CASE ANALYSIS

HEARING IMPAIRMENT

A Clinical Case Presentation Committee of the

College of Nursing and School of Midwifery
City University of Pasay

In Partial fulfillment of the requirements in

NCM 114 Related Learning Experience

By:

Dayag, Mary Joyce

Descarten, Arlan

Dela Cruz, Pauline C.

De vera, Madel

Diaz, Beatrix Hiyasmin

Eusebio, Danica Mikaela

Erlano, Mace Danielle

Espole, Jackie C.

Fabian, April Joy

Felix, Irish Eunice A.

 PERSONAL DATA

Name:Patient X

Address:Antipolo, Angono Rizal

Age:68 years old

Sex: Female

Civil status:Divorce

Religion: Catholic

Birthday:June 07, 1952

Birthplace: Pasay City

Date of Admission:October 11, 2020

Room and bed no. : Room 03 Bed 2

Hospital No: 87000

Case No. : #9816

Attending Physician: Dr. Pads

Chief complaint: “Difficulty of Hearing”

Medical diagnosis:Severe Hearing Impairment

Medical History
History of Present Illness

 Patient X is having a difficulty in responding to verbal cues even with the use of a
hearing aid. She has severe scoliosis and her ears are lower than normal.

 She is inadequate in verbal reasoning with her inability to hear and speak at the
same time her visual discrimination is inadequate.

Past Medical History

 The client always goes for a check-up every month. She had her operation in the
brain when she was only 1 year old.

Family History

(-) Hypertension (-) Asthma

(-) Malignancies (-) Diabetes Mellitus
(-) Exposure to TB

Nutritional History

 She is able to eat a normal diet and drink 6 to 8 glass of water per day.
 She usually eats more on leafy vegetables and has no allergies for food.

Personal / Social History

 The patient was the oldest among the four siblings; she cannot perform her role
as a big sister, she’s living with her family and she tends to isolates herself. The
patient’s family cannot understand her because they are not skilled in performing
sign language.
Nursing Management

 Hearing Aids recommendation

Proper way of using hearing aids
1. Wash your hands
2. Make sure the hearing aid is turned off and the volume is all the way down
3. If you have an ear mold-type hearing aid, check the mold to be sure you have
the right one (they're shaped differently for each ear). Then line up the mold
with your ear, tip it forward slightly, and place in the canal.
4. Gently push the hearing aid into place while rotating it backward slightly to
line up with your ear. The ear mold should fit snugly and comfortably.
5. Gently adjust the other pieces of your hearing aid. Place the behind-the-ear
section carefully over your ear.
6.  Turn on the hearing aid and slowly raise the volume until it's at a comfortable
level.
How to take care for hearing aids
 It's important to keep your hearing aid-especially the ear mold-clean, dry, and free of
ear wax. You can wash the mold part with mild soap and water, but be sure to
detach it from the hearing aid part so you do not damage the electronics. If your
hearing aid does not detach, you can simply wipe the mold section with a damp
cloth. Never immerse your hearing aid in water. Likewise, be sure to store your
clean, dry hearing aid in its case when you're not wearing it.

1. Cerumen management to reduce hearing impairment and allow for the

use of hearing devices
2. Hearing device support so that client can use hearing aids and/or other
assistive listening devices
3. Communication strategies so that conversations with client can be
facilitated.

Case Discussion

This is a case of a 68 year old female (Patient X) who was diagnosed Severe Hearing
Impairment, born on 07 /07/1952, Filipino, Roman Catholic, currently residing in Angono
Rizal, admitted in Pasay City General Hospital with a Chief Complaint of having
Difficulty of Hearing on October 11, 2020.

Hearing Impairment
Hearing loss is a disorder in which a person begins to lose the ability to hear in one or
both ears. It may come on suddenly or develop slowly over a period of years; it may be
temporary or permanent, and vary in severity from mild hearing loss to total deafness.
There are many possible causes of hearing loss ranging from birth defects and ear
infections (common causes in children) to exposure to high levels of noise in the
workplace and the aging process (common causes in adults). There are two major
categories of hearing loss, defined by whether the loss results from problems in the
structures of the outer or middle ear or whether it results from damage to the hair cells
of the inner ear. The first type is called conductive hearing loss (CHL) and the second
type is called sensorineural hearing loss (SNHL). CHL is often reversible while SNHL is
not. People who have both CHL and SNHL are said to have mixed hearing loss.

Conductive hearing loss occurs when sound waves cannot move through the structures
of the outer and middle ear. Ordinarily, sound waves are funneled into the ear by the
pinna, the visible part of the outer ear. The sound waves then pass through the ear
canal, where they cause the eardrum and three tiny bones called ossicles to vibrate.
The vibrations of the ossicles cause the liquid inside a snail-shaped structure called the
cochlea to move. The movement of the liquid in turn causes hair cells inside the cochlea
to respond. The hair cells convert movement into electrical signals that are then relayed
to the brain via the auditory nerve.

Conductive hearing loss can occur when the ear canal is blocked by wax or a

foreign object, the ear drum is punctured, the ossicles are dislocated, or the ear canal is
swollen shut due to infection. Sensorineural hearing loss is caused by damage to the
hair cells in the cochlea or to the nerves that conduct hearing signals to the brain.
This damage can be caused by infections (measles, mumps, rubella, influenza, or
mononucleosis); by trauma; by diabetes and other disorders that affect the circulatory
system; by cancer drugs and some other medications; or by a tumor affecting the
auditory nerve. SNHL is sometimes associated with such problems as tinnitus (ringing
in the ears) or dizziness. 

