chapter 34 sensory stimulation

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 34Sensory Stimulation


Senses Involved in Sensory Reception• Visual (vision)• Auditory (hearing)• Olfactory (smell)• Gustatory (taste)• Tactile (touch)• Stereognosis (perceives solidity of objects)• Kinesthetic and visceral (basic internal orienting systems)


Four Conditions to Receive Data• Stimulus• Receptor• Nervous pathway to the brain• Functioning brain


Question

Which of the following interventions would be appropriate to stimulate the sense of stereognosis in nursing home residents?A. Tape pictures of loved ones on the wallsB. Play soft music in the recreation roomC. Prepare a fragrant cup of tea D. Provide a soft textured blanket on the bed


Answer

Answer: D. Provide a soft textured blanket on the bedRationale:Stereognosis is the sense that perceives the size, shape, and texture of objects, such as, a soft blanket.Taping pictures to the wall stimulates the visual sense.Playing music stimulates the auditory sense (sound).Making tea stimulates the olfactory sense (smell) and the gustatory sense (taste).


Factors Affecting Sensory Stimulation• Developmental considerations• Culture• Personality and lifestyle• Stress• Medications


Reticular Activating System (RAS)• Poorly defined network• Extends from hypothalamus to medulla• Mediates arousal• Optimal arousal state—sensoristasis• Monitors and regulates incoming sensory stimuli


Reticular Activating System


States of Awareness• Conscious

– Delirium, dementia, confusion, normal consciousness, somnolence, chronic vegetative state

• Unconscious– Asleep, stupor, coma


Factors Contributing to Sensory Alteration• Sensory overload• Sensory deprivation• Sleep deprivation• Cultural care deprivation


Sensory Deprivation• Environment with decreased or monotonous stimuli• Impaired ability to receive environmental stimuli• Inability to process environmental stimuli


Effects of Sensory Deprivation• Perceptual• Cognitive• Emotional disturbances


Question

Tell whether the following statement is true or false.In the drive state of RAS known as sensoristasis, nerve impulses from all the sensory tracts reach the RAS, which then allows certain impulses to reach the cerebral cortex and be perceived.A. TrueB. False


Answer

Answer: A. TrueIn the drive state of RAS known as sensoristasis, nerve impulses from all the sensory tracts reach the RAS, which then allows certain impulses to reach the cerebral cortex and be perceived.


Sensory Overload• Patient experiences so much sensory stimuli that the

brain is unable to respond meaningfully or ignore stimuli• Patient feels out of control and exhibits manifestations

observed in sensory deprivation• Nursing care focuses on reducing distressing stimuli and

helping patient gain control over environment


Patient Outcomes for Sensory Alterations• 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


Question

Which one of the following patients would be considered at risk for sensory deprivation?A. A patient with AIDSB. A patient in an intensive care unitC. A patient with a disturbance of the nervous systemD. A patient with intrusive monitoring


Answer

Answer: A. A patient with AIDSRationale:A patient with AIDS may receive an insufficient quantity or quality of stimuli causing sensory deprivation. Patients in intensive care units, patients with a disturbance of the nervous system, and patients who have extensive monitoring are at high risk for sensory overload. This condition is caused by excessive stimuli over which the individual feels little control.


Improving Sensory Functioning• Teach patients and significant others method for

stimulating the senses• Teach patients with intact and impaired senses self-care

behaviors• Interact therapeutically with patients with sensory

impairments


Stimulating a Patient’s Senses


Preventing Sensory Alterations• Control patient discomfort whenever possible• Offer care that provides rest and comfort• 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• Encourage physical activity and exercise• Provide stimulation for as many senses as possible


Caring for Visually Impaired Patients• Teach patient self-care behaviors to maintain vision and

prevent blindness• Acknowledge your presence in patient’s room• Speak in normal tone of voice• Explain reason for touching person before doing so• Keep call light within reach• Orient person to sounds in environment


Caring for Visually Impaired Patients (continued)• Orient person to room arrangement and furnishings• Assist with ambulation by walking slightly ahead of

person• Stay in person’s field of vision if he or she has partial

vision• Provide diversion using other senses• Indicate conversation has ended when leaving room


Question

Which of the following is an appropriate measure when caring for a patient who is hearing impaired?A. Speak to the person before making your presence knownB. Increase noises in the background to stimulate the sensesC. Position self so light is on your faceD. Do not use pantomime to express messages to avoid embarrassment


Answer

Answer: C. Position self so light is on your faceRationale:Positioning self so light is on your face allows the patient to see your lips and expressions. The patient should be oriented to your presence before speaking.Background noises should be reduced and pantomime and sign language can be used as appropriate.


Caring for Hearing Impaired Patients• Teach measures to prevent hearing problems• Orient person to your presence before speaking• Decrease background noises before speaking• Check patient’s hearing aids• Position self so light is on your face• Talk directly to the person while facing him• Use pantomime or sign language as appropriate• Write any ideas you cannot convey in another manner


Communicating With a Patient Who is Confused• Use frequent face-to-face contact to communicate social

process• Speak calmly, simply, and directly to patient• Orient and reorient patient to environment• Orient patient to time, place, and person• Communicate that person is expected to perform self-

care activities• Offer explanations for care• Reinforce reality if patient is delusional


Question

Tell whether the following statement is true or false.When caring for an unconscious patient, the nurse should speak loudly and assume the patient can hear him.A. TrueB. False


Answer

Answer: B. FalseWhen caring for an unconscious patient, the nurse should speak in a normal tone of voice and assume the patient can hear him.


Communicating With an Unconscious Patient• Be careful what is said in person’s presence; hearing is

the last sense that is lost• Assume the person can hear you and talk in a normal

tone of voice• Speak to the person before touching• Keep environmental noises at low level

chapter 34 sensory stimulation

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