Red= New PowerPoint slide Purple= Teacher Notes on pp Green= What professor said about it in class (add on) Sensory Disorders Objectives we are learning about our world without experiencing it up close, right here, right now, in “all its messy, majestic, riotous detail.” The Sensory Experience -Two components -Reception -Perception -The senses involved in sensory reception -Visual -Auditory -Olfactory -Gustatory -Tactile -Stereognosis – this is your mental perception; ability to perceive things -Kinesthetic and visceral- just a sense of movement -Proprioception- proception, the awareness of the position of your movement. A person’s senses are vital to survival, growth and development, and the experience of bodily pleasure. Sensory or communication impairment/disorder can affect physical or mental health, even when temporary or mild. Can lead to injury, isolation, unmet health needs Limited academic or occupational success The sensory experience cont.… Sensory perception -Stimulus -Receptor -Nervous pathway to the brain -Reticular Activating System (RAS) -States of arousal -Conscious -Unconscious RAS: to receive stimuli and respond appropriately, the brain must be alert and aroused. RAS: hypothalamus to the medulla and mediates arousal. BOX 44-2 states of arousal/awareness. Monitors and regulates incoming sensory stimuli, maintaining, enhancing, or inhibiting cortical arousal (1) (2) (3) (4) Nerve impulses from all the sensory tracts reach the RAS, which then selectively allows certain impulses to reach the cerebral cortex and be perceived. Pathway: For a person to receive the necessary data to experience the world, four conditions must be met: A stimulus must be present, a receptor or sense organ must receive the stimulus and convert it to a nerve impulse, the nerve impulse must be conducted along a nervous pathway from the receptor or sense organ to the brain, and a particular area in the brain must receive and translate the impulse into a sensation. The body adapts to constant stimuli, repeated noise, noxious smell, eventually going unnoticed. This is called adaptation. A stimulus must be variable or irregular to evoke a response. Thought and memory play a role in eliciting a response to stimuli. Toddler remembers a painful visit to the pediatrician, can trigger avoidance behaviors in future visits. Conscious Delirium, dementia, confusion, normal consciousness, somnolence, minimally conscious states, locked-in syndrome Unconscious Asleep, stupor, coma Vegetative state Factors affecting sensory stimulation -Developmental considerations -child or older adult; mental retardation -Culture -Personality and lifestyle -Stress and illness -meds can affect senser perception -Medications Age: at birth, many neural pathways are immature and must be stimulated to develop, become refined, and function adequately. Soothing an infant: rocking, cradling, singing, feeding. medically fragile infants are recommended to have limited light and visual and vestibular stimulation to simulate being in the womb. Children play to account for a surplus of physical and emotional energy. Play helps with coordination and exercise. Adults may experience the need to compensate for the loss of one type of stimulation by increasing other sources of sensory stimuli. Touch becomes increasingly important as we age. Box 44-4 details sensory changes related to aging. Also see the accompanying display, Focus on the Older Adult: Sensory Functioning on page 1728. CX: Ethnic norms, religious norms, income group norms, and the norms of subgroups within a culture all influence the amount of sensory stimulation a person seeks and perceives as meaningful. sensory deprivation, sensory overload, and sleep deprivation are all related to or affected by a person’s cultural practices, values, and beliefs. certain cultures view touching as a natural and welcome custom, whereas other cultures may view it as insulting or offensive. Personality: different personality types demand different levels of stimulation. Lifestyle choices can dramatically influence the quantity and quality of stimuli a person receives. Stress and illness: Increased sensory stimulation may be sought during periods of low stress simply to maintain cortical arousal. During high-stress periods, multiple stressors may already be overloading the sensory system, and the person desires decreased sensory stimulation. Illness, a time of stress, can affect the reception of sensory stimuli and their transmission and perception. Therefore, the stress of physical illness, pain, hospitalization, testing, surgery, or treatment may provide more stimulation than a person can process and respond to without assistance. Severe sensory alterations Contributing factors: -Sensory deprivation -Perceptual -Cognitive -Emotional -Sensory overload -Sensory deficits -Sensory poverty -related to safety -Sleep deprivation -Cultural care deprivation Disturbed sensory perception: Deprivation: can lead to perceptual, cognitive, and emotional disturbances. sensory input is decreased or monotonous/unpatterned/meaningless. The RAS is not able to project a normal level of