Question

from normal to severe with at least two different backgrounds. What nursing interventions would you select for this client? Write 3 interventions with rationales for a client with a hearing impairment.

a visual impairment. What nursing interventions would you select for this client? Must submit 3 interventions with rationales for a client with the vision impairment that was chosen.

Answer 1

Interventions are the backbone of nursing. The term describes any action nurses may take to improve the health and comfort of their patients. For those considering advancement in the field, nursing interventions are a crucial concept to master.

According to the Journal of Nursing Education, nursing interventions can be described as one of two ideas:

• Any task that a nurse does to or for a patient.
• Anything a nurse does that leads directly to a patient outcome.

These tasks may be general or specific and direct or indirect. Examples of areas of patient care interventions include:

• Sleep pattern control
• Mobility therapy
• Compliance with diet
• Infection control
• Alcohol abuse control
• Positioning therapy
• Bedbound care
• Energy conservation
• Postpartum care.  

What is hearing impairment:

Total or significant loss of hearing.

Deafness is usually the result of inner ear or nerve damage. It may be caused by a congenital defect, injury, disease, certain medication, exposure to loud noise or age-related wear and tear.

COMMON CAUSES

Hearing loss can have causes that aren't due to underlying disease. Examples include too much ear wax, loud or prolonged noise exposure, ageing, getting an object stuck in the ear or medication side effects.

Symptoms : usually self-diagnosable. The chief symptom is an inability to hear sound.

Treatment depends on severity

For some, hearing may be possible with surgery or a hearing device. Lip-reading skills, written or printed text and sign language may help with communication.

TYPE OF HEARING IMPAIRMENT:

Conductive, sensorineural, and mixed hearing loss, central auditory dysfunction.

Nursing intervention for hearing impairment:-  

• Medical Treatment.
• Hearing Aids.
• Assistive Listening, Hearing Enhancement and Alerting Devices.
• Signaling and Text Display Systems.
• Digital Cell Phones and Hearing Aid Use.
• Cochlear Implants.
• Aural Rehabilitation and Listening and Auditory Communication Enhancement

Main three Nursing interventions for hearing impairment patients are described below:

NURSING INTERVENTIONS*/SELECTED ACTIVITIES AND RATIONAL:

■ Facilitate use of hearing aids, as appropriate.
RATIONAL:Hearing can be enhanced if the volume is appropriate and the
hearing aid is consistently used.
■ Listen attentively.
RATIONAL:Effective listening is essential in a nurse–client relationship. Poor listening skills can undermine trust and block therapeutic communication.

■ Use simple words and short sentences, as appropriate.
RATIONAL:Using simple terms and short sentences facilitates understanding
and minimizes anxiety.
■ Obtain patients attention through touch.
RATIONAL:Gaining the attention of a client with a hearing impairment is an
essential first step toward effective communication. However, the
client’s personal space should be respected and permission to
touch should be obtained.

INTERVENTIONS

When a patient has hearing impairment, a combination of adaptive techniques, environmental modifications, and assistive devices (including hearing aids) is necessary to ensure effective communication.

1.Adaptive techniques. When speaking with a patient who has a hearing impairment it's important

* to face him directly and make sure you have his attention.

* to speak at a normal volume while clearly enunciating (but without using exaggerated lip movements).

* not to cover your mouth with your hand.

* to rephrase sentences instead of repeating them.

* to make sure that hearing aids are in place and that batteries are charged.

* to make sure that glasses are worn when needed.

Identifying hospitalized patients who have a hearing impairment to others (for example, with a bracelet, a bed tag, or a flag on the chart) and posting communication strategies (with the patient's consent) may ease frustration and minimize miscommunication. Remind patients to listen actively. However, many people with hearing impairment find it tiring to keep paying attention, so provide adequate time. Training in word recognition has also been shown to result in some improvements in older adults with hearing impairment.

2.Environmental modifications include strategies to enhance comprehension and minimize background noise. For example, in a restaurant, it may be helpful for the person with hearing impairment who is not using directional hearing aids to sit with his back to the wall, so sound doesn't come from all sides. He should not sit at the end of a table or away from the center of conversation. There should be enough light to allow faces to be clearly seen because visual cues are helpful.

It's difficult to eliminate background noise in clinical settings. In a study of long-term care settings in Scotland, Tolson and McIntosh found that "levels of background noise were shown to be unacceptable in 77% of the observations."Staff conversations, the use of radios and televisions, open doors, and "the careless and noisy use of equipment and movement of furniture by staff" were the most common sources of disruptive sound. However, the researchers found it "impracticable" to reduce the noise level below approximately 60dB (about the level of normal conversation)-doing so required a great deal of effort on the part of the nursing staff and the education of all staff and visitors. Resident-to-resident conversation was facilitated through the provision of additional lighting and rearrangement of furniture. Sommer and Sommer also recommend talking to patients with hearing impairment in private rooms whenever possible.

3.Assistive devices include hearing aids and other devices and services.

Hearing aids have changed significantly over the last decade, and many can now be programmed to closely address specific needs. Hearing aids consist of, at minimum, a microphone that receives sound and transforms it into an electrical signal; an amplifier that increases the loudness of the signal; and a speaker that receives the signal, converts it back into sound waves, and transmits it to the ear. A good fit is essential, so molds of the patient's ears are made.

