Sensory Perception

Sensory Experience
• Individual’s senses  essential for growth &
development, and survival !
 Sensory Experience
• Sensory stimuli  give meaning to events in
the environment
 Sensory Experience
• Any alteration in sensory function  affect
ability to function within the environment
• E.g. : Client with impaired sensory function 
put them at risk in the health care setting
 Components
• Sensory reception  process of receiving
stimuli or data (internal & external)
• Sensory perception  conscious organization
and translation data or stimuli into meaningful
information
 Components
• External stimuli :
- visual
- auditory
- olfactory
- tactile
- gustatory
• Internal stimuli :
- kinesthetic  awareness of position and movement of
body parts
- visceral  any large organ within the body
 Arousal Mechanism
• Arousal : is a physiological
and psychological state of
being reactive to stimuli.
Important in regulating
consciousness, attention,
& information processing
• Reticular Activating System
(RAS)  responsible for
regulating arousal
 Arousal Mechanism
• Sensoristasis  when a person is in optimal
arousal. Adapt to increased or decreased
sensory stimuli.
• The brain has capacity to adapt the stimuli
• Awareness  ability to perceive
environmental stimuli and body reactions and
to respond appropriately through thought and
action
 States of Awareness
State Description

Full consciousness Alert, oriented to time, place, person.

Understand verbal and written words

Disoriented Not oriented to time, place, or person

Confused Reduced awareness, easily bewildered, poor
memory, misinterprets stimuli, impaired
judgment
Somnolent Extreme drowsiness but will respond to stimuli
Semi comatose Can be aroused by extreme or repeated
stimuli
Coma Will not respond to verbal stimuli
Factors Affecting Sensory Function
• Developmental stage
• Culture  cultural deprivation
• Stress
• Medications and illness
• Lifestyle and personality
 Sensory Alterations
• Sensory Deprivation  decrease in or lack
meaningful stimuli
• Sensory Overload  unable to process or
manage the amount or intensity of sensory
stimuli
• Sensory deficits Impaired reception,
perception, or both of one or more of the
senses
 Sensory Deprivation
• Reduced stimulation  RAS unable to maintain normal
stimulation to cortex cerebral
• Clients at risk :
- confined in a no stimulating or monotonous
environment in the home / hospital
- impaired vision or hearing
- Mobility restriction (quadriplegia, bed rest)
- unable to process stimuli (e.g. brain damage)
- emotional disorders (e.g. depresion)
- limited social contact with family and friends
 Sensory Deprivation
• Clinical manifestation :
- drowsiness, sleeping
- decreased attention, difficulty concentrating
- impaired memory
- periodic disorientation, general confusion
- hallucinations or delusions
- crying, annoyance over small matters,
depression
- apathy, emotional lability
 Sensory overload
• Many stimuli  doesn’t feel in control,
may appear fatigued, restlessness, can’t
internalize new information
• 3 factors contribute :
- increased quantity or quality of
internal stimuli (pain, dyspnea, anxiety)
- increased quantity or quality of
external stimuli (noisy, contacts with many
strangers
- inability to disregard stimuli
selectively (medication, nervous system
disturbances)
 Sensory overload
• Clients at risk :
- have pain or discomfort
- acutely ill, have been admitted to an acute
care facility
- closely monitored in an acute care facility
- decreased cognitive ability (e.g. head
injury)
 Sensory overload
Clinical manifestations :
- Complaints of fatigue, sleeplessness
- Irritability, anxiety, restlessness
- Periodic or general disorientation
- Reduced problem solving ability &
task performance
- Increased muscle tensions
 Sensory Deficit
• Loss of sensory function  other sense may
become more acute to compensate for the
loss
• Sensory deficit  at risk for sensory
deprivation and sensory overload (e.g. blind
client)
NURSING MANAGEMENT
 Assessing
Six components :
• Nursing history
• Mental status examination
• Physical examination
• Identification clients at risk
• The client’s environment
• Social support network
 Nursing History
Assessment interview for sensory-perceptual
functioning :
• VISUAL
 Rate the vision (excellent, good, fair, poor)
Wear eyeglasses or contact lens
Recent changes in vision
Difficulty seeing near or far object
Difficulty seeing at night, blurred vision, double vision,
light sensitivity, flashing light
Last visit an eye doctor
 Nursing History
• AUDITORY
 Rate the hearing (excellent, good, fair, poor)
 Wear hearing aid
 Recent changes in hearing
 Locate the direction of sounds, distinguish various sound
 Experience any dizziness, vertigo, ringing, fullness in the ear
• GUSTATORY
 Changes in taste (difficulty in differentiating sweet, sour,
salty, and biter taste)
 Enjoy the taste of previous taste
 Nursing History
• OLFACTORY
Changes in smell
Distinguish good by smell the odor, tell when something burning
Changes in appetite
• TACTILE
Experiencing any pain, discomfort
Decrease ability in perceiving heat, cold, pain
Numbness or tingling
• KINESTHETIC
Difficulty in perceiving the position of body part
 Mental Status
(Glasgow Coma Scale / GCS)
 Mental Status
(Glasgow Coma Scale / GCS)
 Physical Examination
• Visual  Snellen chart, reading material
(news paper, etc.), visual fields
• Hearing  observing the client’s
conversation with others, whisper test,
weber & Rinne tuning fork test
• Olfactory  identifying specific aromas
• Gustatory  identifying 3 tastes
(lemon, salt, sugar)
• Tactile  testing sharp & dull sensation,
hot & cold, light sensation, position
sensation
 Client at Risk
• Read previous slide, please……
Client Environment
Nurse assess the client’s environment for
quality, quantity, & type of stimuli.
• Radio, TV, auditory devices (CD-DVD
player, etc.)
• Clock or calendar
• Reading material (or toys for children)
• Number and compatibility of roommates
• Number of visitors
• Lights
• Therapeutics measures, frequency of
assessment and procedures
 Social Support Network
• Degree of isolation a person feel 
significantly influenced by the quality &
quantity of support from family and friends
• Assess :
Whether the client lives alone
Who visit and when
Any signs of indicating social deprivation
(withdrawal from contact with other, etc.)
 Diagnosing
NANDA NOC NIC