activation in the brain and the person may hallucinate just to keep a normal level of arousal. Perceptual responses result from inaccurate perception of sights, sounds, tastes, smells, and body position, coordination, and equilibrium. Cognitive responses involve the patient’s inability to control the direction of thought content. Typically, attention span and ability to concentrate are decreased. Emotional responses typically are manifested by apathy, anxiety, fear, anger, belligerence, panic, or depression. Who is at risk? Isolated persons, institutionalized pts, small living area in confinement, bedrest. Persons with impaired ability to receive stimuli: impaired vision/hearing/tactile. Affective disorders that “close out the environment”. Persons with brain/spinal cord damage are unable to process the environment, those who are confused or disoriented, on drugs/meds that affect CNS. Overload: brain can’t respond meaningfully or ignore stimuli. excessive stimuli over which the person feels little control. The brain is unable to meaningfully respond to or ignore stimuli. Caused by increased internal stimuli: pain, medical devices, pressure, worry about state of health. Increased external stimuli: healthcare environment such as lights, noises, odors, movement, presence of strangers, intrusive touching of body, dx procedures. Inability to perceptually disregard certain stimuli: nervous system disorders. Who is at risk? ICU pts, chronically ill pts, in pain, intrusive monitoring devices, CNS disturbances. Sleep deprivation can alter the sensory experience of individuals. Nursing process- assessment -Health history and physical examination -Appropriate interview questions -do you know where you are? What is your name? -Assess the components of the sensory experience: -Stimulation -Reception -Transmission–perception–reaction -Ability to perform self-care activities -What are the defining characteristics of sensory deprivation and overload? Be sure to include an assessment of the patient’s environment to determine whether it is providing adequate sensory stimulation for healthy development. Identify at risk patients Because patients may adapt to sensory impairments, it may be helpful to include someone the patient knows well (e.g., a partner or parent) in the assessment to see if that person has noticed behavioral characteristics in the patient that suggest a sensory disturbance Stimulation: Assess for any recent changes in sensory stimulation, for example, reduction of stimulation from one or more sensory modalities. Patients at high risk for problems related to stimulation include children in non-stimulating environments, older people, terminally ill patients, patients on bed rest, patients in isolation, and patients requiring intensive nursing in a critical care setting. Reception: Assess for anything that may interfere with sensory reception and identify any corrective devices the patient uses for sensory impairments, such as eyeglasses, contact lenses, or hearing aids. Transmission–perception–reaction: patients at high risk for transmission–perception– reaction problems, such as the patient who is confused or who has a nervous system impairment. Use everyday interactions as multiple opportunities to assess patients’ abilities to transmit, perceive, and react to stimuli. Assessment of the Ability to Perform Self-Care: safely. Patients with new sensory alterations and their caregivers need to be instructed about practical ways to modify their home environment for safety. recognize that patients who are out of their home environment need to be oriented to their new surroundings. Patients need to know how to call the nurse, how to use the lights and television, and how to navigate safely to the bathroom. Before leaving a patient’s room, do a quick check to ensure that the environment is safe—especially for patients with sensory impairments. DEFINING CHARACTERISTICS OF SENSORY DEPRIVATION AND OVERLOAD Observe for boredom, inactivity, slowness of thought, daydreaming, increased sleeping, thought disorganization, anxiety, panic, illusions, and hallucinations. Know the patient’s usual state so that you can identify changes stemming from sensory deprivation or overload. Important interview questions - president, where u at, what year Reorient!!! The pt. Find out if pt can perform self care. Diagnosis- Disturbed sensory perception -Altered sensory experience as the problem: -Acute Confusion -Risk for acute confusion -Chronic confusion -Impaired memory -Altered sensory experience as the etiology -Altered environmental stimuli: excessive or insufficient -Altered sensory reception, transmission, or integration -Chemical alterations: endogenous (e.g., electrolytes) or exogenous (e.g., drugs) -Psychological stress Acute Confusion: The abrupt onset of a cluster of global, transient changes and disturbances in attention, cognition, psychomotor activity level of consciousness, or sleep–wake cycle (sundown syndrome) Risk for Acute Confusion: A vulnerability to reversible disturbances of consciousness, attention, cognition, and perception that develops over a short period