Hearing loss is a common problem in the general American population, particularly in

older adults. According to the Centers for Disease Control and Prevention (CDC), most
people over the age of twenty begin to develop a mild hearing loss. A third of adults
over the age of seventy have trouble hearing. Hearing loss is more common in older
men than in older women. About 24,000 children (three in every 1,000) are born with
hearing loss in the United States each year. Causes include genetic disorders,
infections before birth (particularly rubella), absence of ossicles or other abnormalities in
the shape or inner structures of the ear, or low birth weight. Hearing loss is equally
common in all racial and ethnic groups, as far as is known.

Conclusion
Our patient Y has severe hearing impairment. She is advised to enrolled in
psychological evaluation therapy to assess her current intellectual and emotional
functioning. With her inability to hear her non-verbal and visual skills are much
developed.

Client shows a borderline functioning; her performance is possibly affected by her

inability to hear and speak caused by her brain surgery. During observations she is
more intellectual in responding to simple questions. She excels in learning basic sign
languages.

Recommendations

 Continue her schooling and special education Psychological Evaluation School

for Sign Languages
 Families are encouraged to learn sign language to facilitate communication,
relationship and understand each other.
 Speak clearly and calmly at a moderate pace while performing sign language
 Provide visual information that is redundant with audible information.
NCP

ASSESSMENT DIAGNOSI OUTCOME PLANNING INTERVENTION EVALUATION

S IDENTIFICATION
-Assess patients for -Hearing loss -Patient will be able  Make sure Independent:  the patient
sign of hearing loss. related to To demonstrate communicati was
excessive understanding by a on is not to  Teach reported
-Assess patient’s noise verbal, written or loud for the patient use improved
ability to understand exposure sign response. patient that and care of satisfaction
verbal AEB patient it harm their hearing with ability
communication. stating ‘ I ear. aid(s) and/or to
can’t hear ‘Determine the other communicat
Subjective: you, I am minimal volume the  Patient assistive e. The
“ Nahihirapan hard of patient can hear and ability to hearing patient was
akong marinig hearing in understand a person. understand devices. demonstrate
yung mga sinasabi both ears. verbal  Explore d increased
sakin. communicati technology ability to
on. such as understand.
Objective: amplifiers, The patient
modifiers for was
● impaired telephones, demonstrate
communication and services d improved
for the ability to
● difficulty in hearing express self.
comprehending or impaired. The patient
maintaining usual These may was able to
communication assist the use
pattern. hearing- alternative
impaired methods of
person communicat
function and ion, as
participate in indicated.
meaningful
activities
Assessment Diagnosis Rationale Nursing Rationale Expected Rationale Evaluation
intervention Outcome
Subj Que: Within 8hrs of Within 8hrs of
“Hindi ko po Impaired Verbal Patient Y is deaf nursing nursing intervention
maintindihan Communication and couldnt intervention the nurse will be
yung sinasabi related to auditory communicate the nurse will able to:
niyo at wala impairment as properly and it is be able to:
akong marinig” evidence by absence affecting her
of speech to verbal responses. *Collect all the
responses and Learn patient *Nurse *Nurse would *This helps the required details for
Objective Que: inattention to noise. needs and pay should set be able to nurse to collect the documents.
*Doesn’t respond attention to collect all the accurate details
aside enough
when asked nonverbal cues. important needed for patient
* Dizziness time to details for care
* Inappropriate attend to all patient care
response of the details
of patient
care.
*Will be able to
Provide an *Patient will *This helps the communicate well
alternative be able to nurse and pt to with the patient
*This will help express herself communicate well. using the
means of
the nurse to to the nurse by interpreter.
communication communicate responding
for times when with the patient with
interpreters are interpreter.
not available 

Give the patient *Patient will *The patient was

*It may be be able to give *This will help the able to express
ample time to a proper patient to be more herself and gave all
difficult for
respond. responses and comfortable in the details the nurse
patients to
accurate details expressing herself need.
respond
by writing or to the nurse.
 under by the
pressure; interpreter that
she understand
they may
the instruction
need extra given.
time to
organize
responses,
find the
correct word,
or make
necessary
language
translations. *Family
members will *Members of the
be able to *This will help family was able to
verbalize the both parties to verbalized and
Involve family planning the explicit the plan understand the
and significant * Enhances nurse and the properly. planning they
participation patient discussed with the
others in plan discussed. nurse.
of care as much and
as possible. commitment
to plan.

*The nurse
will be able to *The nurse was able
decide about *This helps the to determine the
the need of any patient to be more patients home
assistive comfortable and setting and gave the
Assist the patient device for the make her life more proper device she
in seeking an This patient. easy by needed for patients
evaluation of his evaluation technologies that communication at
or her home and fits her and her home.
will help the
work settings. needs.
patient make
decisions
about the
 need for
assistive
devices such
as talking
computers,
*Patient and *The nurse was able
telephone her family will to give details on
typing be able to *This will help the how other therapist
devices, and verbalized patient to know could help her to
interpreters. what therapist what resources that meet her required
they may need will help her and needs.
Refer to to visit for the meet her needs
appropriate *Specialized patients need. with her current
resources (e.g., services may problem.
speech therapist, be required to
group therapy, meet needs.
individual/famil
y and/or
psychiatric
counseling).