Sensory & Perceptual Alterations

Group 3

Beverly Domingo Toni Nadine Lee (BSN IV B)

SENSORY AND PERCEPTUAL ALTERATIONS I. Sensation and Perception Sensations can be defined as the passive process of bringing information from the outside world into the body and to the brain. The process is passive in the sense that we do not have to be consciously engaging in a "sensing" process. A message our brains receive from a sensory receptor. Perception can be defined as the active process of selecting, organizing, and interpreting the information brought to the brain by the senses. A cognitive process through which we interpret the messages our senses provide. Alteration can be defined as How they work together: 1. Sensation occurs: a) Sensory organs absorb energy from a physical stimulus in the environment. b) Sensory receptors convert this energy into neural impulses and send them to the brain. 2. Perception follows: a) The brain organizes the information and translates it into something meaningful. II. Process of sensory reception and perception 1. Sensory reception a. The process of receiving and transmitting stimuli from the periphery or inside the body to the cerebral cortex b. Occurs through stimulation of receptors or special sense organs which transmit their impulses to the spinal cord and then up to the cerebral cortex i. Receptors and/or special senses which receive and transmit stimuli from the external environment include the following: 1. Vision (visual) 2. Hearing (auditory) 3. Smell (olfactory) 4. Touch (tactile) 5. Taste (gustatory) ii. Receptors and/or special senses which receive and transmit stimuli from the internal environment include the following:

1. Kinesthetic - Awareness of the position and movement of body parts 2. Stereognosis - Awareness of an objects size, shape, and texture 3. Visceral - Awareness of the state of the internal organs 2. Sensory perception a. b. The process of perceiving and interpreting external or internal stimuli as meaningful information in the cerebral cortex Occurs through stimulation of neurons in specialized areas of the cerebral cortex

E.g., vision (occipital lobes); hearing (temporal lobes); touch (somatosensory area) 3. Importance of the sensory stimulus in sensory perception a. If a sensory stimulus is unvaried and/or regular, the body will quickly adapt E.g., constant traffic noise b. If a sensory stimulus is variable and/or irregular, the body will not adapt E.g., car horns sounding at different times III. Factors influencing sensory reception and perception A. Developmental stage E.g., an elderly individual, whose ability to see, hear, smell, touch, and taste is diminished, may have difficulty receiving and perceiving stimuli from these special senses B. Culture E.g., a chinese individual, raised in an over-populated environment, may be accustomed to receiving and perceiving a large amount of stimuli from receptors and/or special senses C. Stress E.g., a stressed individual, already overloaded with external and internal stimuli, may have difficulty receiving and perceiving more stimuli from receptors and/or special senses D. Medications E.g., an individual taking opioid narcotics, which depress central nervous system functioning, may have difficulty receiving and perceiving stimuli from receptors and/or special senses

E.g., an individual taking streptomycin, which can cause eighth cranial (acoustic) nerve damage, may have difficulty receiving and perceiving stimuli from this special sense E. Illness E.g., an individual with atherosclerosis of the carotid arteries, which results in constriction of the lumen of these blood vessels, decreased cerebral blood flow, and potential damage to the brain, may have difficulty receiving and perceiving stimuli from receptors and/or special senses E.g., a diabetic individual with a peripheral neuropathy, which results in decreased sensation in an extremity, feeling that the extremity is asleep, and a propensity for injury to the extremity, may have difficulty receiving and perceiving stimuli from receptors in the extremity F. Previous experience E.g., an individual who drives the same route to work each day may have difficulty receiving and perceiving stimuli from receptors and/or special senses along the way G. Life-style E.g., an urban-dwelling individual, who is used to a life-style of abundant stimulation (e.g., surrounded by many people, frequent changes, bright lights, noise), may be accustomed to receiving and perceiving a large amount of stimuli from receptors and/or special senses E.g., an individual who smokes, which results in atrophy of the tastebuds, may have difficulty receiving and perceiving stimuli from this special sense IV. Common alteration in sensory perception ( definition, clients at risk, manifestations and interventions ) A. Sensory deprivation a. Definition 1. a decrease in or lack of meaningful stimuli b. Clients who are at risk for developing sensory deprivation 1. Clients in a environment non stimulating or monotonous

