Sensory needs

1. SENSORY
NEEDS
Muzammil Ali

2. INTRODUCTION
 People are unique because they are able to
sense a variety of meaningful stimuli allow a
person to learn about the environment and
are necessary for healthy functioning and
normal development.

3. CONTD...
 Stimulation comes from
in and outside the body
particularly through the
senses of sight
(visual),hearing(auditory)
,touch(tactile),smell(olfac
tory),taste(gustatory) and
kinaesthetic (position
and movement).

4. CONTD...
 When sensory function is altered ,the
person’s ability to relate to and function
within the environment changes drastically.
 As a nurse you must understand and help
to meet the needs of patients with sensory
alteration.

5. NORMAL PERCEPTION
 Sensation; The conscious and unconscious
awareness of external and internal stimuli.
 Perception: The conscious awareness
and the interpretation of meaning of
sensation.

6. CONTD...
 Normal sensory perception:
There are two components
 1.Sensory reception: It is the process of
receiving the data from the internal or
external environment through various stimuli
 2.Sensory perception: It is the conscious
process of selecting, organising and
interpreting the data from the senses into
meaningful information.

7. CONTD..
 For a person to receive data necessary to
experience the world, four conditions must
be present.
i. A stimulus -an agent, act or other capable
of initiation a response by the nervous
system-must be present.
ii. A receptor or sense organ receive the
stimulus and convert it to a nerve impulse.

8. CONTD...
iii. The nerve impulse be conducted along a
various pathways from the receptor or
sense organ to the brain
iv. A particular area in the brain receive and
translate the impulse into a sensation

9. RECEPTORS/SENSOR ORGANS
 Externally: vision
(visual),hearing
(auditory),touch(tactile),s
mell(olfactory),taste(gusta
tory)
 Internally: kinaesthetic –
refers to awareness of
positioning of body parts
and body movement,
visceral –pertains to inner
organs

11. NORMAL SENSORY PERCEPTION
Sensory perception depends on the
sensory receptors, reticular activating
system(RAS),and functioning
pathways to the brain. awareness of
the stimuli is influenced by RAS.
RAS consists of sensory axons that
project to cerebral cortex. helps
maintaining consciousness & is active
during awakening from sleep.

12. CONTD...
 Example ; we awaken to the sound of
clock, to a flash lighting, to a painful pinch
because of RAS activity that arouses that
cerebral cortex.

13. AROUSAL MECHANISM
 To receive stimuli and respond
appropriately, the brain must be alert or
aroused. the reticular activating system ,a
poorly defined network that extends from
the hypothalamus to the medulla, mediates
arousal.
 The optimal arousal state of the RAS is a
general drive state called sensoristasis.

14. CONTD...
 Nerve impulses from all the sensory tracts
reach the cerebral cortex and to be
perceived.
 With its many ascending and descending
connections to other areas of the brain, the
RAS serves to monitor and maintain
,enhance, or inhibit cortical arousal.

15. CONTD...
 Adaptation -A stimulus must be variable or
irregular to evoke a response. the body quickly
adapts to constant stimuli; thus the repeated
stimulus of continuing noise, such as city
traffic, or a noxious odour eventually goes
unnoticed. This phenomenon is termed as
adaptation.
 Impulses that are not acted on when received
may be used at a later date. The memory
process involves the storage of that material.

16. CONTD...
 For example, thought and memory are
used when a new sensory experience
occurs and the organism uses a response
based on previous knowledge and
experience.

17. CHARACTERISTICS OF NORMAL SENSORY
PERCEPTION;
 Normal measures of the quality and quantity
of special and somatic senses
 Normal vision –visual acuity – 20/20,tricolor
vision, full field vision
 Normal hearing-auditory acuity of sound at
an intensity of 0-25 db, frequency of 125-
8000 Hz per second

18. CONTD...
 Normal taste-ability to discriminate sweet,
sour, bitter, and salty
 Normal smell-ability to discriminate primary
odours.(pungent, musky,floral)
 Somatic senses-ability to discriminate
touch,pressure,vibration,position,temperatur
e,pain etc..

