Question

Giving one nursing diagnosis each for an elder patient with vision and hearing problems and give 10 nursing intervention for each with 10 rationales.

Answer 1

Nursing Dignosis Related to Effects of vision and Hearing loss:

Introduction : The hearing loss mainly causes the communication error as for receptive and Expressive. The person will relate / demonstrate an improved ability to communicate as evidenced by the following indicators:

1. Wear functioning hearing aid if appropriate,

2.communicate through alternative methods .

Nursing Interventions and Rationals of Hearing loss:

1. Ask the person what mode of communication he or she desires,

Record care plan the method to use:

- writing,

- speech-reading,

- speaking,

- Gesturing,

- sign language.

Rationale: Successful interaction with deaf or hearing impaired clients requires knowing back ground issues including age of onset, choice of language, cultural background, education level and type of hearing loss.

2. Assess ability to receive verbal messages ( If client can hear with a hearing aid, make sure that it is On and Functioning)

- check batteries by turning volume all the way up until it whistles. If it doesn't whistle, insert new batteries.

- make sure that the volume is at a level that enhances hearing,

- make a spl effort to ensure the client wears the hearing aid during off-the-unit visits, Or

   If the client hear with only one ear, speak slowly and clearly directly into the good ear

- place bed in a position so the person'S good ear faces the door, stand or sit on the side on which the client hears the best.

Rationale : Many older adults with hearing impairments do not wear hearing aids. Those who wear them must be encouraged to use them consistently, clean and maintain them and replace batteries. Encourage the Client to be assertive in letting significant errors know about situations and environmental areas in which they experience difficulty because of back ground noise,

3. If the person can speech- read:

- Look directly at the person and talk slowly and clearly,

- avoid standing in front of light - have the light on your face so the person can see ur lips,

- Minimize the distractions that may inhibit the person's concentrations,

- Minimise conversations if the person fatigued or use written communication.

- reinforce important communication by writing them down.

Rationale : ten percent of deaf people have the skill and language level to read lips, Only 40% of people English language visible, Lip or speech reading is difficult and fatiguing in the hospital. Unfamiliar terminology, anxiety,and poor lighting can contribute to errors.

4. If client can read or write, provide pad and pencil at all times. If client can understand only sign and language.
- address all communication to the person,not to interpreter, record name and phone number on the care plan or per hospital policy,

- carefully evaluate the person understanding of required knowledge,

- give information in writing.

Rationale : when using an interpreter, something's may be omitted or misunderstood. Whenever possible, give information in writing as well as through the interpreter.

5. Use factors that promote hearing and understanding,

- talk distinctly and clearly, facing the person,

- minimise unnecessary sounds in the room,

- have only one person talk,

- be aware of background noises,

- use gestures to enhance communication,

- encourage person to interact with other people to minimise the feeling of social isolation,

- write as well as speak all important messages,

- validate the persons understanding by asking questions that require more than yes or no answers.

- Avoid asking " do you understand "

Ratonale : Hearing aids magnify all sounds. Therefore, extraneous sounds

( eg: rusting of papers, minor squeaks) can inhibit understanding of voiced messages.

- available to assist clients with hearing impairment is DEAFNET, a computer system that allows clients to type messages to a computer at a phone company, which a voice synthesiser translates verbally.