sensory and perceptual alterations

7/31/2019 Sensory and Perceptual Alterations

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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 thesense 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 ob ject’s size,

shape, and texture

3. Visceral - Awareness of the state of the internalorgans

2. Sensory perception

a. The process of perceiving and interpreting external or internal

stimuli as meaningful information in the cerebral cortex

b. 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 non stimulating or monotonous

environment

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 environmentalstimuli



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 environment to provide meaningful

stimulation

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 stimuliE.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 client’s 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 ingustatory 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

acuity5. 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 orramps 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


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


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 at appropriate

temperatures

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 dishese. 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

sensory and perceptual alterations

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