19. LIFESPAN CONSIDERATION
 Newborn and infant-required repeated
sensory stimulation of nervous system, to
mature and discrimination within the senses
to develop.
 Toddler and preschooler-children’s growth,
development and attachment are directly
linked with sensory stimulation. lack of
meaningful stimulation can lead to
developmental and motor delays.

20. CONTD...
 Child and adolescence-experience rapid
changes in their world, and learning occurs
at an accelerated pace.
 Adult and older adult-sensory perception
function is its peak. as people reach middle
age, they begin to notice certain changes in
their sensory system.

21. FOCUS ON OLDER ADULTS
 The senses of vision, hearing and touch all
decline with age.
 Moreover, many of the chronic illnesses
experienced by elderly people impair
sensory functioning.
 Common sensory problems includes vision
problems such as cataracts,
presbyopia,glaucoma and macular
degenerations.

22. CONTD...
 Hearing problems such as presbycusis
 Diminution of touch with diabetes and CVA
 Altered body sense or awareness
associated with restricted mobility and
arthritis, CVS changes and neurologic
disorders

23. FACTORS AFFECTING SENSORY STIMULATION
 Developmental considerations-Different
types of sensory stimulation is needed for
growth as sensory receptors and organs
and nervous system mature. sensory
functioning tends to decline progressively
throughout adulthood as the result of aging
or chronic illness.

24. CONTD...
 Culture -An individuals culture may dictate
the amount of sensory stimulation
considered normal.
 Age .gender and ethnic norms, norms of
subgroup within a culture all influence the
amount of sensory stimulation sought by an
individual and perceived as meaningful.

25. CONTD...
 Personality and lifestyles
 Different personality types demand different
levels of stimulation.
 One person may thrive on a steady stream
of fast paced changes and excitement
whereas another may feel best when daily
routines are rigidly structured and life sends
no challenges .

26. CONTD...
 Lifestyle choices can dramatically influence
the quantity and quality of stimuli received
by an individual.
 The nurse who elects to work in the
emergency room of a large city hospital is
exposed vastly different stimuli than the
nurse making home visits in a rural areas.

27. CONTD...
 Stress
 Increased sensory stimulation may be
sought during periods of low stress simply to
maintain cortical arousal.
 During high stress periods ,multiple
stressors may already overloading the
sensory system, and decreased sensory
stimulation is desired.

28. ILLNESS AND MEDICATION
 Illness can affect the reception of sensory
stimuli and their transition and perception.
medications that alert or depress the CNS
may interfere with the perception of sensory
stimuli.
 Certain medications may also contribute to
impaired sensory functioning by decreasing
reception (eg.captopril ,an antihypertensive
agent) can cause taste alteration.

29. SENSORY ALTERATIONS
 When a patient is admitted to a health
agency ,he or she is confronted with stimuli
that are different in quality and quantity to
the accustomed stimuli.
 For example. When a patient confined to
bed rest may receive many fewer stimuli,
whereas one undergoing multiple diagnostic
tests may receive greater than normal level
of sensory input.

30. CONTD...
 These and other typical experiences are
likely to result in the patient having sensory
alterations.
 Behavioural changes in hospitalized clients
have been reduced because more attention
is being paid to use of colour and sound
increased privacy and decreased social
interaction.

31. SENSORY ALTERATIONS
a) sensory overload
b) sensory deprivation
c) sleep deprivation,
d) cultural care deprivation.

32. SENSORY DEPRIVATION
Sensory deprivation
 It results when a person experiences
decreased sensory input or input that is
monotonous,unpaterrnned,or meaningless.
with decreased sensory input, the RAS is no
longer able to project a normal level of
activation to the brain, and the individual
may hallucinate simply to maintain an
optimal level of arousal.

