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Sensory/Perceptual Alterations

by Diana Shenefield, PhD
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    00:01 Welcome, this lecture is on sensory/perceptual alterations and it is part of the Psychosocial Integrity part of the NCLEX exam.

    00:10 My name is Diana Shenefield. Let's get started.

    00:14 So what is this topic include? We are gonna look at providing direct patient care that promotes and supports a patient's needs based upon visual auditory, and cognitive distortions.

    00:27 You know we talk about vision and hearing those are pretty easy. You are thinking about can't see, can't hear. So what can I do as a nurse? Or when you starting taking in cognitively and cognitive distortion. What all is that include and are we think about that with our patients? Our learning outcomes is we wanna address our patient's need based on visual, auditory and cognitive disorders.

    00:50 So again our patients that can't see. Are we making sure that their environment safe? If they can't hear.

    00:55 Are we making sure that we are communicating to them? And then they understand what we are saying. Or we are providing them with resources for hearing aid and those kinds of things.

    01:04 And then as far as cognitive distortions, we gonna talk about sensory deprivation, sensory over-stimulation and "What that does to our patients?".

    01:13 They keeps them from understanding our communication and may altered their care or causes serious injury.

    01:20 We are also gonna talk about providing care.

    01:22 To make sure that our patient's sensory needs are provided for.

    01:26 So our practice question for this section is called: The home care nurse is visiting a patient who is in a body cast.

    01:34 So they got in to go home, they are in body cast and they are in their own home.

    01:38 The nurse is performing an assessment and is assessing the psychosocial adjustment of the patient to the cast.

    01:46 The nurse would most appropriately assess: So think about your patient that is in the body cast. They are in their own home.

    01:52 The nurse is going in and trying to figure out if the patient is psychosocially adapting to the cast.

    01:59 So A. The type of transportation available for follow-up care.

    02:03 Or B. The ability to perform activities of daily living.

    02:07 Or C. The need for sensory stimulation.

    02:10 D. The amount of home care support available.

    02:13 Now you may look at four of those answers and say "Well she should be assessing all of those things." And they would be.

    02:20 But we are talking about psychosocial adjustment and so which one of those fits that category.

    02:25 And that would be C. The need for sensory stimulation.

    02:29 You have got your patient that is sitting in a body cast and they are at their home.

    02:33 They are probably not getting out going to the store and doing those kinds of things.

    02:37 So we need to worry about on their sensory deprivation and what that to do into their self-esteem.

    02:43 But also their desire and the motivations to keep going.

    02:47 So "What are things that we are gonna look at?".

    02:49 How does sensory alterations affect our patients? What should we would be watching for? What should we would be assessing? What kind of signs and symptoms are my patient going to show me that I need to pickup on.

    03:03 What are some factors that change sensory perception? Is it something that's gonna be short term? Or is it something that the patients gonna have to learn to live with? And then "How do I identify my patients at risk?".

    03:15 "What kinds of things am I looking for?" Things like diabetes who might have a written apathy because of diabetes. So watching how their vision is and asking them.

    03:27 Or is it your patient in in the ICU who is ben sedated and then wakes up? And there is alarms going on and they are in the small room.

    03:36 So what patients is this going to be more problems for and how I am gonna keep them safe and keep them oriented.

    03:44 So who is at risk? Let's kind of look at the patients that you take care of or you will take care of that might be at risk. But also patients that might show up on the NCLEX exam that you need to understand and recognize that they are at rest.

    03:58 You have patients that are confined in non-stimulating environments.

    04:02 Now to think about, "What is a non-stimulating environment?" Think about may be your patient that's in the mental health facility.

    04:09 Or your patient that is stuck at home and can't get out. May be they are in a wheel chair and they are stuck in their living room. Until somebody can come and move them.

    04:20 So be thinking about those patients and are they getting the stimulation that they need.

