Adaptation Adjustment of living with other living things and environmental conditions. Arousal Condition in which the cortical area of the brain receives and responds appropriately to stimuli. Auditory Pertaining to hearing. Disturbed Sensory Perception A state in which the individual or group experiences or is at risk for a change in the amount, pattern, or interpretation of incoming stimuli. These alterations may be further specified as visual, auditory, gustatory, olfactory, tactile, or kinesthetic. Sensory deprivation, sensory overload, and uncompensated sensory loss may also be used to further specify and in some cases it may be the etiology. Gustatory Pertaining to taste. Kinesthesia Awareness of positioning of body parts and body movement. Olfactory Pertaining to smell. Proprioception Description of the sense, usually at a subconscious level, of the movement and positions of the body and especially it’s limbs, independent of vision. Reticular Activating System (RAS) Network of neurons in the core of the brainstem, with ascending and descending tracts to other areas of the brain that monitor and regulate incoming sensory stimuli and level of arousal. Sensoristasis Arousal state of the reticular activating system; general drive state. Sensory Deficit Impaired or absent functioning of one or more senses. Sensory Deprivation Condition resulting from decreased sensory input or input that is monotonous, unpatterned, or meaningless. Insufficient quantity or quality of stimuli. Sensory Overload Condition resulting from excessive sensory input (excessive stimuli) to which the brain is unable to meaningfully respond. An individual feels little control. Sensory/Perceptual Alteration Disturbance in the body’s ability to receive or process data from its internal or external environment. Sensory Reception The process of receiving data about the internal or external environment through the senses. Stereognosis The sense that perceives the solidity of objects, their size, shape, and texture. Stimulus Agent, act, or other influence capable of initiating a response by the nervous system. Tactile Pertaining to touch. Visceral Pertaining to inner organs. What are the senses by which individuals maintain contact with the external environment? Vision (Visual), Hearing (Auditory), Smell (Olfactory), Taste (Gustatory), and Touch (Tactile). For a person to receive the necessary data to experience the world, what four conditions must be met? A stimulus must be present, a receptor or sense organ must receive the stimulus and convert it to a nerve impulse, the nerve impulse must be conducted along a nervous pathway from the receptor or sense organ to the brain, a particular area in the brain must receive and translate the impulse into a sensation. Where does the Reticular Activating System extend from? The hypothalamus to the medulla. Delirium Acute, conditional, fast onset, duration Dementia Chronically progressive, slow onset, continuous duration. Difficulties with spatial orientation, memory, language, changes in personality are signs. Confusion Reduced awareness, easily distracted, easily started by sensory stimuli, alternates between drowsiness and excitability; resembles minor for of delirium state. Normal Consciousness Aware of self and external environment, well oriented, responsive. Somnolence Extreme drowsiness, but will respond normally to stimuli. Minimally Conscious States Part consciousness; sleep-wake cycles present; some motor function, including automatic movements; inconsistently follow commands. Locked-In Syndrome Full consciousness; sleep-wake cycles present; quadriplegic, auditory and visual function preserved; emotion preserved. Asleep Can be aroused by normal stimuli (light touch, sound, etc.) Stupor Can be around by extreme and/or repeated stimuli. Coma Cannot be aroused and does not respond to stimuli. Vegetative State Cannot be aroused. Sleep-wake cycles, postures or withdraws to noxious stimuli, occasional non-purposeful movement, random smiling or grimacing. What are the defining characteristics for Sensory Deprivation? Physical behaviors such as drowsiness, excessive yawning. Escape behaviors such as eating, exercising, sleeping, running away to escape the deprived environment. Changes in perception such as unusual body sensations, preoccupation with somatic complaints (dry mouth, palpitations, difficulty breathing, nausea); change in body image; illusions and hallucinations. Change in cognitive behavior such as in attention span, inability to concentrate, decreased problem solving and task performance. Change in affective behavior such as crying, increased irritability and annoyance over small matters, confusion, panic and depression. What are contributing factors for Sensory Deprivation? Institutionalized environment, separation from significant others and usual sources of stimuli, treatments that decrease access to stimuli, such as bed rest or isolation. Impaired vision, hearing taste, smell, touch resulting from treatments such as bandages or body casts that interfere with reception of stimuli, or as a result of depression and other affective disorders. Spinal cord injuries, brain damage, confusion, dementia, medications that depress the central nervous system. What patients are at risk for Sensory Deprivation? Institutionalized patients, especially those in long-term care settings. Patients with communicable diseases (e.g., AIDS), Patients confined to a bed, patients with sensory alterations (e.g., impaired vision, hearing, or patients with eye patches or body casts), patients who are depressed, patients from a different culture, patients with a disturbance of the nervous system. What are Nursing Interventions for Sensory Deprivation? Maintain sufficient level of arousal by increasing sensory stimuli from all sensory modalities – Instruct the patient in self-stimulation methods: