sensory impairment Flashcards
1
Q
Diagnostic Studies of Auditory System
A
- Audiometry
- Hearing acuity screening
- Diagnose degree and type of hearing loss
- Audiometer—produces pure tones at varying intensities to which the patient responds; look for specific patterns on audiogram
- Tests involving whispered and spoken voice can provide general screening information.
- In the whisper test, the examiner stands 12 to 24 in (30 to 61 cm) to the side of the patient and, after exhaling, speaks using a low whisper.
- The patient is asked to repeat numbers or words or answer questions.
- A louder whisper is used if the patient does not respond correctly.
- Each ear is tested separately.
- The ear not being tested is masked with the patient occluding the ear.
- Decibel (dB)—intensity or strength of a sound wave
- Hertz (Hz)—unit of measurement to classify frequency of a tone.
- Normal speech = 40 to 65 dB; 500 to 4000 Hz
- 40 to 45 dB loss—moderate difficulty in hearing normal speech
- Hearing aid—makes sound louder but not clearer
2
Q
Auditory Problems/Nursing Management External Ear and Canal
A
- External otitis—Inflammation or infection
Causes
* Swimming; Trauma; Piercing; Infections
Signs
* Ear pain (otalgia)
* Swelling of ear canal—muffles hearing
* Drainage—serosanguinous or purulent
* Fever
Diagnosis:
* Otoscopic exam
* Culture and sensitivity—drainage
* Treatments: 7 to 14 days
* Moist heat
* Mild analgesia
* Topical (otic drops): anesthetics, antibiotics, and corticosteroids
* Patient education
3
Q
Middle Ear and Mastoid: Otitis Media
A
Acute otitis media—infection of tympanum, ossicles, and middle ear.
Swelling of auditory tube traps bacteria; pressure on TM redness, bulging, and pain
Also see fever, malaise, drainage, and reduced hearing
Medical treatment
Oral antibiotics and eardrops
Surgery—myringotomy
Tympanostomy tube—ventilate ear
Allergy (etiology)—antihistamines and nasal corticosteroid
Goals: clear infection; repair perforation; preserve hearing
Antibiotics : otic and systemic
Evacuation of drainage
Surgery: Tympanoplasty and/or mastoidectomy
Postop: impaired hearing (temporary); drain/dressing care; keep suture line dry
Patient education: change dressing/cotton ball
4
Q
hearing loss and deafness causes
A
- Conductive hearing loss occurs in outer and middle ear and impairs the sound being conducted from outer to inner ear. It is caused by conditions interfering with air conduction, such as otitis media with effusion, impacted cerumen and foreign bodies, middle ear disease, and otosclerosis.
- Sensorineural hearing loss is caused by the impairment of the inner ear or vestibulocochlear nerve (CN VIII), resulting in the inability to understand speech. Causes include congenital and hereditary factors, noise trauma, aging, Ménière’s disease, and ototoxicity.
5
Q
hearing loss classification
A
- 0-15= normal
- 16-25= slight
- 26-40= mild
- 41-55 moderate
- 56-70 moderate severe
- 71-90 severe
- > 90 profound
6
Q
hearing loss clinical manifesation
A
- Early signs of hearing loss often go unnoticed by patient
- Early signs of hearing loss include asking others to speak up, answering questions inappropriately, not responding when not looking at speaker, straining to hear, reading lips, and increasing sensitivity to slight increases in noise level.
- Pressure by others is a significant factor in whether help is sought
- Often the patient is unaware of minimal hearing loss. Family and friends who get tired of repeating or talking loudly are often the first to notice hearing loss. Pressure exerted by significant others is a significant factor in whether the patient seeks help for hearing impairment.
- The unseen handicap
- Deafness is often called the “unseen handicap” because it is not until conversation is initiated with a deaf person that the difficulty in communication is realized.
- Understanding should be validated in patient teaching interactions
- Obtain interpreter assistance
- If the significantly hearing-impaired individual uses sign language to communicate, the Americans with Disabilities Act requires providing an interpreter when significant information is presented such as for patient consent or discharge teaching.
7
Q
hearing loss clinical manifestation
A
- Interference in communication and interaction with others can be the source of many problems for the patient and caregiver.
- Signs of hearing loss include asking others to speak up, answering questions inappropriately, not responding when not looking at speaker, straining to hear, and increasing sensitivity to slight increases in noise level.
- Often the patient refuses to admit or may be unaware of impaired hearing. Irritability is common because of the concentration with which the patient must listen to understand speech.
- The loss of clarity of speech in the patient with sensorineural hearing loss is most frustrating.
- Withdrawal, suspicion, loss of self-esteem, and insecurity are commonly associated with advancing hearing loss.