    04:24 What about patients with impaired vision or hearing? Just not being able to see totally cuts off a lot of your environment and makes it so that you can't may be experience new things.

    04:36 And do that kind of [inaudible: 04:37.520] or [inaudible 0:04:38.280]. It also makes us think more about our ailments our pain. And we don't feel like we can get people to understand because we can't visually look at them. Or we can't hear them.

    04:50 So "How do we know if we are communicating?" What about your patients that have mobility restrictions? Again "Are they in traction?". "Are they in a body cast?" You know do they have a double broken leg? And may be this is only going to be for may be 6 weeks.

    05:05 But we still need to watch for sensory stimulation and watch how we were if patient is somebody coming in and visiting them.

    05:12 Or they living at home by themselves and only see a home healthcare nurse may be once a day for an hour. And then you have your patients with limited social contact.

    05:21 Again some of our patients, may be they are homeless.

    05:24 May be they live somewhere where they don't know anybody. May be their family has all passed away and they are all by themselves. So they withdrawal socially they don't have any reason to go out and be social.

    05:35 That can cause a lot of sensory problems as well.

    05:38 Also our patients experiencing pain. If your patients in pain pain is what they are concentrate on and so everything else gets distorted.

    05:48 Sometimes if the patient is really bad. It can also distort cognitively.

    05:52 So if I am going in and I am trying to teach my patient or talk to my patient and they are in so much pain. That they can't hear me or can't see me because of so concentrated on the pain. I am going to miss out on an opportunity for assessment and my teaching is not going to be well received.

    06:09 What about my patient that is acutely ill? You have your patient that comes in to the ER. May be they are having a heart attack.

    06:15 Their mind is focused on what's happening with their body and the whole rest of the world can go on.

    06:20 So again is that the prime time to teach or may be ask real sensitive questions and we need to watch that.

    06:28 And we need to be congestive of our patient. And are they in sensory over-load to where nothing is making any sense? And then our ICU patients.

    06:36 We know our ICU patients because of medications that they are on.

    06:39 Whether [inaudible 0:06:39.880] them or whether its pain medications? That are combined to their ICU room.

    06:45 They got one nurse. There is alarms going off. But their whole world is now in that room.

    06:51 They loose track of day and night. They loose track of what day it is.

    06:56 The lights are always on. Its never dark.

    06:59 So again be watching those patients as well.

    07:01 And then you have your patients that already have a decrease cognitive ability.

    07:06 Whether they were born that way? Or whether they have had a head injury or trauma? So be watching those patients. So be thinking to yourself "Off all my patients who is at risk for sensory and perception difficulties?" So things to keep in mind.

    07:21 Organize your nursing care to kind of keep stimulation down.

    07:26 Now there will be questions on NCLEX that will talk about "Should you cluster your care?". "Should you do it over a time?" And again the only way you can answer that is to read the question and what's going on with the patient.

    07:38 Is it because the patient gets short of breath? Or is it because the patient is over stimulated in the ICU? So make sure you are thinking through about "Should I be letting my patient have a lots of rest?" Or does my patient need my stimulation? Orient the patient: We say over and over again.

    07:56 If you patient is it all disoriented then their sensory perception is totally changed.

    08:03 If you loose sight of "What day it is?" or "Where you are?" everything else seems to get jumbled up.

    08:09 And with that comes being able to take care of yourself.

    08:12 Being able to recognize signs and symptoms in yourself.

    08:15 So make sure that you are constantly orienting people. Asking them their name Making sure that they know the day of the week, and a year and those kind of things.

    08:23 So that we can keep them oriented.

    08:26 Provide nonthreatening and nonjudgmental manner in the way that you are. You know some may comes in your life, "You are acting so weird".

    08:33 All of the sudden that person is gonna shut down.

    08:36 Or if you are yelling at a person who can't hear.

    08:39 You know that may be offensive to them.

    08:41 So again be thinking about "How you are perceived by your patient and is that they way you want to come off to them?".

