concept of sensory alteration
TRANSCRIPT
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Altered
Sensory Perception
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The visual, auditory and olfactory systems
are distance senses, bringing informationabout our environment to our perception.
Each system detects the intensity and
quality of stimuli, encodes and processesthis information, and transmits it to the
cerebral cortex. Together these senses
provide much of the available information
about our environment
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CLASSIFICATION OF SENSE
ORGANS GENERAL SENSE ORGANS
microscopic receptors widely distributed
throughout the body in the skin, muscles,
tendons, joints and other internal organs of
the body
SPECIAL SENSE ORGANS
The special sense organs are responsible
for the special senses of smell, taste,
vision, hearing and equilibrium
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Normal Sensory Perception Sensory perception depends on the sensory receptors,
reticular activating system (RAS), and functioning
nervous pathways to the brain. The RAS influencesawareness of stimuli, which are received through the fivesenses: sight, hearing, touch, smell, and taste.Kinaesthetic and visceral senses are stimulatedinternally.
Reticular activating system (RAS) It is responsible for bringing together information from
the cerebellum and other parts of the brain with thesense organs.
The RAS is highly selective. For example, a parent may
be awakened in the middle of the night at the slightestmurmur of an infant in a bedroom down the hall but maysleep through the loud traffic noises outside the bedroomwindow. Destruction of the RAS produces coma and anelectroencephalograph pattern characteristic of sleep.
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NEURAL PATHWAYS
SENSORY IMPULSES TRAVEL TO THE
BRAIN VIA
2 ASCENDING NEURAL PATHWAYS
SPINO-THALAMIC TRACT &
POSTERIOR COLUMNS
IMPULSES ORIGINATE IN THE
AFFERENT FIBERS OF THEPERIPHERAL NERVES, ARE CARRIED
THROUGH THE POSTERIOR DORSAL
ROOT INTO THE SPINAL CORD
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LATERAL SPINOTHALAMIC
TRACT PAIN
TEMPERATURE
CRUDE & LIGHT TOUCH
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POSTERIOR COLUMNS
POSITION
VIBRATION
FINE TOUCH
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COMPONENTS OF SENSORY
PERCEPTION
RECEPTION
Reception is the process of receiving stimuli from
nerve endings in the skin and body. A receptor
converts a stimulus to a nerve impulse andtransmits the impulse along sensory neurons to
the CNS
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COMPONENTS OF SENSORY
PERCEPTIONPERCEPTION:
It is the ability to interpret the impulses
transmitted from the receptors and give meaning
to the stimuli. After the receptors generate nerveimpulses, the impulses travel along the neural
pathways to the spinal cord and brain. They are
then relayed to the specialized locations in the
brain where perception of the stimuli occurs
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Input of SensesSensory function begins with reception of stimuli by the senses.
Externally, the senses receiving s t imu l i are;
Vision, hearing, smell, taste, and touch.
Receptor o rgans are
The eyes, ears, olfactory receptors in the nose, taste buds of thetongue, and nerve endings in the skin.
Internally, the kinaesthetic and visceral senses receive stimuli.These receptors are nerve endings in the skin and body tissues.The kinaesthetic sense influences awareness of the placementand action of body parts. The visceral sense receives stimuli thataffect awareness related to the body's large interior organs.Vision, hearing, smell, and taste are termed, special senses.Touch, kinesthetic sensation, and visceral sensation are termedsomatic senses. After stimuli are received, they are perceived
with the help of the RAS. Sensory perception is a consociatesprocess of selecting, organizing, and interpreting sensory stimulirequiring intact and functioning sense organs, nervous pathways,and the brain.
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Characteristics of Normal Sensory Perception These are the normal measures in quality and quantity
of the special and somatic senses.
Normal vis ionis associated with visual acuity at or near20/20, full field of vision, and tricolour vision (red,green, blue).
Normal hearingis associated with auditory acuity ofsounds at an intensity of 0 to 25 dB, at frequencies of
125 to 8,000 cycles per second. Normal tasteinvolves the ability to discriminate sour,
salty, sweet, and bitter.
Normal smellinvolves the discrimination of primary
odours, such as cainphoraceotrs, musky, floral,peppermint, ethereal, pungent, and ptitrid.
Somatic sensesinclude discrimination of touch,pressure, vibration, position, tickling, temperature, andpain.
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Normal Sensory Pattern
Sensor stasis
Each person has his or her own comfort zone.
