NEUROLOGICAL SYSTEM

SENSORY RECEPTION- the process of receiving stimuli or data. These stimuli are either external or internal to the body.
External Stimuli: visual, auditory, olfactory, tactile, and gustatory.

SENSORY PERCEPTION- involves the conscious organization and translation of the data or stimuli into meaningful information.


FACTORS AFFECTING SENSORY FUNCTION

a. DEVELOPMENTAL STAGE
-Infants learn to recognize the face of the mother or caregiver and establish essential to later emotional development.
-Young children respond to music by singing and dancing as they begin to interact with their peers in groups.
-As children grow, they learn to interpret visual and auditory signals when preparing to cross the street.
Adults have many learned responses to sensory cues

b. CULTURE
-Often determines the amount of stimulation that a person considers usual or “normal”.
The normal amount of stimulation associated with ethnic origin, religious affiliation, and income level, also affects the amount of stimulation an individual desires and believes to be meaningful.

CULTURE DEPRIVATION- lack of culturally assistive, supportive, or facilitative acts.

c. STRESS-
Increased stress- people may find their senses already overload and thus seek to decrease sensory stimulation.
Client may seek sensory stimulation during times of low stress.

d. MEDICATIONS AND ILLNESS
-Anyone taking several medications concurrently may show alterations in sensory function; elders are specially at risk and need to be monitored carefully.
Certain medications, if taken over a long period of time, become ototoxic (ex. Aspirin, furosemide, aminoglycosides)

e. LIFESTYLE AND PERSONALITY
-Influences the quality and quantity of stimulation to which an individual is accustomed.
People’s personalities also differ in terms of the quantity and quality of stimuli with which they are comfortable.

SENSORY ALTERATIONS

a. SENSORY DEPRIVATION

Decrease or lack of meaningful stimuli.

The Reticular Activating System (RAS) is unable to maintain normal stimulation to cerebral cortex.

CLINICAL MANIFESTATIONS:

Excessive yawning, drowsiness, sleeping

Decreased attention span, difficulty concentrating, decreased problem solving.

Impaired memory

Periodic disorientation, general confusions or nocturnal confusions

Hallucinations or delusions

Crying, annoyance over small matters, depression

b. SENSORY OVERLOAD

A person is unable to process or manage the amount or intensity of sensory stimuli.

Factors that contribute to Sensory Overload:

Increased quantity & quality of internal and external stimuli

Inability to disregard stimuli selectively

CLINICAL MANIFESTATIONS:

Fatigue, sleeplessness

Irritability, anxiety, restlessness

Periodic or general disorientation

Reduced problem-solving ability and task performance

Increased muscle tension

Scattered attention and racing thoughts

c. SENSORY DEFICITS

Impaired reception, perception, or both, of one or more of the senses. ( e.g. blindness, deafness)

Nursing Process Application

ASSESSMENT

a. Nursing History

b. Mental status examination

c. Physical examination

d. Identification of clients at risk

e. Client’s environment

f. Social support network


a. NURSING HISTORY

Nurse assesses present sensory perceptions, usual functioning, sensory deficits, and potential problems

b. MENTAL STATUS EXAMINATION

Assessment of mental status reveals the client’s general cerebral function. These functions include cognitive and affective functions.

Major areas include: language, orientation, memory, and attention span and calculation.


c. PHYSICAL EXAMINATION

Specific sensory tests include the ff:

Visual acuity

Hearing acuity

Olfactory sense

Gustatory sense

Tactile sense


d. CLIENTS AT RISK

Sensory Deprivation: clients who

Are confined in a nonstimulating or monotonous environment in the home or health care agency

Have impaired vision or hearing

Have mobility restrictions

Are unable to process stimuli

Have emotional disorders

Have limited social contact w/ family and friends


e. SENSORY OVERLOAD: CLIENTS WHO:

Have pain or discomfort

Are acutely ill and have been admitted to an acute care facility

Are being closely monitored in an ICU and have intrusive tubes such as IVs, catheters, NGT, or ET.

Have decreased cognitive ability ( e.g. head injury)


f. CLIENT’S ENVIRONMENT

The nurse assess the client’s environment for quantity, quality, and type of stimuli.

The client’s environment may produce insufficient stimuli, placing the client at risk for sensory overload.

Nonstimulating environment: severely restrict physical activity, limit social contact with family and friends.


g. SOCIAL SUPPORT NETWORK

The nurse assesses

Whether the client lives alone

Who visits and when

Any signs indicating social deprivation such as withdrawal from contact with others to avoid embarrassment or dependence on others, negative self-image, reports of lack of meaningful communication with others.


NURSING DIAGNOSIS

Disturbed Sensory Perception (Specify: Visual, Auditory, Kinesthetic, Gustatory, Tactile, Olfactory)

Acute Confusion

Chronic Confusion

Impaired Memory


PLANNING

The overall outcome criteria for clients with sensory-perception alterations are to:

Prevent injury

Maintain the function of existing senses

Develop an effective communication

Prevent sensory overload or deprivation

Reduce social isolation

Prevent activities of daily living independently and safely


APPROPRIATE NURSING ACTIVITIES

Cognitive Stimulation

Communication Enhancement: Hearing deficit & Visual deficit

Nutrition Management

Fall Prevention

Body Mechanics Promotion

Peripheral Sensation Management

Emotional Support

Surveillance: Safety


IMPLEMENTATION

Nurses can assist clients with sensory alterations by:

Promoting healthy sensory function

Adjusting environmental stimuli:

Helping clients to manage acute sensory deficits :

-sensory aids

-promoting the use of other senses

-communicating effectively

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