Download Sensorineural Hearing Loss Teaching Plan Outline (1) PM group

Group: Monica Martinez-Bazan, Sonia Rendon, Alexandra Ponce, Nicole Marcotte
1430- PM Class
Sensorineural Hearing Loss Teaching Plan
ASSESSMENT DATA FOR LEARNING NEED:
Strengths:
Patient and wife wants to helps to improve their quality of life as a couple
Client likes to participate in weekly group card games (motivation)
Patient has family support
Weaknesses:
Patient is 80 years old
Patient expresses hearing loss in both ears
Patient is getting discouraged to attend weekly card games
NURSING DIAGNOSIS:
Actual nursing diagnosis: Situational low self-esteem r/t inactivity secondary to hearing loss AMB irritability and reluctant to participate in activities.
Goal: The patient will accept himself in the situation and incorporate positive changes in his behavior.
Risk nursing diagnosis: Risk for Injury r/t age and hearing deficit AMB change in sensorium and increased susceptibility to falling.
Goal: The patient will remain free from injury
PLANNING/EXPECTED OUTCOMES:
Patient will:
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State pertinent factors contributing to hearing loss
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Identify behaviors that remain under client’s control to
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Express feelings of increased comfort and decreased pain
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Identify strategies to reduce anxiety
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Express positive feelings related to self-esteem
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Regain hearing or develop other means of communication
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Express fears and concerns
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Effectively communicate feelings and needs
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Have access to audiometry testing and hearing aids if indicated
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Express feelings regarding the disorder and exhibit adequate coping mechanisms
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Exhibit no signs or symptoms of infection
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Remain free from injury.
NURSING INTERVENTIONS: ( EQUIPMENT, INSTRUCTIONAL AIDS, METHOD OF COMMUNICATION)
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Face the resident when speaking, and speak clearly and slowly.
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Select a hearing-friendly setting, such as a quiet area without background noise.
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Allow time for the resident to process information and to respond; validate that the resident understands the information.
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Administer prescribed medications, such as analgesics or antibiotics.
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Provide ear care, as ordered. Assist with removal of cerumen, if indicated.
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Provide an alternative method of communication, such as a pen and paper, gestures, or lip reading.
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Assist the resident with using a hearing aid.
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Encourage the resident to participate in care and decision making as appropriate to promote feelings of control and enhance self-esteem.
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Arrange for an audiometry examination, and facilitate the resident's access to a hearing device.
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Provide for a hearing-adaptive telephone.
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Provide support to help the resident resist the urge to withdraw from social situations.
PATIENT EVALUATION:
CONTENT OUTLINE: (SEQUENCE OF INSTRUCTION BEING PROVIDED TO CLIENT )
A. Definition (Concept/Exemplar)
1. (Sensory Perception/ Sensorineural Hearing Loss)- With sensorineural hearing loss, sound wave transmission is interrupted between the inner ear and the
brain due to loss of acoustic nerve function or a damaged cochlea. The most common type of sensorineural hearing loss is prebycusis.
B. Causes: Most commonly caused by viral infections or circulatory disorders. May have a genetic cause or result from an infection, other illness, trauma, or
exposure to loud noise.
1. Genetic: may result from mutation in a single gene (monogenetic) or from a combination of mutations in different genes and environmental factors
(multifactorial).
2. Trauma:
a. Head injury
b. Noise: sustained or repeated exposure to noise pollution at sound intensities greater than 100 to 120 dB can cause corresponding mechanical
damage to the organ of Corti. Severe damage can result in permanent sensorineural deafness to the affected sound frequencies.
3. Central nervous system infections (e.g., meningitis):
4. Degenerative conditions:
a.
Presbycusis: hearing loss due to age (elderly)
5. Vascular:
a.
Atherosclerosis: is a disease in which plaque builds up inside your arteries.
b. Sudden deafness
6. Ototoxic drugs
a.
Aminoglycoside antimicrobials and some other basic antimicrobials
b. Antimalarial drugs
c.
Chemotherapeutic drugs
d. Loop diuretics
e.
Salicylates (aspirin)
f.
The risk of ototoxicity depends on the total dose of the drug and its concentration in the bloodstream. It is increased in persons with impaired kidney
functioning and in those previously or currently treated with another potentially ototoxic drug.
Group: Monica Martinez-Bazan, Sonia Rendon, Alexandra Ponce, Nicole Marcotte
1430- PM Class
7.
Tumors:
a. Vestibular schwannoma (acoustic neuroma): are benign Schwann cell tumors affecting CN VIII. They usually are unilateral and cause hearing loss by
compressing the cochlear nerve or interfering with blood supply to the nerve and cochlea.
b. Meningioma
c. Metastatic tumors: commonly found in the temporal bone.
d. Idiopathic:
g. Ménière disease: is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear, causing a triad of hearing loss,
vertigo, and tinnitus.
C.
Signs and symptoms
1. Characterized by reduced hearing sensitivity and speech understanding in noisy environments, slowed central processing of acoustic information, and
impaired localization of sound sources.
2. It reduces the ability to understand speech and, later, the ability to detect, identify, and localize sounds.