33. FACTORS PLACING THE PATIENT AT HIGH RISK
FOR SENSORY DEPRIVATION
 1. An environment with decreased or
monotonous stimuli(institutionalized
patients, patients confined to a small living
area at home, patients on bed rest or
isolation, intensive care units and so on)
 2.Impaired ability to receive environmental
stimuli(patient with sensory alterations
,impaired vision or hearing, patients with
bandages or casts that interfere with vision,
hearing or tactile stimulation

34. CONTD...
 3.Inability to process environmental stimuli(
patients with spinal cord injuries or brain
damage, patients who are confused or
disoriented, patients taking prescribed or
recreational drugs that affect the CNS)

35. EFFECTS OF SENSORY DEPRIVATION
 Effects of sensory deprivation include
perceptual, cognitive, and emotional
disturbances.
 Perceptual responses
 Inaccurate perception of sights, sounds,
tastes,smell and body position, coordination and
equilibrium; mild to gross distortions ranging
from daydreams to hallucinations.

36. CONTD...
 Cognitive responses
 Inability to control the direction of thought
content; decreased attention span and
ability to concentrate; difficulty with memory
,problem solving, and task performance.

37. CONTD...
 Emotional responses
 Inappropriate emotional responses.
including apathy,anxiety,fear,anger,panic or
depression and rapid mood changes.

38. TYPES OF SENSORY DEPRIVATION
 Visual deprivation; the very fast change in
the ocular dominance of the cells. It occurs
due to the changes of the efficacy of
synapses from the closed eye. and also
depends on the speed of which the
deprivation effects.
 Auditory deprivation-refers to the lack of
adequate hearing stimulation. with auditory
deprivation, brain gradually losses some of
its information processing ability. Ability of
auditory system to process speech declines,
due to lack of stimulation.

39. CONTD...
 Tactile deprivation-deprivation in
coma/immobilisation, a long term care,
poorly responsive patient will be confined to
bed being turned every 2hrs,occasionally
being ambulated.
 Gustatory deprivation-prolonged
intubations, prolonged coma state,
prolonged ryle’s tube feeding, post oral
constructive surgery, oral carcinoma, poor
quality of meal served for long time.

40. RESEARCH INPUT
 Stein-Parbury,J..B et al.Patients
experiences of being in an intensive care
unit;A select literature review.American
Journal of Critical care.9(1),20-27
 The authors reviewed a total of 26 research
studies on patient’s experiences of being in
an intensive care unit.
 Positive experiences included a sense of
safety and security promoted especially by
the nurses.

41. CONTD...
 Negative experiences included impaired
cognitive functioning and discomforts, such
as problems with sleeping, pain,and anxiety.
 The review indicates that critical care staff
can take steps to develop better ways to
understand patient’s experiences.

42. CONCLUSION
 Alteration in sensory perception is a great
challenge to care in ICU setting and other
areas. The nurse should take remedial
measures in order to prevent psychological
and other complications in the patient
admitted in ICU and other areas.

43. ICU PSYCHOSIS
 It is a form of delirium, involves impaired
intellectual functioning which occurs in the
patient who are being treated in an ICU.
 Manifestations
 Individuals who are sensory deprived may
exhibit any of the following characteristics
 Inability to concentrate
 Poor memory,
 impaired problem solving,

44. CONTD...
 confusion
 Irritability
 Emotional labiality,
 Hallucinations(auditory or visual)
 depression,
 boredom and apathy,
 drowsiness
 paranoid or irrelevant talk
 agitation and violent behaviour

45. RESEARCH INPUT
 Elmstahl S, Wahlfried C, Jerntorp P.assessed the
Precipitating and predisposing factors of acute
confusional state among emergency department
patients’ and results shows that A precipitating factor
of ACS was found in 78% of the ACS cases, and the
average number of precipitating factors was 1.6.
Dementia (32%), metabolic disturbances (30%), and
cardiovascular diseases (16%) were the most frequent
precipitating factors among the ACS group.
 Source ;International journal of Psychogeriatrics.1995
Winter;7(4):519-26.