    08:49 Because we wanna make sure that they feel comfortable and after they can talk to us. But that we understand what they are going for.

    08:55 And then provide reality based diversions.

    08:58 One another thing is that can we do in the hospital is TV.

    09:01 And a lot of times people will have favorite TV shows and if we can ask them that and they are only on its certain times. That can help get people back to reality by saying "You know your favorite show is getting ready to come on it. It's Tuesday night." Those kinds of things and hoping they keep them oriented.

    09:17 If they have their vision and there is not a the problem with them reading.

    09:21 You know, make sure they have the glasses so may be they can read the newspaper and then encourage visitors. Encourage people to come in and talk to them to keep them simulated and keep them oriented to what's going on.

    09:35 Sensory Disturbance: We are gonna talk about deprivation, deficit and overload.

    09:40 And in some patients can fit in all three categories during their time in the hospital. Some go in and out.

    09:47 But as nurses we need to realize that this happens.

    09:51 We need to watch for it. We need to do assessments and then we need to intervene when it's going to cause a safety problem with our patient.

    10:00 So sensory deprivation: What we are gonna assess for? Somebody that's deprived sensory deprived they are gonna act bored. Now every patient in the hospital usually acts bored.

    10:11 They are stuck in the hospital. But this kinda goes on to bored to where they don't even want to talk.

    10:17 They don't wanna do may by crossword puzzles. They just wanna watch TV. They just wanna sit in the room.

    10:22 Or you catch them daydreaming. They are not paying any attention to what's going on.

    10:27 Or they sleep a lot. And a lot of times we say "Well, that's good that helps them heal." But we know there is a fine line between sleeping too much to avoid the world and sleeping to heal. And so you need to keep your eye on your patient and watch for that.

    10:42 Then there is thought slowness.

    10:45 You know if you go and talk to somebody and they really seem to have trouble getting their mind around what you are talking about.

    10:52 Again is that a sign of sensory deprivation? Or are they an older person that just takes longer? You have to know your patient and you have to do a good assessment to be able to tell.

    11:03 And then hallucinations, patients that have hallucinations. Hallucinations may cause by a lot of things. May be narcotics that we are giving them.

    11:10 May be they have been on illegal drugs and now they are withdrawn.

    11:14 So again being able to delve into what's causing them and not just assuming one thing or another.

    11:19 But just know the hallucinations is a sign of sensory deprivation until be a cognitive of that.

    11:26 So that you can assess for that. And that's all we are gonna do. We have got our patient.

    11:31 What can we do? We only have so many limited resources in the hospital.

    11:34 We can't bring in the circus and every time we have what we have.

    11:38 But there are thing we can do like increase interaction with the staff.

    11:43 You know may be you have a housekeeper that likes to talk You might wanna point out to them that there is a patient that really need somebody to talk to them. May be dietary could stay a well. May be caseworkers.

    11:54 So again make sure that you are using your staff If there is a chaplain, can they come up and talk just so the person stays engage.

    12:02 Again the TV, some people like TV. Some people don't.

    12:06 But may be is their favorite show. A lot of hospitals now have video where they can watch movies.

    12:13 You know, "Is movies available in the hospital?" Or could they bring something from home? Something that they enjoy to keep them stimulated.

    12:19 Providing touch: Again so many of our patients just need the touch of a human hand. And so remembering that with our back rubs and as we are giving assessment, you know touching their hand.

    12:30 So that they feel the human presence.

    12:32 And then choose foods with varied smells, colors and textures.

    12:37 People relate and are stimulated by foods and smells.

    12:42 And so you know, is there something that they really like to eat. That might be, like I chips or white cookie or something that's crunchy.

    12:51 You would be amazed that the difference of that makes in somebody that's been sensory deprive to just feel that in their mouth.

    12:58 One of the places that we get into a problem with that is your patient that has to have a purity diet.

