals and observing for any signs of cranial nerve VII damage. Key indicators include changes in facial symmetry, difficulty closing the eye, drooping of the mouth, altered tear production, and changes in taste.

The assessment should be thorough and systematic to differentiate between postoperative swelling and actual nerve damage. Moreover, patient education pre- and post-surgery is vital to inform them about potential risks and what symptoms to watch for. Should any issues arise, prompt intervention can prevent long-term deficits and promote optimal healing.