This comfort zone varies from person to personand is the range at which a person performs athis or her peak. Sensor stasis is a state ofoptimum arousal-not too much and not toolittle. The RAS is viewed by some theorists as a
monitor for sensor static balance. Adaptation
Beyond the point of sensor stasis, sensoryadaptation occurs. Sensory receptors adapt to
repeated stimulation by responding less andless. Lead time and after burn are twonecessary time periods crucial to helping aperson deal with new stimuli.
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Lead time is the time each person needs to
prepare for an event emotionally and physically. After burn is the time needed to think about,
evaluate, and come to terms with the activity
after it happens.
The necessary amount of lead time and after
burn is different for each person. Lead time and
after burn helps person process stimuli so he or
she can respond appropriately without becomingoverwhelmed
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Factors Affecting Sensory Perception
Environment
Sensory stimuli in the environment affect sensory
perception. For example, a teacher may not noticethe noise in a consistently noisy environment, suchas the school cafeteria. But the same teacher mayperceive a loud television set very differently in hisor her own home, which is usually quiet.
Previous Experience
It affects sensory perception in that people becomemore alert to stimuli that evoke a strong
response. For example, a person may drive to workby the same route each day, noticing little along theway. A person may listen to the radio inattentivelyuntil a favourite song is played, then listen to everyword. A new experience, such as hospitalization,may cause a client to perceive a barrage ofthreatening new stimuli.
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Lifestyle and Habits
It affects sensory perception. One person may enjoy alifestyle surrounded by many people, frequent changes,bright lights, and noise. Another person may prefer less
contact with crowds, less noise, and a slow-pacedroutine. People with different lifestyles perceive stimulidifferently.
Cigarette smoking causes atrophy of taste buds,decreasing sensory perception of taste. Chronic alcohol
abuse may lead to peripheral neuropathy, a functionaldisorder of the peripheral nervous system those resultsin sensory impairment.
Illness
Certain illnesses affect sensory perception. Diabetes
and hypertension cause changes in blood vessels andnerves, leading to visual deficits and decreasedsensation of touch in the extremities. Cerebrovasculardisorders impair blood flow to the brain, possiblyblocking sensory perception. Pain, fatigue, and stress
caused by illness also affect perception of stimuli.
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Medications
Some antibiotics, including streptomycin and gentamicin, candamage the auditory nerve, impairing hearing. Central nervoussystem (CNS) depressants, such as narcotic analgesics, decreaseawareness and impair perception of stimuli.
Variations in stimulation If a person experiences more sensory stimulation than he or she is
used to or can make sense of, distress and sensory overload mayoccur.
On the other hand, if a person experiences less than the usualstimulation, that person is below his or her optimum state of
arousal and may be at risk for sensory deprivation. Reactions to sensory overload or sensory deprivation are special
challenges that nurses frequently encounter in themselves andclients. Sensory overload and deprivation can lead to perceptual,cognitive, and decisional problems. When the RAS is overwhelmedwith input, a person may experience sensory overload and feel
confused, anxious, and unable to taken constructive action . Whenthe RAS fails to recognize a stimulus because it is below thethreshold level or lacks relevant meaning to the person, sensorydeprivation may occur, and the person experiences depression,restlessness, and hallucinations
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Sensory overload It occurs when a person is unable to process or manage
the intensity or quantity of incoming sensory stimuli. The
person feels out of control and overwhelmed by theexcessive input from the environment. Routine activity inthe health setting can contribute to sensory overload inclients.
These activ i t ies fal l into three main catego ries:
internal factors, information, and
environment .
Internal Facto rs;
such as thinking about surgery or the meaning of amedical diagnosis, can contribute to anxiety andcognitive overload so that the person cannot processadditional stimuli. Pain, medication, lack of sleep, worry,and brain injury also can contribute to a person's
vulnerability to sensory overload.
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Informat ion; It is Imparting information to a client may lead to sensory overload.
Some examples include teaching a client about a procedure,informing a client about a diagnosis, making requests of a client, orhelping the client solve a problem. Anxiety related to medical
diagnosis, prognosis, and treatment can contribute to sensoryoverload. Lights and frequent activity may cause sensory overload ina premature newborn in the neonatal intensive care unit.
Envi ronment ;
The environment of the healthcare agency provides a higher thanusual amount of sensory stimulation. A client newly admitted to thehospital, for example, may have to cope with adjusting to a newroommate, having the television on more than usual, bright lights,paging systems, meeting many staff members, having the bed moveup and down at someone else's bidding, waiting for someone toanswer the call light, uncontrolled pain, and having strangers touchand not respect private body areas. Clients in intensive care unitsoften exhibit symptoms of sensory overload because of the highdegree of light, noise, and activity around the clock.
