The three components of any sensory experience:
reception, perception and reaction
Reception:
begins with stimulation of a nerve cell called a receptor which is usually for only one type of stimulus such as light, touch or sound
When a nerve impulse is created:
it travels along pathways to the spinal cord or directly to the brain
The actual perception:
awareness of unique sensatios depend on the receiving region of the cerebral cortex, where specialized brain cells interpret the quality and nature of sensory stimuli
When a person becomes concious of a stimulus and receives the information, what takes place?
perception
Perception includes:
integration and interpretation of stimuli based on the person's experience.
In is impossible to:
React to all stimuli entering the nervous system
The brains prevents sensory bombardment by:
discarding or storing sensory information
When does sensory alterations occur:
when an individual attempts to react to every stimulus within the environment or if the variety and quality of stimuli are insufficient
sensory deficit:
a deficit in the normal function of sensory reception and perception
a person with a sensory deficit will:
intially withdraw and avoid communication and socialization, but will gradually learn to rely on unaffected senses. some senses may even become more acute to compensate for an alteration
Example of of sensory deficit:
a blind patient deveops an acute sense of hearing to compensate for visual loss.
The reaticular activating system in the brainstem:
mediates all sensory stimuli to the cerebral cortex
Three types of sensory deprivation:
1. reduced sensory input
2. the elimination of patterns or meaning from input
3. restrictive environments that produce monotony and boredom
sensory overload:
when a person receives multiple sensory stimuli and cannot perceptually disregard or selectively ignore some stimuli
visual changes during adulthood include:
presbyopia and the need for glasses for reading
occur usually between ages 40-50
Adult visual changes include:
1. the cornea becomes flatter and thicker
2. aging changes lead to astigmatism
3. pigment is lost from the iris
4. collegen fibers build up in the anterior chamber, which increases the risk of glaucoma
Adult visual changes include:
5. reduced visual fields
6. increased glare sensitivity
7. impaired night vision
8. reduced depth perception
9. reduced color discrimination
Hearing changes begin at the age of:
30
Hearing changes occuring with age include:
1. decreased hearing acuity
2. decreased speech intelligibility
3. decreased pitch discrimination
Hearing changes occuring with age include:
4. low pitch sounds are easiest to hear
5. it is difficult to hear conversations over background noise
6. difficult to discriminate the consonants (z,t,f,g)
7. difficult to discriminate high frequency sounds (s, sh, ph, k)
A concern with normal age-related sensory changes is:
older adults with a deficit are sometimes inappropriatly diagnosed with dementia
Gustatory and olfactory changes begin around age:
50
Gustatory and olfactory changes include:
the decrease in the number of taste buds and sensory cells in the nasal lining.
Proprioceptive changes:
common after age 60 include difficulty with balance, spatial orientation, and coordination
meaningful stimuli:
reduce the indicidence of sensory deprivation.
In the home meaningful stimuli include:
pets, music, television, picturers of family members, and a calendar and clock. The same stimuli need to be present in the health care setting
if a patient is in pain or restricted by a cast or traction:
overstimulation frequently is a problem
The absence of visitors during hospitalization or residency in an extended care facility
influences the degree of isolation a patient feels
occupations involving exposure to high noise levels (factory or airport workers) are:
at risk for noise induced hearing loss and need to be screened for hearing impairments
occupations involving risk of exposure to chemicals or flying objects (welders)
at risk for eye injuries and need to be screened for visual impairments
Carpal tunnel syndrome:
alters tactile sensation and is one of the most common industrial or work-related injuries
Cultural factors that affect sensory alterations:
occur more in select ethnic groups
During the assessment process, thoroughly assess each patient and critically analyze:
findings to ensure that you make patient centered clincial decisions required for safe nursing care
Sensory Assessment includes
1. risk factors (age, environmental or cultural factors)
2. sensory alterations history
3. mental status
4. physical assessment
Sensory Assessment includes
5. ability to perform self care
6. health promotion habits
7. environmental hazards
8. communication methods
9. social support
Example of sensory alterations history:
the nature of sensory alterations or any problem related to an alteration. Have the patient self rate by asking "rate your hearing as excellent, good, fair, poor or bad
Examples of Assessing Mental Status of Sensory Perception:
a patient with severe sensory deprivation is not always able to carry on a conversation, remain attentive or display recent or past memory. An important step toward preventing cognition related disability is education by nurses about disease process, avai
Physical assessment involved in Assessment of Sensory Alterations:
Used to identify sensory deficits and their severity, use physical assessment techniques to assess vision, hearing, olfaction, taste, and the ability to discriminate light touch, temp, pain and position
Ability to perform self care (Assessment of Sensory Alterations)
Assess whether a patient with altered vision is able to find items on a meal try and read directions on a prescription. Ability to perform IADLs
Health Promotion Habits involved in (Assessment of Sensory Aterations)
assess the daily routines that patients follow to maintain sensory function. What type of eye and ear care is part of the patients daily hygiene?
Assess the patients home for common hazards in their environment such as:
1. uneven, cracked walkways
2. extension and phone cords in the main route of walking
3. loose area rugs and runners placed over carpeting
Assess the patients home for common hazards in their environment such as:
4. bathrooms without shower or tub grab bars
5. water faucets unmarked to designate hot and cold
6. unlit stairways, lack of handrails
Safety Hazards to include in assessing a patients room in the hospital setting:
1. is the call light within easy, safe reach?
2. are IV poles on wheels easy to move?
3. are suction machines, IV pumps or drainage bags positioned so a patient can rise from a bed or chair easily?
Communications Methods used in (assessment of sensory alterations)
you need to know whether a patient has trouble speaking, understanding, naming, reading, or writing
Patients with visual impairments are unable to observe:
facial expressions and other nonverbal behaviors to clarify the content of spoken communication
aphasia:
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:
the inability to understand written or spoken language. A patient is able to express words but is unable to understand questions or comments of others.
Global aphasia:
the inability to understand language or communicate orally
Nursing diagnoses relevant to patients with sensory alterations:
risk prone health behavior, impaired verbal communication, risk for injury, impaired physical mobility, bathing self care deficit, dressing self care deficit, toileting self care deficit, situational low self esteem, risk for falls, social isolation
Vision health suggestions:
suggest the use of yellow or amber lenses and shades or blinds on windows to minimize glare
vision health suggestions;
wear sunglasses outside
Color changes involved with vision loss and aging:
perception of colors blue, violet and green usually decline
Color changes involved with vision loss and aging:
brighter colors such as red, orange and yellow are easier to see
to maximize residual hearing function:
work closely with the patient to suggest ways to modify the environment
One way to help an individual with a hearing loss is to:
ensure that the problem is not impacted cerumen. with aging cerumen thickens and builds up in the ear canal
promote the sense of taste by:
using measures to enhance remaining taste perception
good oral hygiene:
keeps the taste buds well hydrated
Always ask the patient which foods are most appealing:
improving taste perception improves food intake and appetite as well
the patient needs to avoid blending or mixing foods because:
these actions make it diffcult to identify tastes
older persons need to chew food thoroughly to:
allow more food to contact remaining taste buds
patients with reduced tactile sensation usually:
have the impairment over a limited portion of their bodies.
If the patient is willing to be touched:
hair brushing, a back rub and touching the arms or shoulders are ways of increasing tacticle contact.
turning and repositioning also:
improve the quality of tactile sensation
hyperesthesia:
overly sensitive to tactile stimulation
olfaction loss:
reduced sensitivity to odors