A 65-year-old client with sensorineural hearing loss is being discharged from the hospital. Which discharge in…

Question

A 65-year-old client with sensorineural hearing loss is being discharged from the hospital. Which discharge instruction should the nurse prioritize to ensure the client's safety and communication effectiveness?

Accepted Answer

보기 4: Face the person when speaking and ensure adequate lighting for lip reading

Facing the person and ensuring adequate lighting maximizes lip reading and visual cues, which are critical for safety and communication in sensorineural hearing loss. Other options either provide harmful advice (cotton swabs), limit quality of life (social isolation), or are ineffective (avoiding hearing aids in noise).

Answer

보기 1: Avoid using hearing aids in noisy environments to prevent further damage

Answer

보기 2: Clean the ears daily with cotton swabs to remove excess wax buildup

Answer

보기 3: Limit social interactions to reduce frustration from communication difficulties

Concept	Key Points
Sensorineural Hearing Loss	Permanent damage to hair cells in cochlea or auditory nerve. Causes: aging (presbycusis), noise exposure, ototoxic drugs. Characterized by difficulty understanding speech, especially in noise.
Nursing Priority (Discharge)	Safety & Effective Communication. Empower client with compensatory strategies to prevent injury and social isolation.
Core Teaching Strategies	Face-to-face communication, good lighting, reduce background noise, speak clearly (not loudly), use written instructions, encourage hearing aid use.
Critical Safety Teaching	NEVER insert objects (cotton swabs, bobby pins) into ear canal. Regular hearing check-ups. Alert to hazards (smoke alarms with strobe lights).

Aspect	Sensorineural Hearing Loss	Conductive Hearing Loss
Site of Problem	Inner ear (Cochlea) or Auditory nerve (CN VIII)	Outer or Middle ear
Common Causes	Aging (Presbycusis), Noise exposure, Meniere's disease, Ototoxicity (e.g., gentamicin)	Cerumen impaction, Otitis media, Otosclerosis, Perforated tympanic membrane
Sound Perception	Sounds are muffled/distorted; difficulty understanding speech ("I can hear you but not understand you").	Sounds are generally softer; hearing may improve in noise (paracusis willisiana).
Weber Test	Sound lateralizes to the better ear.	Sound lateralizes to the poorer ear.
Rinne Test	Air conduction (AC) > Bone conduction (BC) but both are reduced (Positive Rinne).	Bone conduction (BC) > Air conduction (AC) (Negative Rinne).
Primary Nursing Focus	Communication strategies, hearing aid optimization, safety.	Removal of obstruction (e.g., cerumen), treating infection, post-op care for procedures like tympanoplasty.

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A 65-year-old client with sensorineural hearing loss is being discharged from the hospital. Which discharge instruction should the nurse prioritize to ensure the client's safety and communication effectiveness?

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