1. Deafness: Hard of hearing-slight or moderate hearing loss that is serviceable for activities of daily living. Deaf-hearing is nonfunctional for activities of daily living.
    1. Risk factors:
      1. Conductive hearing losses (transmission deafness):
        1. Impacted cerumen (wax).
        2. Foreign body in external auditory canal.
        3. Defects (thickening, scarring) of eardrum.
        4. Otosclerosis of ossicles.
      2. Sensorineural hearing losses (perceptive or nerve deafness):
        1. Arteriosclerosis.
        2. Infectious diseases (mumps, measles, meningitis).
        3. Drug toxicities (quinine, streptomycin, neomycin SO4).
        4. Tumors.
        5. Head traumas.
        6. High-intensity noises.
      3. Central deafness:
        1. Tumors.
        2. Stroke (brain attack).
      4. Noise-induced or occupational noise hearing loss:
        1. Blast injury.
        2. Firearms.
        3. Loud music.
      5. Aging (presbycusis).
    2. Assessment-objective data:
      1. Inattentive or strained facial expression.
      2. Excessive loudness or softness of speech.
      3. Frequent need to clarify content of conversation or inappropriate responses.
      4. Tilting of head while listening.
      5. Lack of response when others speak.
    3. Analysis/nursing diagnosis:
      1. Auditory/sensory/perceptual alteration related to loss of hearing.
      2. Impaired social interaction related to deafness.
    4. Nursing care plan/implementation:
      1. Goal: maximize hearing ability and provide emotional support.
        1. Gain person’s attention before speaking; avoid startling.
        2. Provide adequate lighting so person can see you when you are speaking.
        3. Look at the person when speaking.
        4. Use nonverbal cues to enhance communication, e.g., writing, hand gestures, pointing.
        5. Speak slowly, distinctly; do not shout (excessive loudness distorts voice).
        6. If person does not understand, use different words; write it down.
        7. Use alternative communication system:
          1. Speech (lip) reading.
          2. Sign language.
          3. Hearing aid.
          4. Paper and pencil.
          5. Flash cards.
        8. Supportive, nonstressful environment; alert staff to patient’s hearing impairment.
      2. Goal: health teaching.
        1. Prepare for evaluative studies-audiogram.
        2. Appropriate community resources: National Association of Hearing and Speech Agencies for counseling services; National Association for the Deaf to assist with employment, education, legislation; Alexander Graham Bell Association for the Deaf, Inc., serves as information center for those working with the deaf; American Hearing Society provides educational information, employment services, social clubs.
        3. Use of hearing aid: care-(1) turn off aid when not using (open case at night to prevent draining battery); (2) keep extra battery available; (3) wash with mild soap and warm water; use pipe cleaner to remove wax; (4) do not wear aid in shower or with ear infection; (5) store same place every night and away from pets; (6) if aid does not work: check battery insertion, on-off switch, placement (if ear-molded aid), cleanliness.
        4. Safety precautions: when crossing street, driving.
    5. Evaluation/outcome criteria:
      1. Method of communication established.
      2. Achieves independence (use of Dogs for Deaf, special telephones, visual signals).
      3. Copes with lifestyle changes (minimal depression, anger, hostility).