counting, singing, reading, reciting poetry, Structure meaningful tangible stimuli into patients external environment; include a variety of people, ideas, sensations, a pet may provide excellent stimulation. Visual stimuli, auditory stimulation, gustatory and olfactory stimulation, tactile stimulation, cognitive input, emotional input, culturally assistant, supportive and facilitative acts into nursing care. What are examples of Visual Stimuli? Colorful sheets, pajamas, robes. Colorful uniform tops for the nurse, face-to-face human contact, clocks, calendars, wristwatches, pictures, flowers, greeting cards. What are examples of Auditory Stimuli? Call person by name, conversation that communicates caring as well as orients patient, reading to the patient, television, radio, Ipod. What are examples of Gustatory and Olfactory Stimuli? Attention to oral hygiene and properly fitting dentures, food or different textures, colors, temperatures served attractively, smelling food before eating it and recalling pleasurable aromas from the past, seasoning foods or having favorite foods brought from home. What are examples of Tactile Stimuli? Back rubs or foot soaks, turning or repositioning, passive-range of motion exercises, hair brushing, combing, washing, hugs, touching of arms or shoulders. What are examples of Cognitive Input? Orient patient to environment, encourage patient to participate in self care, discuss current events or patients occupation, hobbies or interests, reinforce reality without arguing with a patient who is hallucinating. “No, I don’t see a man standing there but the linen hamper may be confusing you.” What are examples of Emotional Input? Encourage patient to share fears, concerns and perceptions; reassure patient that illusions and misconceptions do occur with sensory deprivation. What are the defining characteristics of Sensory Overload? Similar to those observed in sensory deprivation. Elderly patients and patients who have suffered a stroke are more likely to experience a confusion or agitation. Young patients are more likely to seek the comfort of their parents’ embrace to block it out. What are contributing factors in Sensory Overload? Increase internal stimuli such as pain, pressure and discomfort (e.g., intravenous lines, catheters, endotracheal tubes, nasogastric tubes), worry about state of health or need to make treatment decisions. Increased external stimuli such as unfamiliar health-care environment, such as lights, noises, sounds, odors, movement and constant presence of strangers, many of whom touch the body; intrusive procedures such as diagnostic tests and treatments; scratchy linens. Inability perceptually to disregard or selectively ignore some stimuli: nervous system disturbances, medications such as caffeine that stimulate the CNS arousal mechanisms. What patients are at risk for Sensory Overload? Acutely or chronically ill patients, patients in pain, patients with intrusive monitoring or treatment equipment, hospitalized patients, especially those in critical care settings, patients with disturbances of the nervous system. What are Nursing Interventions of Sensory Overload? Provide a consistent, predictable pattern of stimulation to help the patient develop a sense of control over the environment, offer simple explanations before procedures, tests, and examinations. Establish a schedule with the patient for routine care such as eating, bathing, turning positioning, coughing and exercising. Speak calmly with the patient and move slowly; communicate confidence. Explore with the patient what stimuli are most distressing and develop a plan to reduce or eliminate these (e.g., incoming phone calls, visitors); earplugs or pain medications may be indicated. Noise-reducing headphones maybe helpful. Identify and, wherever possible, eliminate culturally inappropriate stimuli. What are factors affecting sensory stimulation? Developmental considerations, culture, personality and lifestyle, stress and illness, and medications. What does the Nursing Process for Sensory Stimulation on Assessing involve? Identifying the at-risk patients, assessment of the sensory experience, stimulation, reception, transmission-perception-reaction, defining characteristics of sensory deprivation and overload, physical assessment, and assessment of the ability to perform self-care. Acute Confusion The abrupt onset of a cluster of global, transient changes and disturbances in attention, cognition, psycho-motor activity level of consciousness, or sleep wake cycle. Chronic Confusion An irreversible, long-standing, or progressive deterioration of intellect and personality characterized by decreased ability to interpret environmental stimuli or decreased capacity for intellectual thought processes and manifested by disturbances of memory, orientation, and behavior. Impaired Memory The state in which an individual experiences the inability to remember or recall bits of information or behavior skills. Impaired memory may be attributed or pathophsyiologic or situation causes that are either temporary or permanent. What are common etiologies for disturbed sensory perception? Altered environment stimuli: excessive or insufficient. Altered sensory reception, transmission or integration. Chemical alterations: endogenous (e.g., electrolytes) or exogenous (e.g., drugs). Psychological stress. What does Diagnosing with Sensory Stimulation involve? Disturbed sensory perception as the problem, disturbed sensory perception as the etiology. What does Implementing with Sensory Stimulation Involve? Preventing disturbed sensory perception and stimulating the senses, teaching about sensory experiences, promoting health literacy, meeting the patients needs of patients with reduced vision, meeting the needs of patients with reduced hearing, communicating with a patient who is confused, communicating with a patient who is unconscious.