    13:03 And you will notice a lot times that they have some sort of sensory deprivation because all the food feels exactly the same in their mouth.

    13:11 And so "Is there something you can do to help stimulate their sensors?".

    13:15 And then use light smells. Now we know you can't just spray and perfume around in the hospital.

    13:20 But you can use short smells may be a little oil on your hand or something just to give them something to smell, something different.

    13:29 Something that can stimulate their sensories, perception. Make them smell something different than what they have been smelling all day along. So these are just all ideas. Again wherever you are working in your facility you know ask other nurses, ask other healthcare providers "What can you do? What's available to you?" To keep this person engage to with their environment.

    13:53 Now the other ways, Sensory Overload. A lot of times we find our patients in ICU with patient overload. It's a problem with patients in the NICU. Babies that are so sensitive to sound and sight get very overstimulated.

    14:08 So "What we are assessing for?". Well restlessness if they can't seem to sleep or when they are sleeping they are constantly moving and they can't get into a deep sleep.

    14:18 They become very agitated; because, they just can't take it anymore.

    14:22 Have you ever been anywhere, where those lots of loud noises and people talking to you and then you get to a point where you are just like "I just wanna quite"? Well that's what these patients has as well.

    14:31 All their sensors are overstimulated and they are struck on one spot. They can't escape and so their body reacts in different ways.

    14:39 They become confuse. Their mind get's all jumbled. They become restless.

    14:43 They can become agitated.

    14:45 Sometimes people will then go to sleep to try to avoid the sounds.

    14:50 So you can have deprivation and over-stimulation when your patient is sleeping.

    14:55 As kind of a "I can't take it anymore" so they go to sleep. So watch those patients too.

    15:00 Or thought disorganization. You walk in and the patient is talking about something totally off the wall. Is their mind getting scrambled because of all the noises and sounds? And then again hallucinations.

    15:11 It can show up at any point in time.

    15:13 So "What do I do?". I am in the iCU the monitors have to be there You know the phones have to be ringing. How can I keep my patient from getting sensory overloaded? Well things like restricting visitors.

    15:27 We just talked about "How if somebody needs stimulation?" Bring people in.

    15:31 People in ICUs a lot of time you got physicians making rounds.

    15:35 You have got caseworkers coming in, raspatory, and it's just too many people talking too many noises. So cutting out the people that really don't need to be there.

    15:46 May be allowing only one or two family members.

    15:49 And not have them talking at the patient all the time.

    15:53 It's kind of more of a common sense thing. If you are struck in bed and all these noises what can be eliminated.

    16:00 What about following routines? So that the patient feels like "Okay, they are doing this to me is this time a day?" And trying to keep your care on a regular basis.

    16:10 Raspatory may be comes in every two hours.

    16:14 Keep them on their schedules as much as possible.

    16:16 If one family member comes during a day and another family member comes at night, try to keep that consistent so the patient get used to a routine.

    16:26 And then organizing your care so that they have long periods of rest.

    16:30 And may be the monitors don't have to be turned up for blast in the room. May be only out of the nurses station.

    16:37 May be while you are in there you are talking a little bit softer.

    16:40 So again being cognisant of the noises and things that are going on.

    16:44 But then knowing how to change that and knowing what it is doing to your patient.

    16:49 If I go in and my patient is all over stimulated their heart rate is gonna be up.

    16:52 Their blood pressure is gonna be up. I don't wanna just jump to giving all kinds of medication. If it's over stimulation and I haven't caught on to that.

    17:01 And then sensory deficit. What to watch for if they can't distinguish between sounds? Now most of the times when we have sensory deficit like cognitive hearing or sight. It's something that happens gradually over time.

    17:13 But sometimes if there is a trauma or something like that it could be an immediate thing and so we need to watch. Can they hear? Can they not hear? Why all of the sudden the change? And then are they able to differentiate between different sensations.