of time, which may compromise health Chronic Confusion: An irreversible, long-standing, or progressive deterioration of intellect and personality characterized by decreased ability to interpret environmental stimuli or decreased capacity for intellectual thought processes and manifested by disturbances of memory, orientation, and behavior (alzhemier) Impaired Memory: The state in which a person experiences the inability to remember or recall bits of information or behavior skills. Impaired memory may be attributed to pathophysiologic or situational causes that are either temporary or permanent. Outcome identification & planning -Developmentally stimulating and safe environment -Level of arousal enabling brain to receive and organize stimuli -Intact functioning of the senses -Orientation to time, place, and person In all settings in which nurses care for patients, optimal sensory stimulation is a priority. Must be individualized, and SMART Patients with impaired sensory functioning require individualized outcomes similar to the following: The patient will: report feeling safe and in control of the environment. describe different types of meaningful stimuli present in the environment. demonstrate (describe) appropriate self-care behaviors for visual impairment, hearing impairment, or other sensory impairment. verbalize acceptance of the sensory deficit. Implementation -Teach patients and significant others methods for stimulating the senses. Puzzles, watch certain tv programs, let them tell u what is important, what works for them. -Teach patients with intact and impaired senses self-care behaviors. -Interact therapeutically with patients with sensory impairments. -Prevention -Control patient discomfort whenever possible. We can give meds, -Offer care that provides rest and comfort. Let them rest if needed -Be aware of need for sensory aids and prostheses. -Use social activities to stimulate senses and mind. -Enlist aid of family members to participate in or encourage activities. Ask them take fam member for walk -Encourage physical activity and exercise. -Provide stimulation for as many senses as possible. Evaluation -evaluate the plan’s effectiveness by observing for a decrease in the behavioral manifestations of sensory deprivation or overload. If change in walk u know sum is going on. -patient’s ability to interact appropriately with the environment while practicing necessary self-care behaviors, as well as the patient’s need for nursing care versus the person’s ability to manage the care plan independently. Key word assessment have to do it to know what pt can do and not and have to communicate w pt -Ideally, the patient and family learn to manipulate the environment to promote optimal sensory stimulation for growth and development. Caring for Visually Impaired Patients #1 -Teach patient self-care behaviors to maintain vision and prevent blindness. Let them wear glasses, do not turn your back, face to face -Acknowledge your presence in the patient’s room. Present yourself and what your gonna do -Speak in a normal tone of voice. Do not yell or scream/shout -Explain the reason for touching the patient before doing so. Get consent -Keep the call light within reach. -Orient the patient to sounds in the environment. Caring for Visually Impaired Patients #2 -Orient the patient to the room arrangement and furnishings. If fam member come give extra chair but take it out after -Assist with ambulation by walking slightly ahead of the patient. -Stay in the patient’s field of vision if he or she has partial vision. -Provide diversion using other senses. -Indicate conversation has ended when leaving room. Talk to pt and let them know ur leaving and ask if there anything else to do for them Caring for Hearing-Impaired Patients -Teach measures to prevent hearing problems. -Orient the patient to your presence before speaking. -Decrease background noises before speaking. Turn tv down especially w hearing prob -Check the patient’s hearing aids. -Position yourself so that light is on your face. -Talk directly to the patient while facing him or her. -Use pantomime or sign language as appropriate. Act of showing state of something threw movement of body and faces. -Write any ideas you cannot convey in another manner. Communicating With a Patient Who is Confused -Use frequent face-to-face contact to communicate the social process. -Speak calmly, simply, and directly to the patient. -Orient and reorient the patient to the environment. -Orient the patient to time, place, and person. Correct them if wrong -Communicate that the patient is expected to perform self-care activities. -Offer explanations for care. Tell them the bc and why -Reinforce reality if the patient is delusional. Communicating With an Unconscious Patient -Be careful what is said in the patient’s presence; hearing is the last sense that is lost. If intubated still hear, still talk even if not speaking back, explain everything. Always assume pt can hear. -Assume that the patient can hear you and talk in a normal tone of voice. -Speak to the patient before touching. -Keep environmental noises at a low level.
