PRESENTED BY :

SAWERA IQBAL (37)

SANA MALIK (35)
SEHRISH (42)

SUBJECT
CRITICAL CARE NURSING
PRESENTATION ASSIGNED BY :
SIR RASHID HUSSAIN BURDI

2
PRESENTATION TOPIC

SLEEP & SENSORY

BALANCES
(OVERLOAD & DEPRIVATION)
IN CRITICALLY ILL PATIENT
 S
At the end of my presentation learners will be able to:

 Define sensory system and how sensory perception occur

 Discuss the sensory perceptional alteration
(sensory overload and sensory deprivation)
 Explain sensory balance in critically ill patients
 Define the sleep balance
 Discuss the sleep balance disorders (overload and sleep
deprivation)
 Explain sleep balance in critically ill patients

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SENSORY SYSTEM
A sensory system consists of sensory
neurons(including the sensory receptor
cells) neural pathways and parts of the
brain involved in sensory perception.
The central nervous system receives
information from the internal and external
environment via the sensory organs
Commonly recognized sensory systems are those for
vision,hearning,touch,taste,smell and balance
SENSORY PERCEPTION
SENSORY PERCEPTUAL ALTERATION

Sensory perceptual alteration can be

defined as when there is a change in the
pattern of sensory stimuli followed by
abnormal response to stimuli.
It could be increased , decreased and
distorted with persons
hearing ,vison,touch sensation smell or
kinesthetic activity
SENSORY OVERLAOD
Itoccurs when a person is unable to
process or manage the intensity or
quantity of incoming sensory stimuli. The
person feels out to control
Symptoms of sensory overload
Difficultyfocusing
Anxiety and fear
Insomnia
Extreme irritability
Restlessness and discomfort
Feeling overly excited
CONDITIONS ASSOCIATED WITH
SENSORY OVERLAOD
Generalized anxiety disorder
Fibromyalgia
Multiple sclerosis
Autism
SENSORY DEPRIVATION
Sensory deprivation means depriving
your senses of stimulation
Sensory deprivation lead to
anxiety ,depression hallucination
Symptoms of sensory deprivation
Slowed reaction time
Impaired decision making
 Depression
Irritability
 SENSORY DEPRIVATION
ALTERED SENSORY DEPRIVED ENVIRONMENTS
DEPRIVATION

A person who is
Occurs in such
conditions as spinal immobilized or isolated
cord injury, brain for any reason is
damage, sleep deprived of the usual
deprivation and chronic amount of stimulation
illness. and may show the
manifestation of
sensory deprivation
SENSORY BALANCE IN
CRITICALLY ILL PATIENT
Critical ill patients in the ICU are at
increased risk of developing sensory
alteration.
Sensory and altered perceptions can occur
due to acute illness and environmental
factors, sleep deprivation, immobilization
and social isolation
 Risk factors for Sensory overload &
deprivation in critical ill patient

Sensory overload Sensory deprivation

 Bright lights  Eyes bandage
 Use of mechanical  Bed rest
ventilators  Isolation precautions
 Use of oxygen  Sensory aid not available
(hearing aid, glasses )
TREATMENT
Noise control
Cognitive stimulation therapy
Provide adequate sleep
Psychotherapist
Sleep
SLEEP
is a naturally recurring state of mind
and body, characterized by altered
consciousness, relatively inhibited sensory
activity, reduced muscle activity and
inhibition of nearly all voluntary muscles.
Diurnal rest leads to the tuning down of the
nervous system and the regeneration of
muscles, and results in physiological rest.
 SLEEP CYCLE CONSISTS OF
TWO PHASES
1: REM (rapid eye movement)
2: NREM (non-rapid eye
movement)
The  The NREM phase is divided
REM phase is
into three additional stages:
characterized by
1. N1 – the lightest sleep, the
rapid eyeball transition from wakefulness
movement, muscle to sleep
atonia and dreams 2. N2 - the moment of falling
asleep, characterized by
light sleep
3. N3 - deep sleep, the hardest
to interrupt
PHYSIOLOGICAL SLEEP AND CIRCADIAN RHYTHM

The average duration of diurnal rest in a

healthy adult is 7-8 hours
Hormonal control of sleep
The secretion of melatonin, a hormone
involved in the regulation of the sleep-
wake cycle, is regulated by the circadian
cycle
SLEEP DISORDER
When the neurochemicals are not
interacting appropriately to regulate your
sleep-wake cycle or sleep patterns (REM,
non-REM), sleep issues exist and daily
functioning is impacted.
SLEEP DEPRIVATION