8
Q
hearing loss and deafness tinnitus
A
- Tinnitus is the perception of sound in the ears where no external source is present. It is “ringing in the ears” or “head noise” (www.ata.org). Tinnitus is sometimes the first sign of hearing loss, especially in older people. It may be soft or loud, high pitched or low pitched.
- Tinnitus and hearing loss are directly related. Both are caused by inner ear nerve damage. The main difference between tinnitus and hearing loss is the extent of the damage (as tinnitus can still be heard).
- Although the most common cause of tinnitus is noise, it can also be a side effect of medications. More than 200 drugs are known to cause tinnitus.
9
Q
Hearing Loss and Deafness Health Promotion
A
- Environmental noise control
- Noise is the most preventable cause of hearing loss
- Hearing loss caused by noise is not reversible
- Avoidance of continued exposure to noise levels greater than 70 dB is essential
- Sudden severe loud noise (acoustic trauma) and chronic exposure to loud noise (noise-induced hearing loss) can damage hearing. Acoustic trauma causes hearing loss by destroying the hair cells of the organ of Corti.
- Sensorineural hearing loss as a result of increased and prolonged environmental noise, such as amplified sound, is occurring in young adults at an increasing rate.
- Amplified music (i.e., iPod, MP3 player) should not exceed 50% of maximum volume.
- Ear protection should be worn when firing a gun and during other recreational pursuits with high noise levels.
10
Q
Hearing Loss and Deafness Health Promotion
A
- Hearing conservation at work
- Noise exposure analysis
- Hearing protectors
- Periodic hearing screening
- Education
*** Occupational Safety and Health Administration (OSHA) standards require ear protection for workers in environments where the noise levels consistently exceed 85 dB. Periodic audiometric screening should be part of the health maintenance policies of industry. This provides baseline data on hearing to measure subsequent hearing loss.
11
Q
Hearing Loss and Deafness Health Promotion
A
- Promote childhood and adult immunizations, including the measles, mumps, and rubella (MMR) immunization.
- Rubella infection during the first 8 weeks of pregnancy is associated with a high incidence of congenital rubella syndrome, which causes sensorineural deafness.
- Women of childbearing age should be tested for antibodies to these viral diseases. Various viruses can cause deafness as a result of fetal damage and malformations affecting the ear.
- Women should avoid pregnancy for at least 3 months after being immunized.
- Immunization must be delayed if the woman is pregnant.
- Women who are susceptible to rubella can be vaccinated safely during the postpartum period.
12
Q
Hearing Loss and Deafness Assistive Devices
A
- A hearing aid should be fitted by an audiologist or a speech and hearing specialist. Many types are available, each with advantages and disadvantages.
- The conventional hearing aid serves as a simple amplifier. For the patient with bilateral hearing impairment, binaural hearing aids provide the best sound lateralization and speech discrimination.
- The goal of hearing aid therapy is improved hearing with consistent use.
- Patients who are motivated and optimistic about using a hearing aid will be more successful. Determine the patient’s readiness for hearing aid therapy, including acknowledgment of a hearing problem, how they feel about wearing a hearing aid, how much the hearing loss affects life, and if the patient has any difficulty manipulating small objects such as inserting a battery.
- Use of the hearing aid should be gradually increased from the familiar home environment to outdoor and public areas.
- Hearing aids should be cared for properly, including regular cleaning, weekly battery changes and storage in a dry, cool place with battery removed.
- Nurses have a role in proper hearing aid care for hospitalized patients.
13
Q
types of hearing aids
A
CIC- completely in the canal
ITC- in the canal
ITE- in the ear
BTE- behind the ear
open fit
RIC- reciever in the canal
14
Q
hearing loss and deafness: assistive devices
A
- The cochlear implant is used as a hearing device for people with severe to profound sensorineural hearing loss in one or both ears.
- The ideal candidate is one who has become deaf after acquiring speech and language.
- For patients with conductive and mixed hearing loss, the cochlear Baha system may be surgically implanted. The system works through direct bone conduction and integrates with the skull bone over time.
- Extensive training and rehabilitation are essential to receive maximum benefit from these implants.
- The positive aspects of a cochlear implant include providing sound to the person who heard none, improving lip-reading ability, monitoring the loudness of the person’s own speech, improving the sense of security, and decreasing feelings of isolation. With continued research, the cochlear implant may offer the possibility of aural rehabilitation for a wider range of hearing-impaired individuals.
15
Q
Hearing Loss and Deafness Assistive Devices
A
- The cochlear implant is used as a hearing device for people with severe to profound sensorineural hearing loss in one or both ears.
- The ideal candidate is one who has become deaf after acquiring speech and language.