The primary purpose of a hearing aid is to amplify sounds across a range of frequencies. It does not correct hearing deficits. This may be frustrating to those who expect otherwise and don't allow time to adapt; indeed, because hearing loss usually occurs slowly, the brain becomes unaccustomed to hearing sounds-it can take three months or more to get used to the device and to hearing again. For this reason, new users may prefer lower levels of amplification.

Hearing aids are usually not covered by health insurance or Medicare, although some plans cover a portion of the cost. They range in price from a few hundred dollars per unit to several thousand, depending on the technology. Further, batteries (which can be purchased in bulk) are changed every one to two weeks, adding significantly to overall costs.

Whistling, usually a result of feedback, is a frequent complaint of hearing aid wearers. The device takes sound in through a microphone, amplifies it, and directs it through a speaker toward the tympanic membrane. Whistling can occur when sound leaving the speaker gets fed back into the microphone, which can occur when the hearing aid is not properly fitted into the ear canal. It can also occur if an object (such as a hand, head, or clothing) gets close to the outside of the ear, reflecting sound back into the microphone. Turning the volume too high can also cause whistling. One positive aspect of whistling is that it usually indicates the hearing aid is working. (Indeed, a commonly used technique to test hearing aid batteries involves placing one's hands close to a hearing aid that is turned on. If it doesn't whistle, the batteries may need replacing.)

Communicating with someone with hearing loss

• Gain their attention before you start speaking to them
• Speak clearly but do not shout or speak very slowly
• Make sure they can see your face
• Make sure your face is well lit
• Try not to move around too much during conversation
• Be aware that you may need to repeat what you say a few times, using different words or strategies
• If nothing else works, resort to written communication

*what is Nursing intervention for visual impairment:

Visual impairment is a term experts use to describe any kind of vision loss, whether it's someone who cannot see at all or someone who has partial vision loss. Some people are completely blind, but many others have what's called legal blindness.

Nurses should take responsibility for instigating safety measures, such as good lighting, placing the bedside locker on the side most appropriate for the individual patient, and ensuring that the call bell is placed within easy reach.

Common types of visual impairment

Loss of Central Vision
The loss of central vision creates a blur or blindspot, but side (peripheral) vision remains intact. This makes it difficult to read, recognize faces and distinguish most details in the distance. Mobility, however, is usually unaffected because side vision remains intact.

Loss of Peripheral (Side) Vision
Loss of peripheral vision is typified by an inability to distinguish anything to one side or both sides or anything directly above and/or below eye level. Central vision remains, however, making it possible to see directly ahead. Typically, loss of peripheral vision may affect mobility and if severe, can slow reading speed as a result of seeing only a few words at a time. This is sometimes referred to as "tunnel vision."

Blurred Vision
Blurred vision causes both near and far to appear to be out of focus, even with the best conventional spectacle correction possible.

Generalized Haze
Generalized haze causes the sensation of a film or glare that may extend over the entire viewing field.

Extreme Light Sensitivity
Extreme light sensitivity exists when standard levels of illumination overwhelm the visual system, producing a washed out image and/or glare disability. People with extreme light sensitivity may actually suffer pain or discomfort from relatively normal levels of illumination.

Night Blindness
Night blindness results in inability to see outside at night under starlight or moonlight or in dimly lighted interior areas such as movie theaters or restaurants.

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NURSING INTERVENTION:

Assess the patient’s ability to see and perform activities.

RATIONAL:

Provides a baseline for determination of changes affecting the patient’s visual acuity.

NURSING INTERVENTION:

Indirect ophthalmoscopy

RATIONAL:

Fundus examination through a dilated pupil that may reveal gross macular changes

NURSING INTERVENTION:

Amsler’s Grid

RATIONAL

Used to monitor visual field loss.

NURSING INTERVENTION:

I.V. fluorescein angiography

RATIONAL:

Sequential photographs that may show leaking vessels as fluorescein dye flows into the tissues from the subretinal neovascular net.

NURSING INTERVENTION

Encourage patient to see an ophthalmologist at least yearly.

RATIONAL

Can monitor progressive visual loss or complications. Decreases in visual acuity can increase confusion in the elderly patient

NURSING INTERVENTION:

Provide sufficient lighting for the patient to carry out activities.

RATIONAL:

Elderly patients need twice as much light as younger people.

NURSING INTERVENTION:

Provide lighting that avoids glare on surfaces of walls, reading materials, and so forth.

RATIONAL:

Elderly patient’s eyes are more sensitive to glare and cataracts diffuse and glare so that the patient has more difficulty with vision.

NURSING INTERVENTION:

Provide night light for the patient’s room and ensure lighting is adequate for the patient’s needs.

RATIONAL:

Patient’s eyes may require longer accommodation time to changes in lighting levels. Provision of adequate lighting helps to prevent injury.

NURSING INTERVENTION:

Provide large print objects and visual aids for teaching.

RATIONAL:

Assists patient to see larger print and promotes a sense of independence.