    17:26 We know patients that have had strokes sometimes have a problem where they can't tell between touch or something that's hard or something that's cold.

    17:34 So we need to assess for that because we can have some serious injuries.

    17:38 So what we are gonna do? We have to report our observations.

    17:41 If somebody says, "I can't hear you, I could hear you before", We need to make sure we are passing that on. We need to have a consult.

    17:48 If their vision seems to be changing or they say, "All of the sudden I am seeing double".

    17:52 Or "I see fuzziness in front. Or "all of the sudden I can't see". That something that needs to be reported and documented and we need to reassess to figure out what's going on.

    18:01 And then again, do they need new glasses? Do they need a hearing aid? So many people because all hearing loss and vision loss sometimes happens gradually. They don't even or even aware how bad it's gotten. Because they haven't notice that they are hearing less.

    18:17 They just know people are yelling at them.

    18:19 So what resources as nurses can we provide them with case management and those kinds of things? So that they can have their hearing and their seeing.

    18:28 Or you know other is there a surgery or something.

    18:31 Because we know that if they can't hear or see or they have over stimulation. They are not gonna be able to care for themselves.

    18:38 So be watching in NCLEX for questions about self care.

    18:42 Questions about overload of sensory and what can you do as a nurse.

    18:46 What are the signs and symptoms and do you pickup on that? So that you can intervene or you jumping right to intervention.

    18:55 One thing you wanna remember too in the NCLEX is you need to follow the nursing process which means we always assess before we intervene. And so again if you don't know exactly what's going on with the patient, you can't intervene. You need to assess.

    19:10 So in closing, sensory prevention and perception adaption. You know if eyes and ears those aren't the hard things because we have resources for that.

    19:21 But remember to watch your sensory deprivation overload and deficit. Because it can happen right before our eyes. And again as nurses as healthcare we get very focus on what we need to do for the patient.

    19:34 But just remember a lot of the step that we do for the patient and on the patient is causing a height and sense of stimulation which can be making their progress worse.

    19:45 It can also cause a risk for injury.

    19:48 So you wanna make sure that you are being congestive of that.

    19:51 Sensory deprivation: Again it can happen to our patients. It can happen without us even noticing and what that can do is that, it can cause injury.

    20:01 If you have a patient that's been sensory stimulated and they forgive where they are and what they are going.

    20:07 They can get up and fall. So again a lot of this has to do with safety. It has to do with recognizing signs and symptoms i.e. high heart rate, high blood pressures.

    20:17 And is that the cause or is it a medical cause.

    20:20 So make sure that you are watching your patients. That you pick up on those assessments.

    20:24 Make sure that you are doing a good assessment before you intervene.

    20:28 So that you know exactly the cause of what's going on and don't let sensory deprivation and over stimulation sneak up on you.

    20:35 And watch those NCLEX questions and again remember assess before intervene and don't forget to reevaluate. Good Luck.


    About the Lecture

    The lecture Sensory/Perceptual Alterations by Diana Shenefield, PhD is from the course Psychosocial Integrity. It contains the following chapters:

    • Sensory and Perceptual Alterations
    • Sensory - Essential Guidelines
    • Sensory Deprivation
    • Sensory Overload
    • Sensory Deficit

    Included Quiz Questions

    1. Adherence to medication therapy is essential to reduce risk of vision loss.
    2. Fluid restriction is needed to reduce intraocular pressure.
    3. Disorder often has no symptoms.
    4. Disorder is typically diagnosed after an episode of eye infection.
    1. Report visual changes immediately.
    2. Report itching and redness.
    3. Resume all preoperative activities.
    4. Creamy white discharge is a sign of infection.
    1. Risk for injury
    2. Risk for disturbed sleep pattern
    3. Impaired sensory perception: Auditory
    4. Risk for ineffective coping

    Author of lecture Sensory/Perceptual Alterations

     Diana Shenefield, PhD

    Diana Shenefield, PhD


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