3. High-frequency warning sounds, such as beepers, turn signals, and escaping steam, are not heard and localized, with potentially dangerous results.
4. People may have ringing sounds in their ears.
5. Vestibular symptoms of ototoxicity include light-headedness, giddiness, and dizziness; if toxicity is severe, cochlear symptoms consisting of tinnitus or
hearing loss occur.
D.
Diagnostic Exams/Test
1.
Weber test: Lateralization to nonaffected ear (sensorineural hearing loss); lateralization of sound to affected ear (conductive hearing loss)
2.
Rinne test: Air conduction sound heard longer than bone conduction sound (sensorineural hearing loss); bone conduction sound heard longer than or
equally as long as air conduction sound (conductive hearing loss)
3.
Auditory brain responses may show activity in the auditory nerve and the brain stem.
4.
Pure tone audiometry may show the presence and degree of hearing loss.
5.
Tympanometry reveals fluid or retraction.
6.
Electronystagmography may show the vestibular function involved with hearing loss
7.
Otoscopy may show a middle ear disorder, deformity, obstruction, mass, or impaired integrity.
E.
Diagnosis
1. Actual nursing diagnosis: Situational low self-esteem r/t inactivity secondary to hearing loss AMB irritability and reluctant to participate in activities.
2. Goal: The patient will accept himself in the situation and incorporate positive changes in his behavior.
3.
4. Risk nursing diagnosis: Risk for Injury r/t age and hearing deficit AMB change in sensorium and increased susceptibility to falling.
5. Goal: The patient will remain free from injury
F.
Treatment/Interdisciplinary
1. Drug therapy
a.
Analgesics such as acetaminophen (Tylenol) and ibuprofen (Advil) for pain relief
b. Antipyretics
c.
High-dose oral steroids, such as prednisone (Winpred) or dexamethasone (oral; injection) (Dexpak), for sudden sensorineural hearing loss
2. Assistive devices
a.
Hearing aids
b. Cochlear Implants
G.
Pre/Post1. Hearing Aids
a.
Start at the lowest setting and gradually increase
b.
Wear for short periods in the beginning
c.
Amplifies all noise including background noise
d.
Clean earmold regularly
e.
Turn off and remove battery when not in use
f.
Carry extra batteries
2.
Cochlear Implant
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Do not take aspirin or ibuprofen for 10 days before surgery.
2. Wash your hair the night before surgery. Do not wear any
makeup or jewelry the day of surgery.
3. Do not eat or drink anything (including water) after midnight
before surgery. You may brush your teeth, but do not swallow any
water.
4. You can take your regular medications the morning of surgery,
with a sip of water. If you are diabetic, you may have to adjust your
insulin or medication dose.
5. Arrange for someone to drive you home after surgery
Additional imaging or hearing tests may be required prior to surgery.
Post-operative medications may include steroids, antibiotics, antacids, ear drops or others as needed. These will be discussed on
the day of discharge. After discharge from the hospital you may resume most normal activities.
You may not do any heavy lifting (nothing over 25 lbs.) and you may not do any vigorous exercises (jogging, tennis, aerobics).
Do not bend. If you need to bend over to pick up something, bend at your knees.
You may shampoo your hair 48 hours after surgery carefully.
Do not take any medication containing aspirin or ibuprofen for 10 days after surgery unless instructed by the physician.
Flying is usually permitted one week after surgery.
Check with your doctor first before resuming swimming or other water sports.
If your work is not strenuous, you may return to work 3 to 4 days from the date of surgery.
Check with your doctor if your work requires heavy lifting.
You may drive if no dizziness is present and you are not taking narcotic pain relievers.
Group: Monica Martinez-Bazan, Sonia Rendon, Alexandra Ponce, Nicole Marcotte
1430- PM Class
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H.
I.
You may hear a variety of strange noises in your ear, such as cracking, popping, ringing, etc., and you may sense a feeling of
fullness or pressure in your ear.
You may also have pain when chewing. This is normal.
Do not blow your nose vigorously for 10 days after surgery.
After 10 days, you may blow your nose gently, one side at a time, with your mouth open.
Your ear may protrude or stick out for a week or so after surgery, this is normal and is due to edema or swelling of the tissues
after surgery.
This swelling may even migrate to the tissues in front of the ear or around the eye.
Call your doctor or the clinic immediately if you experience any of the following:
a. Fever (oral temperature above 101.5 degrees Fahrenheit)
b. New weakness or numbness of the face
c. Pain that is not helped by taking pain medication and is getting
worse rather than better. Severe new headaches.
d. Redness and/or swelling around the incision
e. Severe vertigo and vomiting
Side effects and/or complications
1. Risks from the Surgical Implant Procedure
a.
Injury to the facial nerve --this nerve goes through the middle ear to give movement to the muscles of the face. It lies close to where the surgeon
needs to place the implant, and thus it can be injured during the surgery. An injury can cause a temporary or permanent weakening or full paralysis
on the same side of the face as the implant.
b.
Perilymph fluid leak --the inner ear or cochlea contains fluid. This fluid can leak through the hole that was created to place the implant.
c.
Infection of the skin wound.
d.
Blood or fluid collection at the site of surgery.
e.
Attacks of dizziness or vertigo.
f.
Tinnitus, which is a ringing or buzzing sound in the ear.
g.
Taste disturbances --the nerve that gives taste sensation to the tongue also goes through the middle ear and might be injured during the surgery.
h.
Numbness around the ear.
i.
Reparative granuloma --this is the result of localized inflammation that can occur if the body rejects the implant.
Discharge Plan
a.
If hearing deteriorates, refer the patient for speech and hearing rehabilitation.
b.
Refer the patient to special augmentation services for telephone use.
c.
Refer the patient to community resources, as appropriate
METHOD OF EVALUATION (HOW YOU WILL MEASURE OUTCOMES)

Hearing ability

Signs and symptoms of progressive hearing loss

Response to medications

Ability to communicate needs
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Adaptation to hearing aid or other devices
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Postoperative status