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Nora Estrada- Mrs. Horton Michele Yzagurirre- Mrs. Horton Hannah Cooper- Mrs. Osborn Christa O’neil- Mrs. Osborn Anna Contreras-- Mrs. Horton Sensory Outline 03/08/16 RNSG 1430 Conductive Hearing Loss Conductive hearing loss: occurs when there is a problem conducting sound waves anywhere along the route through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles). (Where the problem lies in the middle ear - ear drum or ossicles). Due to Causes/findings for conductive hearing loss which are: External ear conditions- deformities Impacted earwax or foreign body- includes small things like pebbles, insects, beans, etc. Otitis externa- painful outer ear infection Middle ear conditions Trauma - Damage to ear drum. Perforation, tympanic membrane thickening Otitis media - fluid buildup in the middle ear Otosclerosis- stiffness of the bones in the ear Tumors 1. How you will assess this family member’s understanding of conductive hearing loss? The Nurse will encourage the family to express their feelings and to ask any questions or concerns they might have in regards to the plan of care for their child. The Nurse should ask them to set some goals that they would like to see happen during the duration of the total care of their child, before, during, as well as after. The nurse should then use this time to provide emotional support as well as education and referrals that would better assist the family in all the basic needs for their child’s health and wellness in regards to his hearing loss. 2. How conductive hearing loss diagnosed? Tests to diagnose may include: Physical exam. Your doctor will look in your ear for possible causes of your hearing loss, such as earwax or inflammation from an infection. Inspection of the external ear is examined by inspection and direct palpation; the auricle and surrounding tissues should be inspected for deformities, lesions, and discharge, as well as size and symmetry. The doctor will use proper otoscope examination of the external auditory canal and tympanic membrane to look for abnormalities. Your doctor may ask to see if you can hear sounds as spoken to differently in general. Whisper Test: whispers softly from a distance of 1 or 2 feet from the non-occluded ear and out of the patient’s sight. The patient with normal acuity can correctly repeat what was whispered. Tuning fork tests. Tuning forks are two-pronged, metal instruments that produce sounds when struck. Simple tests with tuning forks can help your doctor detect hearing loss. A tuning fork evaluation may also reveal whether hearing loss is caused by damage to the vibrating parts of your middle ear (including your eardrum), damage to sensors or nerves of your inner ear, or damage to both. Weber test: The Weber test uses bone conduction to test of sound. A tuning fork set in motion by grasping it firmly by its stem and tapping it and ,it is placed on the patient’s head or forehead Sound is heard best in affected ear (with hearing loss). A person with a conductive hearing loss hears bone-conducted sound as long as or longer than air-conducted sound. Rinne test: The stem of a vibrating tuning fork between two positions: 2 inches from the opening of the ear canal (for air conduction) and against the mastoid bone (for bone conduction). As the position changes, the patient is asked to indicate which tone is louder or when the tone is no longer heard. Audiometer tests- In which an audiologist conducts the test, the patient wear earphones and hear sounds directed to one ear at a time. The audiologist presents a range of sounds of various tones and asks you to indicate each time you hear the sound. With audiometry, the patient wears earphones and signals to the audiologist when a tone is heard. When the tone is applied directly over the external auditory canal, air conduction is measured. The unit for measuring loudness (intensity of sound) is the decibel (dB), the pressure exerted by sound. Hearing loss is measured in decibels—it is converted into a percentage to determine the hearing loss. Loss in Decibels Interpretation 0–15 Normal hearing <15–25 Slight hearing loss <25–40 Mild hearing loss <40–55 Moderate hearing loss <55–70 Moderate to severe hearing loss <70–90 Severe hearing loss Profound hearing loss <90 Other diagnostic testing to determine of further issues with hearing loss: Tympanogram: A tympanogram, measures middle ear muscle reflex to sound stimulation and compliance of the tympanic membrane by changing the air pressure in a sealed ear canal. Auditory Brain Stem Response: is a detectable electrical potential from cranial nerve VIII and the ascending auditory pathways of the brain stem in response to sound stimulation. Electronystagmography: is the measurement and graphic recording of the changes in electrical potentials created by eye movements during spontaneous, positional. Helps to diagnose causes of unilateral hearing loss of unknown origin, vertigo, or tinnitus. Middle Ear Endoscopy: Using endoscopes with very small diameters and acute angles, the ear can be visual examination of the middle ear. 3. The treatment? Treatment measures: Simple removal of impacted cerumen or foreign objects in the external auditory canal. Surgical procedures, such as those used to reconstruct the tympanic membrane (surgical correction) then the hearing alternatively may be improved with amplification with a conduction hearing aid. Hearing aids remain the mainstay of treatment for many persons with conductive hearing loss. Hearing implantable cochlear prosthesis for the profoundly deaf have been developed and are available for use in adults and children. Treatment of the ear infections. 4. The collaborative care for this child? The collaboration should be between physician, nurses and parents to assure the parents understand and are managing symptoms of the ear infection (i.e. fever, pain). Purchase of an otoscope to check the child's ear at home. Teach and reteach the child the importance of not sticking objects into ear. Parental education of effective communication by obtaining child’s attention before speaking, facing the child before talking and at eye level, modifying the environment to reduce noise. Suggest once an ear cleaning of earwax (if applicable) at annual wellness check-up. Referral to speech pathologist if signs of delayed speech or decreased language development appear as hearing loss progresses. Referral of diagnostic hearing testing is performed by a licensed audiologist (or in the scenario has this already been done since it says David was diagnosed with CHL?) Psychosocial – Child may feel embarrassed if others find out that he can’t hear. Possible learning deficit in classroom due to hearing loss and noise of classroom environment, reducing academic achievement. Communication difficulties can lead to isolation and lowered self-esteem. 