Management of Patients with Multiple Sensory Deficits Identify three initial nursing diagnoses for Mrs. Henson and list the defining characteristics that would support each of your identified nursing diagnoses.

The three initial diagnoses for Mrs. Henson would be to observe her responses when initiating conversation or talking to her, determine if the patient has cerumen impaction, and performing a whisper test. These diagnoses are aimed at determining the patient’s ability to hear and respond to the nurse and others. Observing the patient when having a conversation will allow the nurse to gauge the patient’s facial expression and attention. The patient could be getting distracted due to her other ailments and conditions and this might be the reason she is not able to hear instructions being given. Nurses are trained to be more patient with patients with hearing aids because they might lose attention. Observing the patient when talking to her will allow the nurse to see if the patient is receptive to what she is being told. The lack of reception and response would mean that the patient does not hear what she is being told and there is a need for further testing. This would also allow the nurse to rule out other issues like fatigue as reported by the physical therapy assistant. Elderly patients might fail to follow instructions being given when they are tired and this might be caused by fatigue. Therefore, it is vital that we rule out the possibility of the patient being fatigued.

The second diagnosis would be determining if the patient has cerumen impaction. This is a buildup of secretions and sloughed epithelial cells. This accumulation could result in symptoms like hearing loss, dizziness, otorrhea tinnitus, or other symptoms. Cerumen could also prevent the necessary assessment of the ear canal. Cerumen which is basically a buildup of ear wax can happen to anyone, but it is most likely to occur in people who use hearing aids. In order to diagnose for cerumen impaction, the nurse will make use a special instrument called an otoscope to be able to see if there is any wax buildup in the ear. Hearing aids users are most at risk of this because the hearing aids might be pushing the wax further inside the ears. Hearing aids also prevent the ear wax from being removed naturally by motions like chewing...

Therefore, any person who uses hearing aids should be checked regularly and have their ears cleaned to remove any buildup of wax.
Performing a whisper test will establish the level of hearing of the patient. A whisper test is aimed at gauging the patient's hearing at different levels in order to also test the effectiveness of her hearing aids. Since she is already using hearing aids, it is vital that the nurse determines how effective the hearing aids are working in order to rule them out as the issue. The use of the whisper test might not be the recommended test for hearing loss, however, it can still be used to diagnose a patient who is suffering from hearing impairment and to also test for the effectiveness of their hearing aids.

What assessments would the nurse perform to assess Mrs. Henson’s hearing ability?

Numerous studies have indicated that assessments for hearing impairment are rarely conducted for elderly adults and patients. In most cases, the first step for any hearing impairment assessment is checking for cerumen occlusion. However, considering the patient's ongoing ailments it is vital that other assessments be carried out to determine if the patient has a hearing impairment and to also rule out a failure of her hearing aids. Observation of the patient while speaking to her would offer the necessary clues as to whether the patient is able to hear. In case the nurse notices that the patient is leaning towards or tilting her head towards the person speaking to her then she might have difficulty hearing. Another assessment that can be used is the hearing handicap inventory for the elderly (HHIE), which is a 10-item self-administered questionnaire aimed at assessing the social and emotional effects of hearing impairment. This questionnaire has been found to have good sensitivity and specificity for moderate and marked hearing loss.

The nurse could also make use of the tuning-fork test to assess the patients hearing loss. The patient already wears bilateral hearing aids and this clearly shows they have a hearing problem. However, since the patient seems non-responsive to instructions, her hearing problem could have become worse especially due to her stroke or because of her age. Using the tuning-fork test while the patient is wearing her…