Download Nora Estrada- Mrs. Horton Michele Yzagurirre

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:
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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:
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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
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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:
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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.
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Treatment of the ear infections.
4. The collaborative care for this child?
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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
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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.
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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
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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.
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Financial Assistance- The following programs help and assist families with
children with hearing loss cover medical expenses, equipment needed, and other
financial expenses.
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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
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The Better hearing Organization –Financial Assistance programs
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Hearing loss Association of America
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Children of the Silent World- assists low-income children with purchasing hearing
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aids
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Parent Infant Financial Aid
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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.
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Center for Hearing and Speech (CHS) – empower parents to become advocates for
hearing-impaired child and provide information and tools to overcome challenges.
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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:
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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:
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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?
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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:
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Conductive Hearing Loss Skit
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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