46. SENSORY OVERLOAD
 Sensory overload is an condition that results
when an individual experiences so much
sensory stimuli that the brain is unable to
respond meaningfully or ignore the stimuli.
 The person feels out of control and may
exhibit all the manifestations observed in
sensory deprivation.

47. CONTD...
 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 out
sensory overload.

48. SENSORY OVERLOAD
 Contributing factors
 Increased internal stimuli
 Increased external
 Inability perceptually to disregard or
selectively ignore some stimuli

49. CONTD...
 Patients at risk
 Acutely or chronically ill patients
 Patients in pain
 patients with intrusive monitoring or
treatment equipment,
 patients in CCU’s
 patients with disturbance of nervous system.

50. SENSORY DEFICITS
 Impaired or absent functioning in one or
more senses is termed as sensory deficit.
 Examples are impaired sight and hearing.
altered taste, numbness and paralysis
results in altered tactile perception and
impaired kinaesthetic senses.

51. RESEARCH INPUT
 Mold JW, Vesely SK, Keyl BA, Schenk
JB, Roberts M.et all assessed the
prevalence, predictors, and
consequences of peripheral sensory
neuropathy in older patients. and found
that Peripheral sensory deficits are
common in the elderly. In most cases, a
medical cause is not obvious. Their
consequences may not be as benign as
often supposed.
 Source; Journal of American Board Family
Practices. 2004 Sep-Oct;17(5):309-18.

52. SENSORY DEFICITS
 Impact on daily living
 Visual deficits-problem with self care
activities as basic as dressing, toileting and
preparing meals.
 Hearing deficits; restrict people from
watching tv, listening to radio, answering
telephone

53. CONTD...
 Taste &smell; may loss interest in eating
 Sensory deficits involving touch; at risks for
burns & injuries to the extremities
 Cognitive dysfunction; exhibit poor
judgement and problem solving during
everyday activities

54. NURSING PROCESS
 Assessment
 Explore the clients sensory perception
focusing on the clients environment and
cliets behaviour that indicates problem
 Family and friends may provide helpful data
about changes in clients behaviour that
iondicate problems in sensory perception.

55. ASSESSMENT
 Subjective data
 Normal pattern identification
 Risk identification
 elicit information about the clients age,
culture,language,activity level, medical
history and medications
 assess the degree of stimulation in the
environment

56. CONTD...
 older clients are more at risk for sensory
deficit
 clients with cultural and language barriers
may be at risk
 A history of illness, such as
diabetes,hypertension,stroke,or spinal cord
injury also increase the clients risk for
sensory deficits.
 Risk factors for sensory perception
dysfunction

57. CONTD...
 Sensory deprivation, room closed to nursing
station; ICU/intermediate unit; bright light;
use of mechanical ventilators; use of ECG
monitoring etc.
 Sensory deprivation-private room; eye
bandaged; bed rest, sensory aid not
available, isolation precautions, few visitors

58. ASSESSMENT
 Dysfunction identification
 Collect the data about any actual sensory
perception problems, determining if the
client has difficulty with vision, hearing,
smell, taste, and touch.
 If problems are identified, find out when the
problem was started, its severity, and what
the client had done about it.
.

