Chapter 49
Sensory Alterations
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Terminology
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Senses:
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Sight/visual
Hearing/auditory
Touch/tactile
Smell/olfactory
Taste/gustatory
Position and motion/kinesthetic
Stereognosis is a sense that allows a person
to recognize the size, shape, and texture of
an object.
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Scientific Knowledge Base
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Sensory reception involves the stimulation of
sensory nerve fibers and the transmission of
impulses to higher centers within the brain.
Normal sensation
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Reception: stimulation of a receptor such as light,
touch, or sound
Perception: integration and interpretation of stimuli
Reaction: only the most important stimuli will elicit
a reaction
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Case Study
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Mrs. Alicea is a 73-year-old woman who is at the
senior health center for her routine 6-month checkup.
She has been visiting the senior center on a regular
basis for the past 8 years. Mrs. Alicea has lived alone
since her husband died 1 year ago. She lives in a
single-story, four-room home a few miles from the
health center.
Her son, Rico, lives 5 minutes away. Rico drives Mrs.
Alicea to her visits. Six months ago, Mrs. Alicea
reported progressive hearing loss. Today she reports
“having trouble seeing.”
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Sensory Alterations
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Sensory deficits
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Sensory deprivation
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Deficit in the normal function of sensory reception
and perception
Inadequate quality or quantity of stimulation
Sensory overload
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Reception of multiple sensory stimuli
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Nursing Knowledge Base:
Factors Affecting Sensory Function
Age
Meaningful stimuli
Various changes occur
across the life span.
Reduce the incidence of
sensory deprivation
Number of stimuli
Social interaction
Can cause sensory
overload
Increases with lack of
socialization with family
Environmental factors
Cultural factors
Occupation, recreation,
and sports activities
Sensory alterations occur
in select groups.
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Case Study (cont’d)
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Peter Morris, a 33-year-old nursing student
assigned to the senior center, is learning to
conduct assessments and to develop health
promotion plans for patients.
For the past month, Peter has been attending
his clinical rotation and participating in
teaching health promotion activities. He is
enjoying this rotation because he is learning
more about geriatric patients and is finding
that they are very independent and capable
of having productive lifestyles.
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Critical Thinking + The Nursing
Process
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Integrate pathophysiological knowledge about
sensory deficits and factors affecting function
Apply evidence-based standards of care:
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American Academy of Ophthalmology
American Speech-Language-Hearing Association
Include previous experiences:
Assessment
Nursing
Diagnosis
Planning
Implementation
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Evaluation
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Assessment
Persons at risk
Sensory alteration history
Mental status
Physical assessment
Ability to perform self-care
Health promotion habits
Environmental hazards
Communication methods
Social support
Use of assistive devices
Other factors affecting perception
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Case Study (cont’d)
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Mrs. Alicea reports that at her last visit to the
ophthalmologist, she was told she had a
cataract.
Peter learns that Hispanic/Latino individuals
in the United States have higher rates of
visual impairment and blindness compared
with members of other ethnic groups. Visual
field loss has a negative impact on healthrelated quality of life: driving, distance and
peripheral vision activities, and a sense of
independence.
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Quick Quiz!
1. An elderly patient who lives in an adult
assisted-living facility mentions that he is
experiencing hearing and vision changes.
During your assessment, you would
associate this type of sensory deprivation
with
A. Stable affect.
B. Altered perception.
C. Improved task completion.
D. Increased need for social interaction.
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Aphasia Definitions
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Patients with aphasia have varied degrees of
inability to speak, interpret, or understand
language.
Expressive aphasia, a motor type of
aphasia, is the inability to name common
objects or express simple ideas in words or
writing.
Sensory or receptive aphasia is the inability
to understand written or spoken language.
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Nursing Diagnosis (examples)
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Risk-prone health
behavior
Impaired verbal
communication
Risk for injury
Impaired physical
mobility
Risk for falls
Social isolation
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Bathing self-care
deficit
Dressing self-care
deficit
Toileting self-care
deficit
Situational low selfesteem
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Case Study (cont’d)
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Mrs. Alicea states, “I’m having difficulty
reading and moving around the house. I
cannot judge the steps clearly. I have
difficulty judging distances between objects,
which is worse at night.”
Results of a home hazard assessment show
that Mrs. Alicea’s home has dim lighting,
stairs without handrails, and numerous throw
rugs on the floor.
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What diagnosis do you think Peter will choose?
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Planning
Include family
members.
Use standards as
guides.
Partner with the
Make safety a top
patient to set realistic
priority.
goals and achievable
outcomes.
Value other
Consider communityprofessionals’
based resources.
contributions.
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Case Study (cont’d)
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Goal: Mrs. Alicea’s home environment is safe
and free of hazards within 4 weeks.
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What expected outcomes would you include?
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Implementation
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Patients can learn to adjust to sensory
impairments at any age with the proper
support and resources.
Health promotion
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Screening
Preventive safety (trauma, vaccines)
 Use of contact lenses, eyeglasses, hearing aids
 Promotion of meaningful stimuli
 Creating a safe environment
 Communication
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Acute Care
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Orientation to the environment
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Communication
Control of stimuli
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Address the patient by name, place call light within
reach, use nightlight, reduce clutter.
Reduce sensory overload.
Combine nursing activities.
Control extraneous noise.
Safety measures
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Safety Measures
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Restorative and Continuing Care
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Maintaining healthy lifestyles
Understanding sensory loss
Socialization
Promoting self-care
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Increases self-esteem
Enhances safety awareness
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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What interventions would apply to these
rationales?
1. Sensitivity to glare increases because of clouding
of the lens.
2. Light intensity needs to be 3 times as powerful for
older adults to produce the same visual acuity as
for younger people.
3. Removal of trip hazards prevents falls and
promotes a safe environment.
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What fall prevention interventions would
Peter choose?
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Promoting Self-Care
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Quick Quiz!
2. A patient with glaucoma is being discharged
from the hospital. When teaching the patient
and family ways to improve home safety, the
nurse tells the family to:
A. Use throw rugs to prevent tripping.
B. Paint the floor black and white to improve
perception.
C. Install extra incandescent lighting.
D. Install handrails painted the same color as
the walls.
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Case Study (cont’d)
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What nursing actions would be appropriate
for Peter to take to evaluate Mrs. Alicea’s
situation?
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Ask Mrs. Alicea at her next visit if she has
experienced any trips or falls since modifications
were made to her home.
Ask Rico if his mother is having any difficulties
moving through her home.
Conduct a home visit, and reassess the home
environment.
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Evaluation
The patient is the only person who can tell you if sensory ability has improved as a
result of nursing interventions.
The patient is the only person who can tell you if
sensory ability has improved as a result of nursing
interventions.
The patient is the only person
who can tell you if sensory ability
has improved as a result of
nursing interventions.
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