Disturbed sensory Body image Cognitive stimulation

perception (specify Cognitive orientation Communication enhancement
visual, auditory, Sensory function : Vision : hearing deficit
kinesthetic, Vision compensation Communication enhancement
gustatory, tactile, behavior : visual deficit
olfactory) Cognitive orientation Environmental management
Communication : receptive
Distorted thought self control
Hearing compensation
behavior
 Implementation
• Promoting health sensory function
• Adjusting environmental stimuli
 preventing sensory overload
 preventing sensory deprivation
• Managing acute sensory deficits
 use of sensory aids
• Communicating effectively
 impaired vision
 impaired hearing
 impaired olfactory sense
 impaired tactile sense
The confused client
 The unconscious client
Promoting health sensory function
• Detecting sensory problem early  infant should
be screened for hearing loss by 1 month of age
• Chronic ear infection, live / work with high noise
level  routine auditory testing
• Women who are considering pregnancy  Testing
for syphilis & rubella
• Periodic vision screening of all newborns & children
• Provide appropriate sensory input
• Implement client safety  keeping the bed in the
lowest position, placing the bell near the patient
 Adjusting environmental stimuli
Preventing sensory overload :
• Minimize unnecessary light, noise, distraction
• Control pain
• Introduce yourself by name
• Provide orienting cues (clock, calendars, equipment)
• Provide a private room
• Limit visitors
• Plan care to allow uninterrupted periods rest of sleep
• Speak in a low tone
• Provide new information gradually
• Reduce noxious odors
• Assist the client with stress-reducing techniques
 Adjusting environmental stimuli
Preventing Sensory Deprivation
• Encourage to use eyeglasses and hearing aids
• Communicate frequently and maintain meaningful
interactions
• Provide a telephone, radio, TV, calendar
• Have family and friends bring freshly cut flowers and
plants
• Increase tactile stimulation
• Encourage social interaction
• Encourage environment changes
 Communicating Effectively
Impaired vision
• Always announce your presence when
entering client’s room
• Stay in the client’s field of vision
• Speak in a warm and pleasant tone of
voice
• Always explain what you are going to do
• Explain the sound in the environment
• Indicate when the conversation has
ended when you are leaving the room
 Communicating Effectively
Impaired hearing
• Moving to a position where you can
be seen or gently touching the client
• Decrease background noise before
speaking
• Talk at moderate rate tone, don’t
shouting !
• Avoid talking when you have
something in your mouth (chewing,
wearing mask)
 Communicating Effectively
Impaired olfactory sense
• Need to be taught about the dangers of cleaning with
chemical such as ammonia, keep gas stoves in good
working order
• Inspect food for freshness (check color & texture), check
expired date, packages
Impaired tactile sense
• Be aware of hot temperature  burns
• Adjust the temperature, using thermometer
• Decreased sensation to pressure  change the position
frequently