Stressors that affectCognition &Perception

SensorySleep

NUR101FALL 2008LECTURE # 18K. BURGER

PPP By Sharon Niggemeier RN MS

Sensory Needs• Senses- needed for survival, growth &

development and bodily pleasure

• Give meaning to events in the environment

• Alterations in senses- affect ability to function in the environment

Sensory Experience• When we sense things: process of sensory

reception (receive stimuli) and sensory perception (organization and transmission of stimuli into meaningful data…influenced by experiences, knowledge, attitudes)

• Sensory reception – stimuli can be visual, auditory, olfactory, tactile or gustatory. Also can be kinesthetic, stereognosis or visceral.

• RAS(reticular activating system)- responsible for stimulus arousal (monitors & regulates incoming stimuli)

Consider this….

Sensory Adaptation• Stimulus must be variable to create a response,

otherwise it is gradually ignored.• Think about when you are in a client’s room on

the clinical unit to which you are assigned:Do you hear all the overhead pages?Do you hear all the beeping IV pumps?Do you hear the rattling of garbage pails being emptied?Do you hear the roommate’s TV?

• Important! Nurses adapt to unit noises and may not realize stimuli affecting their clients.

Factors Affecting Sensory Functioning

• Developmental level

• Culture

• Stress

• Meds

• Illness & Therapies

• Personality

Think-Pair-Share

• Think about some of the unit noises we discussed on the Consider this… Slide

• Which noises bother YOU the most?What could you do to decrease this sensory overload?

• Share your experience with a classmate and discuss other interventions.

Sensory Alterations• A change in environment can lead to MORE

or LESS normal stimuli.

• When stimuli is different from what one is used to it leads to sensory alterations.

• Hospitalized patients will experience sensory alterations due to different stimuli loads.

• Can result in sensory overload or sensory deprivation

Sensory Overload• Results from being unable to manage

sensory stimuli: (too much stimuli)• Pain, dyspnea, anxiety (internal)• Noise, intrusive procedures, contact

with many strangers (external)• Inability to disregard stimuli: for

example meds that stimulate the arousal mechanism, may prevent one from ignoring noise

Assessment: Sensory Overload

• Unrealistic perceptions, ineffective coping

• Acts bewildered,disoriented, difficulty concentrating, muscle tension

• Reduced problem-solving ability, scattered attention, racing thoughts

Interventions: Sensory Overload

• Prevent sensory alteration

• Reduce environmental stimuli, promote sleep

• Establish a routine for care

• Speak calmly and slowly with simple explanations

• Eliminate personal stimuli

Sensory Deprivation• Results from decreased sensory input or

meaningless input: (too little stimuli)

• Isolation/non-stimulating monotonous environment

• Impaired ability to receive and/or send stimuli IE: vision, hearing deficits, speech deficits ( expressive or receptive aphasia)

• Inability to cognitively process stimuli-confused, brain injury, meds affecting CNS

Sensory Deficits

• Impaired reception, perception or both of the senses

• Blindness, deafness, loss of taste, smell, touch

• One sense may become more acute to compensate for deficit

• At risk for sensory overload in the compensated sense or deprivation overall

Assessing: Sensory Deprivation

• Drowsiness/sleeping/yawning• Decreased attention span, difficulty

concentrating, impaired memory• Disorientation, confusion, hallucinations

RAS needs stimulus; body may produce hallucinations to maintain optimal arousal

• Crying, annoyance over small matters, depression

• Apathy, daydreaming, boredom, anger

Assessment: Sensory Deficit• Assess loss of one or more senses• Note behaviors to compensate for

deficit-always turns right ear toward person speaking to compensate for hearing loss

• Assess for diseases that can affect senses, inner ear infection causes loss of kinesthetic sense, neurological disease can effect tactile perception

NURSING DIAGNOSIS

• Disturbed sensory perception• Social Isolation• OTHERS in which decreased sensory perception

may be an etiology?Situational low self-esteemDisturbed thought processes

WHAT IS A PRIORITY NURSING DIAGNOSIS for the client with altered sensory perception?

RISK FOR INJURY

PLANNING• Client will:

Demonstrate understanding by a verbal, written, or signed response (SENSORY DEFICIT)

• Client will:Demonstrate relaxed body movements and facial expressions (SENSORY OVERLOAD)

• Client will:Increase and maintain personal interactions(SENSORY DEVICIT)

• Client will:Remain free from injury

Interventions: Sensory Deprivation

• Prevent sensory alteration

• Teach self stimulation methods- reading, singing etc.