59. CONTD...
 Also determine whether the client is
anxious, depressed, withdrawing from social
contact or having any difficulty
concentrating, makings or remembering

60. NURSING ASSESSMENT
 Objective data
 Assessment of sensory perceptual
status
 Vision -presence of visual problems
including decreased acuity, blurred vision,
double vision, rainbow or halos around
objects, photosensitivity, loss of peripheral
field problems
 Difficulty seeing near or far
 Family history of visual problems
 Use of contact lenses or eyeglasses

61. CONTD...
 Auditory -presence of hearing problems,
recent changes in hearing ability, ability to
distinguish sounds, presence of buzzing or
ringing noises, use of hearing aid
 Gustatory-changes in ability to taste,
difficulty in differentiating salty, sweet, sour
and bitter tastes, changes in appetite

62. CONTD...
 Olfactory-changes in ability to smell, ability
to distinguish normal smells
 Tactile -difficulty in feeling temperature
changes in extremities, impairment of pain
reception in extremities, presence of
unusual sensations in extremities

63. NURSING ASSESSMENT
Sense Techniques of assessment
Vision Use snellen chart to measure
visual acuity, test visual field
Hearing Whisper numbers in each ear,
while occluding the other;
ask the client to repeat.
Perform Weber, Rinne tuning
fork test. observe clients
conversation with others
Smell With eyes closed, have client
identify three odours

64. Taste With eyes closed, have client identify
three tastes
Somatic
sensation
Test light touch of extremities with whisp
of cotton; test sharp and dull sensation
using point and blunt end of a pin. test
two point discrimination using two
points held closed together. test hot and
cold sensation usingb test tube filled
with hot and cold water. Test vibration
sense using tuning fork over joints; test
position sense by moving clients fingers
or toes.

65. DIAGNOSTIC TESTS AND
PROCEDURES
 Electrolyte imbalances, alteration in blood
chemistry and levels of drugs that affect the
CNS can alter sensoristasis.
 Special visual and auditory acuity tests also
may be ordered.
 Neurologic tests such as nerve conduction
studies, CT scan, and cerebral angiography
may be performed.

66. NURSING DIAGNOSIS
 Activity intolerance r/t impaired balance and
coordination
 Anxiety r/t paranoia stemming from hearing
impairment, sensory deprivation
 Impaired verbal communication r/t difficulty
in receiving, transmitting and perceiving
sensory stimuli.
 Altered growth and development r/t non
stimulating environment

67. CONTD...
 High risk for injury r/t decreased or impaired
sensation
 Sleep pattern disturbance r/t sensory
deprivation
 Altered thought processes (illusions,
hallucinations) r/t sensory deprivation or
overload

68. NURSING INTERVENTIONS
 The nurse can assist patients to improve
sensory functioning by teaching patients
and significant others means to stimulate
the senses, teaching patients with intact and
impaired senses appropriate self
behaviours, interacting therapeutically with
impaired patient.

69. NURSING INTERVENTIONS
 Maintain sufficient level of arousal by
increasing sensory stimuli from all sensory
modalities.
 Instruct the client in self stimulation
methods; counting, singing, reading.
reciting poetry
 Structure meaningful tangible stimuli into
patient’s external environment; include a
variety of people, ideas, sensations, a pet
may provide excellent stimulation

70. SENSORY STIMULATION PROGRAMME
 Therapeutic programme using sensory
stimulation to help sensory impaired patient
to recover functional sensibility in the
damage area and learn adaptive
functioning
 Purposes
 To retrain their sensory pathways
 Adopt to the changed abilities and regain
function .

71. STIMULATION METHODS
 Visual stimulation
 Colourful sheets,
pyjamas, robes
 Colourful uniform
tops for the nurse
 Face to face human
contact
 Clocks, calendars,
wrist watches
 Pictures, flowers,
greeting cards

72. CONTD...
 Auditory stimulation
 Call parson by name
 Conversation that communicates caring as
well as orients patient
 Reading to the patient
 Television ,radio

73. CONTD...
 Gustatory and olfactory stimulation
 Attention to oral hygiene and properly fitting
dentures
 Foods of different textures, colours,
temperatures served attractively
 Smelling food before eating it and recalling
pleasurable aromas from the past

74. STIMULATION REDUCTION METHOD
 In case of sensory overload
 Limiting extraneous noise,lights,room
clutter,interuption,pain and stress reduces
stimulation
 Assist the client with the essential ADLs
 Additional task can be added as the client is
able to cope.
 Offer simple explanations before
procedures,tests,and examinations.
 Speak calmly and move
slowly;communicate confidence

75. CONTD...
 Explore with the patient what stimuli are
most distressing and develop a plan to
reduce or eliminate these(eg. incoming
calls, visitors);ear plugs or pain medication
may be indicated.
 Be careful not to cause sensory deprivation
 Identify and, wherever possible, eliminate
culturally inappropriate stimuli.