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Sensory Deprivation
Although sensory deprivation can bethought of as the opposite of sensory
overload, they share many elements.
Sensory deprivation generally means a
lessening o r lackof meaningful
sensory stimuli, monotonous sensory
input, or an interference with the
processing of information.
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Sensory deprivat ion (under st imu lat ion)
It can be just as disruptive as sensory overload. Cognitiveand emotional deterioration can occur when stimuli are
reduced below a person's optimum level of stimulation.One common source of sensory deprivation is a suddendecrease in stimuli when a person moves from a fast- to aslow-paced environment.
Each person's tolerance of and reaction to a lessening or
lack of meaningful sensory stimuli differs, but clients withextreme cases experience a gross misperception ofevents and personality changes. Any time a clientexperiences an interference with or a diminution ofsensory input, that person may be at risk for sensorydeprivation.
In the hospital such occurrences fall in to two generalcategories: altered sensory reception
deprived environments;
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A ltered senso ry recept ion
Occurs in such conditions as spinal cord injury,
brain damage, changes in receptor organs,sleep deprivation, and chronic illness. Theperson does not receive adequate sensoryinput because of an interference with thenervous system's ability to receive and process
stimuli.
Deprived env ironments
It can have negative effects on a person's
sensor stasis. A person who is immobilized orisolated for any reason is deprived of the usualamount of stimulation and may showmanifestations of sensory deprivation
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Manifestations of Altered SensoryPerception Function
Anxiety Cognitive Dysfunction, which is a
Disturbance in remembering, reasoning, andproblem solving may occur with sensory
overload. Hallucination and Delusions (beliefs not
based in reality) reflect an unconscious need
or fear Sensory Deficit
Depression and withdrawal
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Impact on Activities of Daily Living Sensory perception dysfunction may have effects on activities of
daily living (ADLs). Visual deficits cause problems with self-careactivities as basic as dressing, toileting, and preparing meals.Hearing deficits may restrict people from watching television,listening to the radio, and answering the telephone. Safety hazardsalso exist for who are hearing impaired.
People with taste and smell deficits may lose interest in eating.
Those with sensory deficits involving touch are at risk for burns andinjuries to the extremities. Moving around outside the home may beimpossible without special aids or help .
Many jobs are prohibited for people with sensory deficits, and drivingmay not be allowed.
This further restricts the environments in which they may move aboutsafely, making them dependent on others. If the affected person isthe major wage earner, a reduction in or loss of income may occur.
People with cognitive dysfunction from sensory overload ordeprivation may exhibit poor judgment and problem solving duringeveryday activities, increasing the necessity for family members tomonitor activities and decisions.
All these concerns place more stress on the family to cope with sensory
dysfunctions.
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Risk Factors for Sensory Perception Dysfunction in theHealthcare Environment
Sensory Over load
Room close to nurse's station
ICU or intermediate unit Bright lights
Use of mechanical ventilator
Use of ECG monitor
Use of oxygen
Use of IVs Other equipment
Frequent treatments
Sensory Depr ivat ion
Private room
Eyes bandaged
Bed rest
Sensory aid not available (hearing aid, glasses)
Isolation precautions
Few visitors
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SENSORY DEFICITS:
Impaired or absent functioning in one or
more senses are termed as sensory
deficits
Eg: impaired sight and hearing, altered
taste, numbness and paralysis that results
in altered tactile perception, and impaired
kinaesthetic sense
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Impaired vision:
Vision occurs when light rays that focus onthe retina trigger a nerve impulse that is
transmitted to the visual area of brain in
the occipital region. Visual deficits mayresults from trauma or diseases of the eye,
microvascular problems, or CNS
disorders. Common causes of visual
deficits include refractive errors, orbitaltrauma, cataracts, glaucoma, diabetic or
hypertensive retinopathy, or loss of visual
field after stroke.
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Impaired hearing :
Hearing occurs when sound wavesentering the ear canal are converted to
vibrations and transferred from the middle
ear to the inner ear. Vibrations cause thehair cells in the cochlea to bend,
generating impulses that are carried by
cranial nerveVIII to the brain. The auditory
area in the brain is located in the temporallobes. The auditory area interprets the
sound and and allows you to determine
from which direction the noise is coming.
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IMPAIRED HEARING
Hearing deficits may result from injury or
diseases in the structures of the ear, the
nerves or the brain. Inability to hear
decreases the ability to communicate andhampers social interaction. It may interfere
with a persons ability to understand
instructions from health care professionalsand create a safety hazard due to inability
to hear warnings.