E.g., clients in an institutionalized environment; separated from significant others and usual sources of stimuli; undergoing treatments that decrease access to stimuli (e.g., isolation, bedrest) 2. Clients who are unable to perceive environmental stimuli

E.g., clients with brain damage; clients taking medications that depress the central nervous system (cns) (e.g., opioid analgesics) 3. Clients who are unable to receive environmental stimuli E.g., clients with impaired vision, hearing, smell, touch, and taste; clients undergoing treatments that decrease ability to sense stimuli (e.g., bandages, body casts); clients with depression or other affective disorders c. Manifestations of sensory deprivation 1. Physical behaviors: drowsiness; excessive yawning 2. Escape behaviors: eating, exercising, sleeping, running away to escape the deprived environment 3. Changes in perception: unusual body sensations; preoccupation with somatic complaints (e.g., dry mouth, palpitations, difficulty breathing, nausea); change in body image; illusions (misinterpretation of external stimuli), hallucinations (perceptions of external stimuli in the absence of such stimuli) 4. Changes in cognitive behavior: reduced attention span; inability to concentrate; decreased problem solving and task performance; impaired memory 5. Changes in affective behavior: feelings of boredom; apathy, emotional lability, depression, annoyance about small matters d. Common interventions for sensory deprivation 1. Encourage the client to use aids such as eyeglasses and hearing aids 2. Address the client by name, and touch the client while speaking if this is not culturally offensive 3. Communicate frequently with the client, and maintain meaningful interactions E.g., discuss current events 4. Provide a radio and/or television, clock, and calendar 5. Adjust the stimulation environment to provide meaningful

E.g., enable the client to look through a window 6. Encourage social interaction B. Sensory overload a. Definition

1. The inability to process or manage the amount or intensity of sensory stimuli b. Clients who are at risk for developing sensory overload 1. Clients experiencing an increased quantity or quality of internal stimuli E.g., clients in pain; clients experiencing pressure and discomfort of invasive tubes (e.g., intravenous lines, catheters, endotracheal tubes); clients worried about state of health or need to make treatment decisions 2. Clients experiencing an increased quantity or quality of external stimuli E.g., clients in an unfamiliar, busy healthcare environment with many varied lights, noises, sounds, odors, movements, and strangers, many or whom touch their body; clients undergoing invasive monitoring or intrusive procedures 3. Clients experiencing an inability to disregard stimuli selectively 1. E.g., clients with cns disturbances that stimulate the arousal system (e.g., hyperthyroidism); clients taking medications that stimulate the arousal system (e.g., theophylline [theodur], pseudoephedrine hydrochloride [sudafed]) c. Manifestations of sensory overload 1. Complaints of fatigue, sleeplessness 2. Irritability, anxiety, restlessness 3. Periodic or general disorientation 4. Reduced problem-solving ability and task performance 5. Increased muscle tension 6. Hallucinations, illusions d. Common nursing interventions for sensory overload 1. Minimize unnecessary light, noise, and distraction 2. Control pain as indicated 3. Describe any tests and procedures to the client beforehand 4. Plan care to allow for uninterrupted periods for rest or sleep 5. Support accurate perceptions 6. Provide orienting cues, such as clocks, calendars, equipment, and furniture in the room

7. Introduce self by name and address the client by name 8. Provide new information gradually 9. Speak in a low tone of voice and in an unhurried manner 10. Provide a private room 11. Limit visitors 12. Take time to discuss the clients problems and correct misinterpretations 13. Assist the client with stress-reducing techniques 14. When providing information, ask the client to repeat it so that there are no misunderstandings C. Sensory deficits (visual, auditory, tactile, olfactory, gustatory) a. Definitions of sensory deficits 1. Vision - The state of impaired function in visual sensory reception or perception 2. Hearing - The state of impaired function in auditory sensory reception or perception 3. Smell - The state of impaired function in olfactory sensory reception or perception 4. Tactile - The state of impaired function in tactile sensory reception or perception 5. Taste - The state of impaired function in gustatory sensory reception or perception b. Manifestations of sensory deficits 1. Vision - Reported and measured change in visual acuity 2. Hearing-Reported and measured change in hearing acuity 3. Smell -Reported and measured change in olfactory acuity 4. Tactile -Reported and measured change in tactile acuity 5. Taste -Reported and measured change in gustatory acuity c. Common nursing interventions for sensory deficits 1. Vision 1. Use assistive devices, e.g.: a. Eyeglasses with proper prescription, cleaned, and in good repair b. Pocket magnifiers c. Near-vision microscopic glasses