Sleep deprivation is defined as not

obtaining adequate total sleep. Insufficient
sleep adversely affects how the body
functions.
SYMPTOMS OF SLEEP
DEPRIVATION
Fatigue
Irritability
Mood changes
Difficulty focusing and remembering
CAUSES OF SLEEP DEPRIVATION
There are many reasons why a person may not get
enough sleep. Examples include:
1. A sleeping environment that is noisy or not the right
temperature
2. Sleep apnea
3. Chronic pain
4. Chronic fatigue syndrome
5. Substance misuse
6. Depression
7. Anxiety
8. Bipolar disorder
9. Schizophrenia
EFFECTS ON THE BODY
Sleep deprivation can affect  various aspects of health,
including:
 The brain: Sleep deprivation affects the prefrontal cortex,
which handles reasoning, and the amygdala, which deals
with emotion. A lack of sleep may also make it harder for a
person to form new memories, which can affect learning
 The immune system: Sleep deprivation may cause a person
to be more prone to infections, which may take longer to
resolve
 The cardiovascular system: Sleep helps the heart vessels
heal and rebuild and affects processes that maintain blood
pressure, sugar levels, and inflammation control. Too little
sleep may increase the risk of cardiovascular disease.
 TREATMENT
Some approaches that do not involve drugs include:
 Relaxation techniques: Meditation, mindfulness
training, breathing exercises, can help reduce tension.
 Cognitive behavioral therapy: Known as CBT,
this may help a person identify thought patterns that
are contributing to limited sleep.
 Medications
doxylamine (Unisom)
zolpidem (Ambien)
butabarbital (Butisol)
SLEEP OVERLOAD
Sleep overload  is defined as obtaining
excessive sleep.
NARCOLEPSY

Narcolepsy is a neurological disorder of

sleep regualtion.People with narcolepsy
experience excessive daytime sleepiness
and uncontrolled episode of falling asleep
during the daytime/
These sudden sleep attacks may occur
during any type of activity at any time of
the day.
SLEEP IN CRITICAL ILL PATIENT
SLEEP IN CRITICAL ILL PATIENT
Sleep of critical ill patients is influenced
by noise, pain experienced, discomfort,
medication administered in the intensive
care setting and the mode of mechanical
ventilation.
SLEEP IN CRITICAL ILL PATIENT

Fatigue observed in intensive care unit

patients leads therefore to more pronounced
consequences of sleep deprivation, which in
turn can hamper the recovery process.
An increased number of awakenings may
have similar consequences as sleep
deprivation.
 Low quality sleep may also contribute to the
occurrence of psychotic states, i.e. delirium in
ICU patients
 Sleep disturbing factors in critical ill
patients 
Environmental factors Pharmacological agents Medical intervention
Noise Steroids Presence of tracheal tube
Light Beta-blockers Postoperative period
Nursing interventions Chronic intake of hypnotic Dialysis
drugs

Diagnostic tests Diuretics Non-invasive ventilation

Vital parameters Benzodiazepines
measurement

Blood collection Regular administration of

opioids

Administration of medication Magnesium

CLINICAL SCENARIO
A 36 year old male has been came to
psychiatric OPD ward he reports
difficulty falling asleep for the past 5
month he also report being very agitated
at the slight thing
 NURSING CARE PLAN
SUBJECTIVE DATA
 The patient reports
difficulty falling asleep
since 5 month
 He state that since he
started his new job 7 month
ago working the night shift
for 3 month he is getting
less sleep.
OBJECTIVE DATA
 A 36 old male patient come
to psychiatric OPD, patient
looks very tired with dark
circles underneath his eyes.
 Patient is restless, alteration
in concentration
 NURSING CARE PLAN
NURSING DIAGNOSIS
 Disturbed sleep pattern
related to lifestyle changes
 Sleep deprivation related to
inadequate quantity and
quality of the sleep
 Risk for injury related to
inadequate sleep
GOALS/EXPECTED OUTCOMES
 The patient will report
optimal balance of sleep
 Patient will report less
agitation
 Patient will report absence
of restlessness
 NURSING CARE PLAN
NURSING
INTERVENTIONS
EVALUATION
 The nurse will assess the  After nursing intervention
patients sleeping pattern and the patient was able to
help him develop a sleeping display improvement in
plan. The nurse will educate sleeping pattern
patient sleep in dark, quite  The patient does not look
and comfortable atmosphere weak and restless compare
 The nurse will discourage to the past
patient that he cannot take
caffeine or large meal intake
2 hours before sleep
REFERENCES
Sole M.L,Klein D.G, Moseley M.J. Introduction to Critical
Care Nursing.Elsevier (2012) 6th edition

Kamdar BB, Needham DM, Collop NA. Sleep deprivation

in
critical illness: its role in physical and psychological
recovery.
J Intensive Care Med. 2012;27(2):97-111.
.

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