NCP Nursing Diagnosis: Disturbed Sensory Perception: Auditory Hearing Loss; Hearing Impaired; Deafness

Nursing Diagnosis: Disturbed Sensory Perception: Auditory
Hearing Loss; Hearing Impaired; Deafness
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Hearing Compensation Behavior
* Risk Control: Hearing Impairment

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Communication Enhancement: Hearing Deficit
* Ear Care

NANDA Definition: Change in the amount or patterning of incoming stimuli accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli

Hearing loss is common among older adults but may also occur as the result of congenital exposure to virus; during childhood after frequent ear infections or trauma; and during adulthood as the result of trauma, infection, or exposure to occupational and/or environmental noise. When hearing loss is profound and precedes language development, the ability to learn speech and interact with hearing peers can be severely impaired. When hearing is impaired or lost later in life, serious emotional and social consequences can occur, including depression and isolation. Some causes of hearing loss are surgically correctable. Many hearing assistive devices and services are available to help the hearing-impaired individual. Nursing interventions with the hearing impaired are aimed at assisting the individual in effective communication despite the loss of normal hearing.

* Defining Characteristics: Asking others to repeat spoken messages
* Inappropriate response to questions
* Head tilting
* Cupping hands around ears
* Social avoidance or withdrawal
* Irritability
* Difficulty learning or following directions
* Dizziness
* Ear pain

* Related Factors: Middle ear injuries secondary to penetration of eardrum
* History of head trauma, especially direct blow to ear(s)
* Prolonged or cumulative exposure to environmental noise greater than 85 dB
* Otosclerosis
* Meniere’s disease
* Presbycusis (loss of hearing associated with aging)
* Acoustic neuroma
* Congenital rubella exposure
* Ototoxic drug use
* Chronic or recurring otitis media
* Inoperative or poorly fitted hearing aids
* Accumulated earwax

* Expected Outcomes Patient achieves optimal functioning within limits of hearing impairment as evidenced by ability to communicate effectively and to engage in meaningful activities.

Ongoing Assessment

* Assess patient’s ability to hear by performing the following:
o As screening, note patient’s ability to hear and appropriately respond to normal conversational voice; do this within patient’s sight, then again from out of patient’s sight. Patients may rely on lip-reading to a greater extent than they are aware.
o Ask family or caregivers about their perception of patient’s hearing impairment.
o Review audiogram, if available. This diagnostic study indicates both type and amount of hearing loss.
* Assess age. Neurosensory hearing loss affects many older individuals; high-pitched sounds, and the ability to comprehend some consonants, are the earliest effects. Patients may be unaware of progressive hearing loss; family, friends, and caregivers often first notice requests for verbal repetition, lack of response to verbalizations, and misanswered questions.
* Assess whether hearing loss is recent, progressive, or present since childhood. Adults with new or progressive hearing loss require attention to the emotional and social implications of impaired communication, whereas those who have had hearing loss since birth or childhood probably have the skills, tools, and resources available to cope with hearing impairment.
* Review medical history. History of head or ear trauma and frequent bouts with ear infections are often associated with hearing loss.
* Review exposure to environmental noise, either as the result of occupation, recreation, or accident. Occupational Safety and Health Act (OSHA) requires hearing protection in workplaces with noise levels exceeding 90 dB. Young persons who frequent rock concerts or listen to very loud music place themselves at risk for hearing loss. Hearing loss that results from noise is not reversible.
* Review recent use of drugs that are ototoxic. Aspirin, quinidine, some chemotherapeutic agents, and the aminoglycosides are known ototoxic agents. Withdrawal of these drugs when hearing impairment occurs often allows for full return of hearing.
* Check ears for earwax. Wax prevents sound transmission and may clog hearing aid(s).
* Note/investigate social and emotional impact of hearing loss. Loss of hearing may lead to reclusiveness, isolation, depression, and withdrawal from usual activities. The decision to wear a hearing aid is often resisted because of the social stigma perceived in conjunction with aging and loss of abilities.
* For patients with hearing aids:
o Note condition/age of hearing aid(s).
o Note frequency with which patient wears hearing aid(s).
o Check hearing aid(s) for fresh, functional batteries.
o Check hearing aid(s) for wax impaction.
* Assess for drainage from ear canal. Purulent, foul-smelling drainage indicates an infection; serous, mucoid, or bloody drainage may indicate effusion of the middle ear after an upper respiratory or sinus infection.
* Culture any drainage from the ear canal(s). This determines presence of infectious pathogens.
* Ask patient whether the ear(s) is painful. Pain is a symptom of increased pressure behind the eardrum, usually a result of infection.
* Assess for dizziness, dysequilibrium. Disorders of the ear (e.g., Meniere’s disease) may be accompanied by dizziness because of the inner ear’s role in maintenance of equilibrium.
* Assess patient’s ability to effectively administer ear drops.

Therapeutic Interventions

* Use touch and eye contact. These gain patient’s attention.
* When speaking, do the following:
o Reduce or minimize environmental noise. Reduce noise so that speaker does not have to compete to be heard.
o Face patient in good light and keep hands away from mouth. This enhances patient’s use of lip-reading, facial expressions, and gesturing.
o Speak close to patient’s "better" ear, as appropriate.
o Avoid shouting or yelling. This prevents humiliation.
o Use simple language and short sentences.
o Speak slowly.
* Use grease boards, computers, or other writing tools. These help communicate with profoundly hearing-impaired individuals.
* For patients with hearing aid(s), ensure that hearing aid(s) is in place, clean and working. Patients with new hearing aid(s) need time to adjust to the sound produced. Encouragement is often needed, especially among elderly patients who may decide that the hearing aid(s) is not worth the effort.
* Provide encouragement to use hearing aid(s).
* Prepare patient for ear surgery. Tympanoplasty (removal of dead tissue, restoration of bones with prostheses) and mastoidectomy (removal of all or portions of the middle ear structures) are common surgical treatments for hearing loss.

Education/Continuity of Care

* Teach patient or caregiver to administer ear medications. Drops should be administered at room temperature to avoid pain and dizziness; tip of applicator or dropper should not be allowed to come into contact with anything. Head should be positioned to allow medication to flow into ear canal; this position should be maintained for 1 to 2 minutes.
* Instruct patient or caregiver in safe techniques for cleaning ears. Thin washcloths and fingers are best for cleaning ears. Cotton-tipped applicators should be avoided to prevent inadvertent injury to eardrum.
* Teach patient or caregiver use and care of hearing aid(s) and/or other assistive hearing devices.
* Explore technology such as amplifiers, modifiers for telephones, and services for the hearing impaired (e.g., closed-caption TV, telephone hearing-impaired assistance). These may assist the hearing-impaired person function and participate in meaningful activities.
* Instruct patient in the importance of routine examination by an audiologist. Exams detect changes in hearing or need for change in hearing aid(s).