1 INTRODUCTION

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

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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.

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The group NMB-4 was assigned at Sped Wangal, La Trinidad Benguet from 8am- 5pm on January 19-21 and 26- 28 2012 under the supervision of Mrs. Minda M. Bahug and Mr. Dexter Cuanso. During our shift we were able to handle patients with different cases. One of many cases we encountered is the Hearing impairment.

Our group chose Hearing Impairment because it is interesting and it is the only information that we can access.

Goal:

Is to provide quality and effective nursing care to our patient and to deepen our understanding about hearing impairment.

Objectives:

1. Provide information and heath teachings to hearing impaired. 2. Implement the nursing care plan. 3. Establish a good working relationship with the children and teachers. 4. design a Nursing Care Plan for the child who have hearing impairment 5. teach them on proper hygiene

4 Scope and Delimitation: The group have been deployed to the different child problem such as mutism, Hearing impaired, mental retardation, down syndrome, autism and ADHD. We were able to gather information from the cases of mutism and hearing impairment since most cases are highly confidential. Moreover, last week was their examination that is why the extent of care rendered to the student is only limited.

5 CHAPTER 1

A. DEMOGRAPHIC PROFILE

Name:

Patient X

Age: Birthday: Nationality: Religion: Gender: Civil Status: Address: Occupation: Hearing Impaired class: B. MEDICAL HISTORY B1. PAST ILLNESS

15 years old June 7, 1980 Filipino UCCP Female Single Palew Caponga, Tublay, Benguet Student Brgy. Magiting/Magalang

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

6 B2. PRESENT ILLNESS Client cannot respond to verbal cues even with the use of a hearing aid. She has severe scoliosis and her ears are lower than normal. She always wears sunglasses because she does not have eyelids. Her IQ is in the SB of 71 it means within borderline level of intellectual functioning. Specifically, she is inadequate in verbal reasoning with her inability to hear and speak at the same time her visual discrimination is inadequate. B.3 Psychosexual Developmental History Patient x is 15 years old at her age she should manifest the following psychosexual development: For Erik Erickson Identity vs. Role Confusion (13 to 21 years old) The adolescent is newly concerned with how they appear to others. Superego identity is the accrued confidence that the outer sameness and continuity prepared in the future are matched by the sameness and continuity of one's meaning for oneself, as evidenced in the promise of a career. The ability to settle on a school or occupational identity is pleasant. In later stages of Adolescence, the child develops a sense of sexual identity.

7 As they make the transition from childhood to adulthood, adolescents ponder the roles they will play in the adult world. Initially, they are apt to experience some role confusion- mixed ideas and feelings about the specific ways in which they will fit into society- and may experiment with a variety of behaviors and activities (e.g. tinkering with cars, baby-sitting for neighbors, affiliating with certain political or religious groups). Patient x family cannot understand her sign language. She displayed tantrums when shes angry. According to her teacher she sometimes feels insecure towards her siblings because she cannot perform her role as a big sister to them. She is shy when someone notices her.

For Sigmund Freud Genital stage The fifth stage of psychosexual development that spans from puberty to adult life, and thus occupies most of the life of a man and of a woman; its purpose is the psychological detachment and independence from the parents. The genital stage affords the person the ability to confront and resolve his or her remaining psychosexual childhood conflicts. As in the phallic stage, the genital stage is centered upon the genitalia, but the sexuality is consensual and adult, rather than solitary and infantile.

8 The psychological difference between the phallic and genital stages is that the ego is established in the latter; the person's concern shifts from primary-drive gratification (instinct) to applying secondary processthinking to gratify desire symbolically and intellectually by means of friendships, a love relationship, family and adult responsibilities. At patient x age she still depends on her parents on some of activities of daily living due to her condition. For Jean Piaget Formal operational stages of cognitive development Can think logically about abstract propositions and test hypotheses systematically and becomes concerned with the hypothetical, the future, and ideological problems

Patient x can think logically she is good in mathematics but due to her hearing disabilities she has difficulty of acquiring more knowledge.

9 II. ASSESSMENT GORDONS 11 FUNCTIONAL HEALTH PATTERN 1. Health-Perception Health-Management Pattern According to the referral note she has a severe scoliosis congenital brain abscess. At the age of 1 year old she was diagnosed with brain tumor, a reason to undergo operation. She was hospitalized every month. Her speech is very limited up to the present cant hear even with hearing aid. Her ears are lower than normal. 2. Nutritional-Metabolic Pattern She is able to eat a normal diet and drink 6 to 8 glass of water per day. 3. Elimination Pattern Urine is yellow in color. She defecates once a day. Upon assessment patient communicates using sign language that her stool is soft in consistency and brownish in color. 4. Activity-Exercise Pattern The patient is walking when going to school. She still depends on her parents on some of activity of daily living.