- For patients with conductive and mixed hearing loss, the cochlear Baha system may be surgically implanted. The system works through direct bone conduction and integrates with the skull bone over time.
- Extensive training and rehabilitation are essential to receive maximum benefit from these implants.
- The positive aspects of a cochlear implant include providing sound to the person who heard none, improving lip-reading ability, monitoring the loudness of the person’s own speech, improving the sense of security, and decreasing feelings of isolation. With continued research, the cochlear implant may offer the possibility of aural rehabilitation for a wider range of hearing-impaired individuals.
16
Q
hearing loss & deafness assistive techniques
A
- Speech reading, commonly called lip reading, can be helpful in increasing communication.
- The patient is able to use visual cues associated with speech, such as gestures and facial expression, to help clarify the spoken message.
- In speech reading, many words will look alike to the patient (e.g., rabbit, woman).
- Help the patient by using and teaching verbal and nonverbal communication techniques as described in Table 21-14.
- Sign language is used as a form of communication for people with profound hearing impairment.
- It involves gestures and facial features such as eyebrow motion and lip-mouth movements.
- American sign language (ASL) is used in the United States and in English-speaking areas of Canada
17
Q
Hearing Loss and Deafness Presbycusis
A
- Presbycusis (hearing loss associated with aging) includes loss of peripheral auditory sensitivity, decline in word recognition ability, and associated psychologic and communication issues.
- Often, more than one type of presbycusis may be present in the same person.
- The cause of presbycusis is related to degenerative changes in the inner ear. Noise exposure is thought to be a common factor related to presbycusis.
- Presbycusis includes loss of peripheral auditory sensitivity, decline in word recognition ability, and associated psychologic and communication issues.
- Because consonants (high-frequency sounds) are the letters by which spoken words are recognized, the ability of the older person with presbycusis to understand the spoken word is greatly affected. Vowels are heard, but some consonants fall into the high-frequency range and cannot be differentiated. This may lead to confusion and embarrassment because of the difference in what was said and what was heard.
- The prognosis for hearing depends on the causeof the loss.
18
Q
Gerontological considerations
A
- Presbycusis—hearing loss due to aging
- Tinnitus—ringing in ears
- Reduced transmission of sound— atrophy of cerumen glands; dry earwax
- Balance—atrophy of vestibular structures, slow motor responses, and musculoskeletal limitations
- Sound amplification with the appropriate device is often helpful in improving the understanding of speech. In other situations, an audiologic rehabilitation program can be valuable.
- The older adult is often reluctant to use a hearing aid for sound amplification. Reasons cited most often include cost, appearance, insufficient knowledge about hearing aids, amplification of competing noise, and unrealistic expectations.
- Most hearing aids and batteries are small, and neuromuscular changes such as stiff fingers, enlarged joints, and decreased sensory perception often make the care and handling of a hearing aid a difficult and frustrating experience for an older person.
- Some older adults may also tend to accept their losses as part of getting older and believe there is no need for improvement.
19
Q
visual problems
A
- Refraction—eye’s ability to bend light rays so they fall on retina; create sharp image
- Refractive errors—blurred vision
- Myopia—nearsighted
- Hyperopia—farsighted
- Presbyopia—loss of accommodation
- Astigmatism—visual distortion
- Aphakia—absence of lens
- Strabismus—double vision
- Can’t focus both eyes simultaneously
- One eye deviates in (estropia), out (exotropia), up (hypertropia), or down (hypotropia)
- Nonsurgical corrections:
- Corrective glasses
- Myopia, hyperopia, presbyopia (readers), astigmatism
- Combined presbyopia and other refractive errors—bifocals or trifocals
- Contacts lenses
- Know pattern of wear; daily versus extended
- Monitor for complications—keratitis
- Patient education—proper care and reporting
20
Q
visual problems
A
- Nonsurgical corrections:
- Corrective glasses
- Myopia, hyperopia, presbyopia (readers), astigmatism
- Combined presbyopia and other refractive errors—bifocals or trifocals
- Contacts lenses
- Know pattern of wear; daily versus extended
- Monitor for complications—keratitis
- Patient education—proper care and reporting
- Surgical therapy
- Laser
- Laser-assisted in situ keratomileusis (LASIK)
- Photorefractive keratectomy (PRK)
- Laser-assisted subepithelial keratomileusis (LASEK)
- Implant
- Refractive intraocular lens (refractive IOL)
- Phakic intraocular lens (phakic IOL)
21
Q
visual impairment
A
- Vision that cannot be fully corrected
- Low vision—some good usable vision
- Severe vision impairment—unable to read newsprint; may/may not be legally blind
- Legal blindness—central visual acuity of 20/200 or less in better eye with correction or peripheral field vision of 20 degrees or less
- Most blindness in United States results from: cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy
