Which behavior would the nurse assessing a patient with hearing loss expect to encounter

Assessing patients effectively

Here's how to do the basic four techniques

WHEN YOU PERFORM a physical assessment, you'll use four techniques: inspection, palpation, percussion, and auscultation. Use them in sequence—unless you're performing an abdominal assessment. Palpation and percussion can alter bowel sounds, so you'd inspect, auscultate, percuss, then palpate an abdomen.

1. Inspection

Inspect each body system using vision, smell, and hearing to assess normal conditions and deviations. Assess for color, size, location, movement, texture, symmetry, odors, and sounds as you assess each body system.

2. Palpation

Palpation requires you to touch the patient with different parts of your hands, using varying degrees of pressure. Because your hands are your tools, keep your fingernails short and your hands warm. Wear gloves when palpating mucous membranes or areas in contact with body fluids. Palpate tender areas last.

Types of palpation

Light palpation

Figure

• ▪ Use this technique to feel for surface abnormalities.
• ▪ Depress the skin ½ to ¾ inch (about 1 to 2 cm) with your finger pads, using the lightest touch possible.
• ▪ Assess for texture, tenderness, temperature, moisture, elasticity, pulsations, and masses.

Deep palpation

Figure

• ▪ Use this technique to feel internal organs and masses for size, shape, tenderness, symmetry, and mobility.
• ▪ Depress the skin 1½ to 2 inches (about 4 to 5 cm) with firm, deep pressure.
• ▪ Use one hand on top of the other to exert firmer pressure, if needed.

3. Percussion

Percussion involves tapping your fingers or hands quickly and sharply against parts of the patient's body to help you locate organ borders, identify organ shape and position, and determine if an organ is solid or filled with fluid or gas.

Types of percussion

Direct percussion

This technique reveals tenderness; it's commonly used to assess an adult's sinuses.

Figure

• ▪ Using one or two fingers, tap directly on the body part.
• ▪ Ask the patient to tell you which areas are painful, and watch his face for signs of discomfort.

Indirect percussion

This technique elicits sounds that give clues to the makeup of the underlying tissue. Here's how to do it:

Figure

• ▪ Press the distal part of the middle finger of your nondominant hand firmly on the body part.
• ▪ Keep the rest of your hands off the body surface.
• ▪ Flex the wrist of your nondominant hand.
• ▪ Using the middle finger of your dominant hand, tap quickly and directly over the point where your other middle finger touches the patient's skin.
• ▪ Listen to the sounds produced.

4. Auscultation

Auscultation involves listening for various lung, heart, and bowel sounds with a stethoscope.

Getting ready

• ▪ Provide a quiet environment.
• ▪ Make sure the area to be auscultated is exposed (a gown or bed linens can interfere with sounds.)
• ▪ Warm the stethoscope head in your hand.
• ▪ Close your eyes to help focus your attention.

How to auscultate

• ▪ Use the diaphragm to pick up high-pitched sounds, such as first (S1) and second (S2) heart sounds. Hold the diaphragm firmly against the patient's skin, using enough pressure to leave a slight ring on the skin afterward.
• ▪ Use the bell to pick up low-pitched sounds, such as third (S3) and fourth (S4) heart sounds. Hold the bell lightly against the patient's skin, just hard enough to form a seal. Holding the bell too firmly causes the skin to act as a diaphragm, obliterating low-pitched sounds.
• ▪ Listen to and try to identify the characteristics of one sound at a time.

Source: Health Assessment made Incredibly Visual!, Lippincott Williams & Wilkins, 2007.

Diagnosis

Tests to diagnose hearing loss may include:

• Physical exam. Your doctor will look in your ear for possible causes of your hearing loss, such as earwax or inflammation from an infection. Your doctor will also look for any structural causes of your hearing problems.
• General screening tests. Your doctor may use the whisper test, asking you to cover one ear at a time to see how well you hear words spoken at various volumes and how you respond to other sounds. Its accuracy can be limited.
• App-based hearing tests. Mobile apps are available that you can use by yourself on your tablet to screen for moderate hearing loss.
• Tuning fork tests. Tuning forks are two-pronged, metal instruments that produce sounds when struck. Simple tests with tuning forks can help your doctor detect hearing loss. This evaluation may also reveal where in your ear the damage has occurred.
• Audiometer tests. During these more-thorough tests conducted by an audiologist, you wear earphones and hear sounds and words directed to each ear. Each tone is repeated at faint levels to find the quietest sound you can hear.

Treatment

If you have hearing problems, help is available. Treatment depends on the cause and severity of your hearing loss.

