SENSORY STIMULATION

Stress of illness or trauma and need for diagnosis and treatment may quickly result in sensory deprivation or overload, with serious disturbances in visual, perceptual, cognitive or emotional functioning.

I.

SENSORY EXPERIENCE

sensory reception – process of receiving data about internal or external environment through the senses sensory perception – conscious process of selecting, organizing, and interpreting data from the senses into meaningful information - influenced by intensity, size, change, representation of stimuli, or past experiences, knowledge and attitudes Necessary Conditions: stimulus – agent, act, or other influence capable of initiating response by nervous system - receptor or sense organ must receive stimulus and convert it to nerve impulse - nerve impulse must be conducted along pathway to the brain - particular area in brain must receive and translate A. AROUSAL MECHANISM - to receive stimuli and respond appropriately, brain must be alert or aroused reticular activating system (RAS) – poorly defined network that extends from hypothalamus to medulla, mediates arousal - monitors and regulates incoming sensory stimuli; maintaining, enhancing, inhibiting cortical arousal adaptation - body quickly adapts to constant stimuli - repeated stimuli of continuing noise eventually goes unnoticed; therefore, stimuli must be variable or irregular to evoke a response B. DISTURBED SENSORY PERCEPTION - stimuli that are different in quality and quantity than that to which he/she is accustomed - likely to result in disturbed sensory perceptions experienced by the pt - sensitivity to how color, sound, and touch are stimulating pt combined with attention to pt’s need for privacy and social interaction can significantly reduce disturbances - factors contributing to severe sensory alteration include sensory overload, sensory deprivation, sleep

deprivation, and cultural case deprivation 1. SENSORY DEPRIVATION – when a person experiences decreased sensory input or input that is monotonous, unpatterned, or meaningless - RAS is no longer able to project normal level of activation to brain - factors include environment with decreased or monotonous stimuli; impaired ability to receive environmental stimuli or casts that interfere with vision, hearing, or tactile stimulation; inability to process environmental stimuli perceptual responses – involve inaccurate perception of sights, sounds, tastes, smells, and body position, coordination, and equilibrium cognitive responses – involve pt’s inability to control direction of thought content - attention span and ability to concentrate are decreased emotional responses – manifested by apathy, anxiety, fear, anger, belligerence, panic, or depression - rapid mood chgs 2. SENSORY OVERLOAD – condition that results when a person experiences so much sensory stimuli that the brain is unable to either respond meaningfully or ignore - feeling of being out of control - amt and quality are influenced by factors such as age, culture, personality, and lifestyle - brain is assaulted by constant presence of strangers; strange sights, odors, sounds, and feels of unfamiliar environment; constant presence of pain or discomfort from dressings, IV lines, drainage tubes, or endotracheal tubes; ever-present worries about meaning and course of illness - care focuses on reducing distressing stimuli and helping pt gain control over environment SENSORY DEFICITS – impaired or absent functioning in one or more senses - may be reversible or permanent, may occur gradually or all at once, may be present at birth or evolve later 3.

II.

FACTORS AFFECTING SENSORY STIMULATION

DECREASE IN VISION - ensure use of corrective lenses (contacts, glasses, magnifiers) - provide adequate lighting and clear pathways - provide enlarged print

DECREASE IN HEARING – ensure use of hearing assistive devices - use lower tone when speaking - speak so that pt can visualize mouth movements DECREASED SENSE OF TOUCH – protect from temperature extremes - breaks in skin, blisters, drainage, or open wounds - ensure ambulating with assistive devices SENSORY DEPRIVATION – discourage use of sedatives - provide interaction w/children and pets - ensure shared meals w/institutionalized pts - encourage participation in exercise classes and activity therapy - ensure frequent visits from family and community resources (Meals on Wheels) SENSORY OVERLOAD – orient pt to person, place, and time - decrease environmental noise participation in nursing care A. - encourage

DEVELOPMENTAL CONSIDERATIONS - different types of sensory stimulation are needed for growth - appropriate stimulation includes soothing, holding, rocking, and changes of position, singing and being talked to, and changing pattern of light and shade - for children, developmentally appropriate play develops muscles and coordination, provides outlet for surplus physical energy, develops communication skills, provides sources of learning, acts as stimulant to creativity, develops social skills, teaches sex roles, provides outlet for release of emotional energy, and develops self-insights - sensory functioning tends to decline progressively throughout adulthood as a result of aging or chronic illnesses B. CULTURE - dictate amt of sensory stimulation considered normal - male and female roles may be culturally defined - ethnic norms, religious norms, income group norms, and norms of subgroups influence amt of stimulation and perception of meaningful - sensory deprivation, sensory overload, and sleep deprivation are all related to or affected by cultural practices, values, and beliefs - pt may find comfort in cultural and religious symbols of care and healing that are absent in hospital environment C. PERSONALITY
AND

LIFESTYLE

- choices can dramatically influence quantity and quality of stimuli received - ex. nurse who works E.R. of large city is exposed to vastly different stimuli than one making home visits in a rural setting D. STRESS - increased stimulation during periods of low stress maintain cortical arousal - during high periods, multiple stressors overloading sensory system, and decreased stimulation is desired - stress of physical illness, pain, hospitalization, testing, surgery, or treatment may provide more stimulation than can be processed and responded to E. MEDICATIONS - meds that alert or depress CNS may interfere with perception of stimuli - may contribute to impairment of sensory functioning by decreasing reception

III.
A.

APPLICATION

OF

NURSING PROCESS

ASSESSMENT - include pt’s environment to determine whether it’s providing adequate sensory stimulation for health development STIMULATION – any recent chgs or new or unusual stimulation - determine if type presented is developmentally appropriate - high risk pts include children in nonstimulating environments, older people, terminally ill pts, pts on bed rest, pts in isolation, and pts requiring intensive nursing in critical care - ex. “Are you bored?” “Who visits you while you’re in the hospital?” 2. devices RECEPTION – anything that may interfere with reception and any corrective - high risk pts include people with visual, auditory, or other sensory impairments - ex. “Please read my name tag (or print on a page)” “Repeat the words that I’ll speak softly close to ea. ear” “Close your eyes, stick out your tongue, and tell me if what I place on your tongue is sweet, sour, bitter, or salty” 3. TRANSMISSION – PERCEPTION – REACTION – pts who are confused or have a nervous system impairment 1.