• Provide stimulation – visual, auditory, gustatory, tactile and cognitive

• Provide reality orientation

• Utilize interpreters for communication barriers

Interventions: Sensory Deficit• Deficit may be new- determine ability

to compensate• Provide care to facilitate sense • Provide glasses, hearing aids, adaptive

equipment etc. to reduce sensory deficit

• Utilize all health care team members to assist with sensory deficit…dietary for loss of gustatory sense

Which of the following are guidelines that should be followed when caring for visually impaired clients? (select ALL that apply)

a. Wait for the person to sense your presence in the room before identifying yourself

b. Speak in a normal tone of voicec. Explain the reason for touching the person after doing sod. Orient the person to the arrangement of the room and its

furnishingse. Assist with ambulation by walking slightly behind the

personf. Sit in the person’s field of vision if he or she has partial

or reduced peripheral vision

Which of the following are guidelines to follow when caring for

clients with hearing impairments (select ALL that apply)

a. Increase the noise level in the roomb. Clean ears on a daily basisc. Position yourself so that the light is on your face when

you speakd. Talk to the person from a distance so that he/she may

read your lipse. Demonstrate or pantomime ideas you wish to expressf. Write any ideas that you cannot convey to the person in

another manner.

Communication Methodsfor

Clients with Special Needs

• Review Box 24-10 in Potter & PerryPage 357

Evaluation: Sensory alterations

• Were outcomes met ?

• Is patient compensating ?

• Sensory deprivation hasn’t become sensory overload?

• Does nursing care plan need modifying if goals not met?

Sleep/Rest• Essential for health• Illness requires increased need for

sleep/rest• Rest – calmness, free from stress/anxiety• Sleep – altered state of consciousness in

which reaction and perception is decreased

• Effects of sleep on the body not completely understood

Sleep• Circadian synchronization- sleep-wake

pattern follows the body’s biologic clock• RAS and Bulbar synchronizing region of Pons work

together to control sleep/wake cycles

• Restores balance to nervous system • Promotes physiological & psychological restoration

• Lack of sleep- irritable, poor concentration, difficulty making decisions

Sleep Stages

• NREM- non-rapid eye movement

• 75-80% of adult sleep• Has 4 stages

I – sl. AwarenessII- easily arousedIII – less easily arousedIV – Delta sleep; arousal difficult

• REM(Stage V)- rapid eye movement• 20-25% of adult sleep• Dreaming

Eyes dartingfacial muscles flacid

• Essential for emotional equilibrium

Sleep Requirements

• Individualized

• Less sleep required the older one is…newborns sleep 16-18 hr/day (with more Delta & REM sleep) whereas elders sleep 6 hr/day ( with less Delta & REM sleep)

Factors Affecting Sleep• Health/illness (CAD pain, GI secretions increased

in REM sleep, • Environment• Exercise and Fatigue• Lifestyle • Emotional stress• Stimulants/Alcohol (decrease Delta & REM sleep)• Diet• Smoking• Medication• Motivation

Sleep Disorders

• Insomnia

• Narcolepsy

• Sleep apnea

• Parasomnias

Assessing: Sleep

• Pattern• Quality• Energy level• Sleeping aids• Sleep disturbances

-nature-onset-causes-symptoms (Do you snore? Do you wake up with HA?)

Assessing Sleep

What are some objective signs of inadequate sleep the nurse should be observant to?

Physical signs of fatigue: facial drooping, lids swollen, eyes reddened

Behavioral signs: yawning, slowed speech, slumped posture

Also check for obesity, large thickened neck, enlarged tonsils

Nursing Dx

• Sleep pattern disturbance R/T physical discomfort AEB s/p L hip arthroplasty, positioning restrictions and client statement “I can’t sleep on my back; I like to sleep on my side”

• Sleep deficit R/T shift changes at work AEB “ I’m tired going to work but when I get home I can’t fall asleep”

Nursing Diagnoses with Sleep Deprivation as etiology

• Anxiety r/t

• Activity intolerance r/t

• Ineffective coping r/t

• Risk for injury r/t

Outcome Criteria

Client will:• Wake up less frequently during the night• Fall asleep without difficulty• Verbalize plan that provides adequate time

for sleep• Identify actions that can be taken to

improve quality of sleep• Awaken refreshed and be less fatigued

during the day

Implementing: Promote Sleep

• Restful environment

• Comfort/relaxation

• Bedtime rituals

• Sleep pattern• Medications

Pharmacological Approaches

• Herbals: Melatonin, Chamomile

• Sedatives: Temazepam (Restoril) Triazolam ( Halcion )

Zolpidem ( Ambien) Alprazolam ( Xanax) Diazepam ( Valium )