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IMPAIRED TASTE
taste imparts interest to food. Taste deficits may decrease
the pleasure associated with eating; weight loss andmalnutrition may result.
Taste depends on the functioning of the taste buds
on the tongue and, to a lesser extent, on the soft palate.
Four types of taste buds exist: sweet, sour, salt, and
bitter. The buds for sweet and salty tastes are primarilyon the tip of the tongue; for sour taste, on the lateral
sides of the tongue; and for bitter taste, primarily on the
posterior tongue and the soft palate. When stimulated,
taste buds generate nerve impulses that travel along thefacial and glossopharyngeal nerves (cranial nerves VII
and IX, respectively) to the taste area in the parietal-
temporal cortex.
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Impaired smell
The sense of smell is triggered when chemoreceptors in the upper nasal cavities detect
vaporized chemicals. Chemo receptors generate
impulses carried by the olfactory nerve (CN I) into the olfactory area in the temporal
lobes. Vaporized molecules can be detected
from a far distance, so the sense of smell can
serve as an early warning system for detection
of smoke and noxious chemicals.
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Causes : impaired smell
cranial nerve damage,
a tumor, or atherosclerosis.
Zinc deficiency, heavy smoking, cocaineuse,
rhinitis, and sinusitis can cause reversible
anosmia.
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Impaired tactile perception
The dermis of the skin contains receptors
for the cutaneous sensation of light touch,
pressure, heat, cold and pain. Information
from these receptors is transmitted to thesensory areas in parietal lobes. The
number of cutaneous receptors
determines the sensitivity of an area andthe amount of space devoted to the region
in the sensory cortex area.
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Impaired tactile perception
contd.. Loss of tactile sensitivity: causes:-
cerebrovascular accident, brain or spinal tumor or injury, or
peripheral nerve damage caused by
diabetes, GBS, or chronic alcoholism.
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Impaired kinaesthetic sense:
Kinaesthesia or muscle sense, is a
complex process involving propioceptors
that detect stretch in muscles to create a
mental picture of how the body ispositioned. Conscious muscle sense is
perceived in the parietal lobes.
Unconscious muscle sense occurs in thecerebellum, which co-ordinates
movement.
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Impaired kinaesthetic sense:
causes Parkinsons disease,
other neurologic disorders,
tumors, CVA, and
certain medication
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ASSESSMENT
SCATTER STIMULI OVER THE DISTALAND PROXIMAL PART OF ALL
EXTREMITIES AND TRUNK TO COVER
MOST OF THE DERMATOMES.
ABNORMAL SYMPTOMS MAY
INDICATE NEED TO TEST THE ENTIRE
BODY SURFACE.
PAIN
NUMBNESS
TINGLING
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Assessment contd.
COMPARE SENSATION ON
SYMMETRIC PARTS OF THE BODY
IF DECREASE IN SENSATION
SYSTEMATIC TESTING
FRON POINT OF DECREASED
SENSATION TOWARD SENSITIVE
AREA
NOTE WHERE SENSATION CHANGES
MAP BORDERS OF DEFICIENT AREA
Assessment contd
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Assessment contd..
NOTE, IF THE PATTERN OF SENSORY
LOSS IS DISTAL
GLOVE AND STOCKING (HANDS &
FEET)
DERMATONES
C3-FRONT OF NECK
T10-UMBILICUS C6-THUMB
L1-INGUINAL
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Diagnostic Statement:
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Diagnostic Statement: Senso ry/Perceptual A lterat ions
Defin i t ion;Sensory/perceptual alteration is a
state in which a person experiences a change in the amount orpatterning of oncoming stimuli, accompanied by a diminished,exaggerated, distorted, or impaired response to such stimuli(NANDA, 1999) .
Nurse-Client Interaction It promotes sensory health function. Clients at risk for sensory
deprivation may need frequent interaction initiated by the nurse. In
any case, provide appropriate: stimuli, such as addressing The Clientby name, explaining all activities, and, when leaving, acknowledgingclient that the nurse will return. Length, tendency, and content ofinteractions should he based on individual needs. Talking to theclient, showing the client equipment or articles used in care,encouraging
the client to smell and taste food that is served, and touching theclient are appropriate stimuli during interactions
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Nursing Interactions for Altered
Sensor- Perception function Stimulation
Providing meaningful external stimuli can helpa client overcome sensor' deprivation or
sensory deficit as; playing the television or the
radio occasionally. playing tennice,
Encouraging use of a clock and calendar,
Encouraging the client to dress or the day's
activities, putting till pictures,
Encouraging visitors, opening the drapes, andturning on lights.
Plan: the bed or chair so the client can see or
hear activities in the area.