d. Large-print wristwatch, phone dialers, books 2. Use other senses to heighten vision, e.g.: a. Listen to books on taped cassettes b. Install textual cues on walkways or ramps to alert client to intersection 3. Use sharp visual contrasts to heighten vision, e.g.: a. Color-coded dials on irons, stoves, dryers, washers, thermostats b. Reference points on dials marked at their desired settings c. Colored rims placed around dishes and cups 4. Minimize glare, e.g.: a. Soft, diffuse lighting b. Tinted glass windows with adjustable shades or sheer curtains c. Shielding eyes in sunlight with visors or hats with brims d. Avoiding driving at dusk or night 5. Maintain a safe environment, e.g.: a. Uncluttered b. No unexpected furniture rearranging 2. Hearing 1. Use assistive devices, e.g.: a. Hearing aids in good repair with working battery b. Amplified or light-signaled phone ringer, doorbell, alarm clock, etc. c. Closed-caption television d. Tdd (for the telephone) 2. Use methods that foster communication, e.g.: a. Talking at a moderate rate and in a normal tone of voice b. Addressing the client directly c. Avoiding talking with something in your mouth

d. Avoiding covering your mouth with your hand e. Speaking clearly and accurately as possible f. Avoiding "overarticulating" g. Pronouncing every name with care h. Changing to a new subject at a slower rate 3. Maintain a safe environment, e.g.: a. Use light-signaling devices for burglar alarms, smoke detectors b. Using vision to discover sources of danger 3. Smell 1. Maintain food safety, e.g.: a. Use only dated canned food b. Date fresh foods c. Discard outdated canned and/or fresh foods d. Observe the color and consistency of canned, fresh, or leftover foods for evidence of spoilage 2. Provide pleasant olfactory stimulation in the environment, e.g.: a. Fresh flowers b. Sachets c. Wearing light perfume or fragrance 3. Maintain a safe environment, e.g.: a. Smoke detectors with working batteries b. Gas appliances monitored closely for leaks 4. Tactile 1. Use protective measures to prevent injury, e.g.: a. Using bath thermometer b. Assessing the skin daily c. Relieving pressure on bony prominences 2. Use methods to enhance the remaining tactile sensation, e.g.:

a. Using clothes with a variety of textures b. Therapeutic touch c. Massage d. Turning and positioning e. Hairbrushing and grooming 5. Taste 1. Use methods to enhance remaining taste perception, e.g.: a. Good oral hygiene 2. Use methods to enhance the taste of foods, e.g.: a. Appropriate seasonings b. Different textures c. Not overcooking or overprocessing to preserve texture d. Adding vinegar and lemon juice for tartness e. Eating each food separately f. Consciously remembering the taste of different foods g. Serving foods temperatures at appropriate

h. Taking sips of water between foods 3. Use methods to enhance the visual appeal of foods, e.g.: a. Using different colored foods b. Arranging foods aesthetically c. Molding pureed foods into attractive shapes d. Serving foods on attractive dishes e. Setting an attractive table V. Other Alterations in Sensory Perception A. Cognitive dysfunction: - reduction of mental capabilities; disorientation, confusion B. Hallucinations/delusions: - seeing or hearing things that are not there/beliefs not based in reality C. Sensory deficit:

loss of function or perception (blindness, deafness, CVA, spinal cord injuries)

D. Anxiety: - from inability to interact fully with environment due to sensory deficit E. Depression: - feelings of helplessness & loss of self-esteem( appetite, apathy, sleeplessness) VI. Assessment Data A. Interview: - Assess mental status, normal level of stimulation, response to change, social situation, lifestyle/habits, risk factors B. Physical examination: - Look at eyes, ears, nose, mouth extremities - Hearing, vision, taste, smell, touch can all be assess through variety of tests C. Diagnostic tests: - include electrolytes, blood chemistry, neurological studies, visual & auditory acuity tests, CT scan