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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

3. 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

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 - encourage
participation in nursing care

A. 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. APPLICATION OF NURSING PROCESS


A. ASSESSMENT
- include pt’s environment to determine whether it’s providing adequate
sensory stimulation for health
development

1. 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. RECEPTION – anything that may interfere with reception and any corrective
devices
- 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
- 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