5. The resources those are available to this mother that can help with education, financial assistance , and support. Resources Education- These are some of the different types of learning experiences for parents with children with hearing loss. The following programs are offered nationally by different organizations. Beginnings for Parents of Children Who are Deaf or Hard of Hearing, Inc. - Resource and Reference organization that produces material and videos for families to make good choices about communication methods. Boys Town Research Hospital-Center for Hearing Loss in Children- providing information on childhood learning National Cued Speech Association Nazareth College of Rochester-Events and CampsJohn Tracy Clinic-Free home study programs SEE Center for the Advancement of Deaf Children-Parent information packet and Training workshops Alexander Graham Bell Association for the Deaf, Inc.-Reading material, books, journals, videotapes, newspapers American Society for Deaf Children-Parent-to- Parent Support Auditory-Verbal International, Inc. – Provides resources and information to parents to teach their children. Cued Speech Center, Inc. -Education counseling and consultation services National Information Center on Deafness-Organizations dedicated to parent education Sunshine Cottage School for Deaf Children- Parent Infant Program- provides guidance and support. Social workers and counselors on 24 hours. . Financial Assistance- The following programs help and assist families with children with hearing loss cover medical expenses, equipment needed, and other financial expenses. Texas Department of Assistive and Rehabilitation Services- Miracle Ear Children’s Foundation- For children 16 years and younger. Help Kids Hear- for parents of hard of hearing kids and is dedicated to helping parents find information and resources they need in dealing with a deaf/hard of hearing child. Ear Community –charitable organization that helps individuals who were born with conductive hearing loss Starkey Hearing Foundation and Hear Now- assistance for low-income individuals The Better hearing Organization –Financial Assistance programs Hearing loss Association of America Children of the Silent World- assists low-income children with purchasing hearing aids Parent Infant Financial Aid Family/ Social Support- The following programs and organizations helps family which includes advice, information, having the opportunity to get to know other parents(networking) that have a child with hearing loss, finding childcare or transportation, and giving parents time for personal relaxation and time to listen. Center for Hearing and Speech (CHS) – empower parents to become advocates for hearing-impaired child and provide information and tools to overcome challenges. Play therapy Parent Social Support Groups Counseling Assessments Parenting Classes Parent Activities Communication Options 6. The prognosis for the diagnosis: Getting the proper treatment for a positive prognosis: Finish treatments for ear infections Restore hearing with proper aids Cochlear transplants Hearing Aid Technology Follow up visit with the Audiologists Get proper medical attention as soon as a problem with the ear occurs. Prevention: Minimize your exposure to loud noises that are persistent. Never listen to music through headphones or ear buds with the volume all the way up. Wear ear plugs or protective earmuffs See your doctor about a baseline hearing test Avoid the child putting objects in ears 7. Other potential psychosocial implications for both the child and the other family members? Parents may not have any other family social support system to help with financial expenses Child may have difficult time performing social relationships with other children through sports or any other activity due to loss of hearing Parents may think that they are the only parents going through this situation and may not feel accepted by other parents and friends Nursing Diagnoses: Actual Nursing Diagnosis P-Deficient of Knowledge Related to E: Lack of knowledge of resources Evidenced by S: mother believes that she caused son’s hearing loss and states she had frequently poured warm mineral oil in his ear to, “cure him of his ear infections” secondary to conductive hearing loss. Goal: Mrs. Dickinson will attend a parent-to-parent educational support group twice a month to enhance knowledge on conductive hearing loss. Mrs. Dickinson will demonstrate knowledge by not pouring mineral oil in son’s ear. Risk Diagnosis P: Risk for caregiver role strain Related to S: mother stating that she has become very emotional and distraught because she believes that she has caused son’s hearing loss. Goal: Mother will identify and use available support services and community resources. Mother will attend a support service session once a week. Audience involvement: Conductive Hearing Loss Skit Will show a video to show if someone has hearing loss developing Will take hearing loss self -quiz Will pass out pamphlets on conductive hearing loss References/citations: Resource: http://www.asha.org/public/hearing/Effects-of-Hearing-Loss-on-Development/ Handbook of nursing diagnosis edition 14, Wolters Kluwer/Lippincott & Wilkins by Lynda Juall Carpenito Taylor, Carol. Fundamentals of Nursing. Wolters Kluwer Health, 10/2014. VitalSource Bookshelf Online. Spangler, M. L. (2009). Your Guide To Financial Assistance for Hearing Aids. To Financial Assistance for Hearing Aids, 1-48. Retrieved March 5, 2016, from http://www.betterhearing.org/sites/default/files/hearingpediaresources/Financial_Assistance_for_Hearing_Aids.pdf Parent's Guide. (n.d.). A Guide For Parents of Children with Hearing Loss, 1-25. Retrieved March 5, 2016, from http://www.oticon.com/~asset/cache.ashx?id=12986&type=14&format=web