10 5. Sleep-Rest Pattern Patient is able to sleep well. Shes always sitting in her chair most of the time and can do minimal interaction with her classmates. The patient explained through sign language that she can sleep 6 to 8 hours a day. 6. Cognitive-Perceptual Pattern The patients ears are symmetrical but lower than normal. It is free from lesions, she has difficulty in hearing and responding to the questions being asked without using sign language. She is at risk of acquiring infection due to the absence of her eyelids. She gives information with regards to her feelings and concerns toward her health condition. She is oriented to time and aware of the place where she is and the people around her. 7. Self-Perception Self-Concept Pattern According to her, she was nervous on her first day of class due to her condition. Patient is able to do some of the activities such as playing, and doing her home works. She shows feeling of insecurity and feels inadequate as compared to her siblings.

11 8. Role-Relationship Pattern The patient was the oldest among the four siblings; she cannot perform her role as a big sister, shes living with her family and she tends to isolates herself. The patients family cannot understand her because they are not skilled in performing sign language. 9. Sexuality-Reproductive Pattern N/A 10. Coping-Stress Tolerance Pattern Patient X expressed her feelings through sign language that she doesnt share her problems to her family; she cannot really express herself fully because of her disability and most of the family members are not skilled and can understand sign language 11. Value-Belief Pattern Patient X is affiliated to UCCP church and she goes to church every Sunday with her family.

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B. Intellectual Evaluation Verbal reasoning Abstract/visual reasoning Quantitative reasoning Short term memory Interpretation: Score 63 76 71 Classification Mild retardation Borderline Borderline Age Equivalent 7-8yrs, 8 months 9yrs, 8 months 10-11 yrs.

Base from table above her abstract reasoning is classified as mild retardation with a score of 63. Her quantitative reasoning is classified as Borderline with a score of 76 and at the same time her short term memory is also classified as borderline with a score of 71. In this connection her IQ is in the SB of 71 it means within borderline level of intellectual functioning. Specifically, she is inadequate in verbal reasoning with her inability hear and to speak at the same time her visual discrimination is inadequate.

13 III. PSYCHOPATHOLOGY According to the referral notes, she has severe scoliosis and congenital brain abscess. With the age of 1, she was diagnosed with brain tumor, brain surgery was done. When she reached the age of 4, her family noticed that she doesnt respond to verbal cues. The family suspected that it might be the cause of the surgery; the tumor might be located on the hearing part of the brain. They tried other alternatives like hearing aid but it did not work. She was evaluated at the Philippine Mental Health Association (PMHA) and they interpreted her intellectual functioning as borderline with SB score of 71.

CHAPTER IV. CARE PLAN

Assessment S>N/A O >inability to speak dominant language >does not response to verbal cues >cannot hear even with the help of hearing aid >use of nonverbal cues Explanation of the Problem At an early age of 1, she was diagnosed of brain tumor and undergone surgery. When she reached the age of 4, her family noticed that she doesnt respond to verbal cues. The family suspected that the tumor might have damaged the hearing part of the brain.They tried other alternatives like hearing aid but it didnt work. Nursing Objectives >After 3 days of nursing intervention the client will be able to establish method of communication through sign language in which needs can be expressed. Intervention Dx>Assess response to communication impairment, willingness to find alternate means of communication Tx>Establish relationship with the client, observing carefully and attending to clients nonverbal expression >Provides alternative methods of communication like, letters/picture board and sign language > Provide needs and stay with the client until effective communication is established. >reduce environmental barriers that can interfere with clients Expected outcomes >the client can express feelings and needs through the use of sign language.

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Nursing Diagnosis: Impaired verbal communication related to complications after brain surgery

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comprehension Edx>Advise family of clients communication deficits and needed means of communication >recommend placing information to includes clients name, address and telephone number for immediate emergency assistance.

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18 V. CONCLUSION Our patient X has hearing impairment. She is currently enrolled in Wangal sped for psychological evaluation and 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 their class in terms of numbers and shows interest in activities. She excels on their class and outstanding in doing sign language. VI. RECOMMENDATION 1. Continue her schooling and special education in Wangal SPED Centre. 2. Parents are encouraged to learn sign language to facilitate communication, relationship and understand each other. 3. Continue therapy for her scoliosis and check-up for physical health. 4. Speak clearly and calmly at a moderate pace while performing sign language

19 5. Provide visual information that is redundant with audible information.

VII. EVALUATION

After 4 days of staying at Wangal SPED the following objectives was partially met. Provided information and health teachings towards her hearing impairment, Implemented the nursing care plan, Established a good working relationship with the children and teachers, designed a Nursing Care Plan for the child who have hearing impairment, taught them on proper hygiene

Overall, the group was able to meet some of the objectives successfully.