76. SENSORY AIDS
 Vision
 Eye glasses with proper prescription
 Adequate room lighting, drapes open
 Sunglasses or window shades to reduce
glare
 Literature with large prints
 Uncluttered environment. clock with large
number magnifying glass.

77. HEARING
 Hearing aids
 Speak slowly and distinctly in the client’s full
view
 Avoiding background noise.
 Headset for telephone communication
 Closed caption television

78. NURSING INTERVENTIONS
 safety
 Safety is always a special concern for
patients with sensory alterations
 Nurse are responsible for ensuring that the
patients environment is as free of danger as
possible and for assisting the patient to
develop new self-care behaviours to
compensate for sensory impairments.

79. COMMUNICATION METHODS
 Client with aphasia
1. Listen to the client and wait
the client to communicate
1. Use simple short questions, facial
gestures to give additional clues.
2. If the client has problem in speaking, ask
questions that require simple yes or no
answers or blinking of eyes.
3. Offer pictures or communication board to
the client so that the client can point.

80. CONTD...
 Unconscious patients
 Be careful of what is said in the presence of
patient’s presence because hearing is
believed to be the last sense lost in the
unconscious patient.
 Talk with person in a normal tone of voice
 Speak to the person before touching.
remember that touch can be an effective
means of communicating with unconscious
patient.
 Keep environmental noises at as low as
possible.

81. NURSING INTERVENTIONS
 Client with artificial airway
 Use pictures, objects or cards so that the
client can point
 Offer a pad and pencil or magic boards for
the client to write the message. do not
speak loudly or shout.
 Sensory deficits –use appropriate sensory
aids

82. ALTERNATIVE TREATMENTS
 Isolation tank -The
technique Restricted
Environmental Stimulation
Therapy(REST) or
Floatation REST .
 It is a lightless, soundproof
tank in which subjects float
in salty water at skin
temperature, first used by
John C.Lilly in 1954

83. CONTD...
 Acupressure –Based on the concepts of
acupoints and energy flow. Pressure is
applied on the acupoint.
 Acupuncture- needles are inserted into
specific points where the energy is flowing
there by correcting the level of providing
external energy.

84. CONTD...
 Reflexology –it re-establishes the
neurologic connection between brain and
motor system.
 Biofeedback-Relies on instrumentation to
measure physiological processes.
Feedback helps in controlling physiological
function and change voluntarily.

85. CONTD...
 Music therapy-The
structured use of music
and music activities
geared towards helping
individuals with
disabilities to attain
various physical,
cognitive, language and
communication oriented
goals.

86. CONTD...
 Yoga –It is based on the
posturing, breathing and
meditation.
 It helps in strengthening
the body and unifies
body and mind, helps in
distressing, improves
attention and
concentration, brings
self awareness.

87. REFERENCES
 Ruth F Craven,J Hirne “Fundamentals of Nursing”
lippincott, 3rd edition.Page no.1173-1187
 Taylor, Lillis, Lemone “Fundamentals of Nursing-art
and science of Nursing Care” lippincott, 4th
edition.Page no.1167-1187
 Barbara Kozier “Fundamentals of Nursing” Pearson
Education. 7th edition.Page no.1167-1187
 Kaplan, shaddok “ Concise Text Book of
Psychiatry”, page no: 409-425.
 www. ncbi.nlm. nih.gov