- use everyday interactions as multiple opportunities to assess abilities to transmit, perceive, and react to stimuli - ex. “Have you found it difficult to communicate verbally?” 4. BEHAVIORAL MANIFESTATIONS OF SENSORY DEPRIVATION/OVERLOAD – assess for specific indications (boredom, inactivity, slowness of thought, daydreaming, increased sleeping, thought disorganization, anxiety, panic, illusions, and hallucinations) - rapid mood changes

IV.

ANALYSIS / NURSING DIAGNOSIS

V.

PLANNING
- care focuses on: • developmentally stimulating and safe environment • exhibit level of arousal that enables brain to receive and meaningfully organize patterns of stimulation • demonstrate intact functioning of senses • maintain orientation to time, place, and person • respond appropriately (verbally and nonverbally) while executing self-care activities - outcomes similar to the following • report safe feeling and in control • describe different types of meaningful stimuli present • demonstrate (describe) appropriate self-care behaviors • verbalize acceptance of sensory deficit

VI.

IMPLEMENTING

- teach pts and significant others methods for stimulating senses, appropriate self-care behaviors, interacting therapeutically - safety is always a special concern - ensure environment is as free of danger as possible A. PREVENTING DISTURBED SENSORY PERCEPTION AND STIMULATING SENSES - most effective means is prevention - create functional and meaningful environment while keeping limitations in mind - requires careful observation, analysis, and creative planning - appropriateness depends on circumstances - promote well-being by offering care that provides rest and comfort - be aware of need for sensory aids and prostheses - social activities help stimulate senses and mind - encourage physical activity and exercise

- provide stimulation for as many senses as possible (varied sights, sounds, smells, body positions, and textures) - consider cultural factors B. MEETING NEEDS OF PATIENTS WITH REDUCED VISION - always check if a visual problem is temporary, permanent, partial or complete - first priority is self-care behaviors for maintaining vision and preventing blindness - avoid rubbing eyes, eyestrain, damage from ultraviolet rays, nonprescription eyedrops and seek attention for symptoms - protect eyes from foreign bodies, keep eyeglasses clean, protected and adjusted - use caution with aerosol sprays, ammonia, lye - visit physician frequently - know danger signals that indicate serious problems - when communicating with visually impaired pt: • acknowledge your presence – identify yourself by name and title • speak in normal tone of voice • explain reason for touching before doing so • keep call light or bell w/in easy reach • orient person to environmental sounds • orient person to arrangement of room and furnishings (clear pathways) • assist w/ambulation, allowing pt to grasp your arm • stay in person’s field of vision • provide diversion using other senses • indicate when conversation has ended and when you’re leaving the room C. MEETING THE NEEDS OF PATIENTS WITH REDUCED HEARING - temporary loss conductive in nature are due to problems with external or middle ear (wax buildup, foreign-body obstruction, infection) - sensorineural hearing losses are caused by inner ear or CNS problems and may not be totally correctable - preventions include: • avoid excessive noise, inserting sharp objects into ears, excessive cleaning, practices that can cause infection (treating infection early) • know symptoms - - stmts. repeated, inability to hear from distances, need to see person talking, leaning forward or turning toward speaker, talking too loudly, strained facial expression

- when communicating: • orient pt to your presence • decrease background noises • make sure hearing aids are working • make sure pt can see your lips and expressions • talk directly to pt while facing him/her - - angle chair so that your voice reaches the ear that hears best; if pt is able to lip-read, use simple sentences and speak in quiet, natural manner; do not chew gum, cover your mouth, or turn away from pt; demonstrate or pantomime ideas; use sign language or finger spelling; write D. COMMUNICATING WITH PATIENT WHO IS CONFUSED - pt who lack mental ability to process stimuli may be aware of this inability and find it frustrating - in the case of a pt oblivious of deficiency, always protect the safety of the pt - interventions include: • frequent face-to-face contact • speak calmly, simply and directly to pt • orient and reorient to environment and fill pt’s personal space with as many personal object as possible • use conversation, watches, clocks, calendars, newspaper, television, radio and other devices to orient to time, place, and person • clearly communicate that pt is expected to perform self-care activities • emphasize pt strengths and verbally reinforce strengths • offer simple explanations for care, new activities, etc. • vary environmental stimuli gradually • use objects from pt’s past • reinforce reality E. COMMUNICATING WITH A PATIENT WHO IS UNCONSCIOUS - be careful of what is said - - hearing is believed to be last sense lost - assume person can hear you - speak to person before touching - keep environmental noises at lowest level possible

V.

EVALUATING

- evaluate plan’s effectiveness by observing for decrease in behavioral manifestation of sensory deprivation or overload - working if pt who had begun to withdraw and spend most time lying in bed with blank facial

expression appears more alert and begins to initiate conversations and take interest in personal care - evaluate pt’s ability to interact appropriately and need for nursing care vs. his/her ability to manage care plan

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