Options include:

• Removing wax blockage. Earwax blockage is a reversible cause of hearing loss. Your doctor may remove earwax using suction or a small tool with a loop on the end.
• Surgical procedures. Some types of hearing loss can be treated with surgery, including abnormalities of the eardrum or bones of hearing (ossicles). If you've had repeated infections with persistent fluid, your doctor may insert small tubes that help your ears drain.
• Hearing aids. If your hearing loss is due to damage to your inner ear, a hearing aid can be helpful. An audiologist can discuss with you the potential benefits of a hearing aid and fit you with a device. Open fit aids are currently the most popular, due to fit and features offered.
• Cochlear implants. If you have more severe hearing loss and gain limited benefit from conventional hearing aids, then a cochlear implant may be an option. Unlike a hearing aid that amplifies sound and directs it into your ear canal, a cochlear implant bypasses damaged or nonworking parts of your inner ear and directly stimulates the hearing nerve. An audiologist, along with a medical doctor who specializes in disorders of the ears, nose and throat (ENT), can discuss the risks and benefits.

Mayo Clinic Minute: Hearing aids not 'one-size-fits-all'

Cynthia Hogan, Ph.D., Audiology, Mayo Clinic

Dr. Hogan: "Hearing aids, because they're digital, can be adjusted over a wide range of hearing loss."

That's one reason why audiologist Dr. Cynthia Hogan says with these devices, one-size-fits-all does not apply.

Dr. Hogan: "So there isn't one best hearing aid for older people versus younger people. We try to choose a hearing aid that's going to fit the person's needs."

Important decisions include whether the device will have rechargeable batteries or ones that need to be replaced, and whether the hearing aid will sit behind or in the ear.

Dr. Hogan: "This is a full-shell, in-the-ear hearing aid. And, so, it fits all into the ear."

One of the benefits of this device is wearers can answer and listen to a phone call as they have their whole life. Some hearing aids can even connect to a person's cellphone.

Dr. Hogan: "They can watch videos or things like that directly from their phone to their hearing aid."

An audiologist like Dr. Hogan can help you sort through all the options and create a personal solution for your hearing problem.

For the Mayo Clinic News Network, I'm Jeff Olsen.

Note: This content was created prior to the coronavirus disease 2019 (COVID-19) pandemic and does not demonstrate proper pandemic protocols. Please follow all recommended Centers for Disease Control and Prevention guidelines for masking and social distancing.

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Coping and support

These tips can help you communicate more easily despite your hearing loss:

• Tell your friends and family. Let them know that you have some hearing loss.
• Position yourself to hear. Face the person you're talking to.
• Turn off background noise. For example, noise from a television may interfere with conversation.
• Ask others to speak clearly, but not more loudly. Most people will be helpful if they know you're having trouble hearing them.
• Try to have the other person's attention before speaking. Avoid trying to converse with someone in a different room.
• Choose quiet settings. In public, choose a place to talk that's away from noisy areas.
• Consider using an assistive listening device. Hearing devices, such as TV-listening systems or phone-amplifying devices, smartphone or tablet apps, and closed-circuit systems in public places can help you hear better while decreasing other noises around you.

Preparing for your appointment

If you suspect you may have hearing loss, call your doctor. After an initial evaluation, your doctor may refer you to a hearing specialist (audiologist).

Here's some information to help you prepare for your appointment.

What you can do

• Write down your symptoms and how long you've had them. Is the hearing loss in one ear or both? Ask friends and family to help you make the list. They may have noticed changes that aren't obvious to you, but the changes may be important for your doctor to know.
• Write down key medical information, especially related to any ear problems. Include any chronic infections, injury to your ear or previous ear surgery. Also list medications, vitamins or supplements you take.
• Summarize your work history, including any jobs, even those in the distant past, that exposed you to high noise levels.
• Take a family member or friend along. Someone who accompanies you can help you remember all the information from your doctor.
• Write down questions for your doctor.

For hearing loss, some questions to ask include:

• What's the most likely cause of my symptoms?
• What else might be causing my symptoms?
• What tests do you recommend?
• Should I stop taking any of my current medications?
• Should I see a specialist?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• How would you describe your symptoms? Do you have pain or drainage in the affected ear or ears?
• Did your symptoms come on suddenly?
• Do you have ringing, roaring or hissing in your ears?
• Do your symptoms include dizziness or balance problems?
• Do you have a history of ear infections, ear trauma or ear surgery?
• Have you ever worked in a job that exposed you to loud noise, flown airplanes or been in military combat?
• Does your family complain that you turn up the volume of the television or radio too high?
• Do you have trouble understanding someone talking to you in a low voice?
• Do you have trouble understanding someone on the telephone?
• Do you often need to ask others to speak up or repeat themselves? Does this happen more often in a noisy setting, such as a crowded restaurant?
• Can you hear a coin hitting the floor or a door closing?
• Can you hear when someone approaches you from behind?
• If your hearing is impaired, does it bother you or affect your quality of life?
• Would you be willing to try a hearing aid?

What types of behaviors are indicative of hearing loss?

Which type of hearing loss would the nurse identify as occurring when conditions in the outer or middle ear impair the transmission of sound through air to the inner ear?

Which is the most common complaint of a client with ear disorder?

What are the general manifestations of hearing impairment?