This document discusses sensory perception and alterations. It defines sensory reception as the process of receiving stimuli, and sensory perception as consciously organizing and translating stimuli into meaningful information. Common causes of sensory alterations include developmental stage, culture, stress, social interaction, environment, and lifestyle. The document outlines ways to prevent sensory deprivation and overload in patients, such as minimizing unnecessary stimuli, controlling pain, and encouraging social interaction. It also provides nursing diagnoses and interventions for managing sensory deficits.

1. Mrs. YashlyVarghese
Lecturer
Amala college of nursing

3. Introduction
Many patients have preexisting
alterations in sensory functions
Nurses meets needs of patients with
preexisting sensory alterations and
recognize most important risk

4. COMPONENTS OF SENSORY EXPERIENCE
Sensory reception
Sensory perception

5. Sensory reception
It is the process of receiving
stimuli or data.

6. STIMULI

7. EXTERNAL STIMULI
Vision (sight)
Auditory ( hearing )
Olfactory (smell )
Tactile (touch )
Gustatory (taste )

8. INTERNAL STIMULI
Kinesthetic
Visceral

9. INTERNAL STIMULI
Kinesthetic
Refers to awareness of the
position of body parts
Eg : a person walking aware
of leg movement

10. INTERNAL STIMULI
Stereogenesis
Ability to perceive and
understand an object
through touch by its size,
shape, and texture

11. INTERNAL STIMULI
Visceral
Refers to any large
organ with in the body
Eg: a full stomach

12. Sensory perception
It involves conscious
organization and translation
of the data or stimuli in to
meaningful information

13. SENSORY PROCESS
Stimulus
Receptor
Impulse conduction
Perception

14. SENSORY PROCESS
Stimulus
Agent or act that stimulates a nerve
receptor
Receptor
A nerve cell acts as receptor by
converting stimulus in to nerve impulse

15. SENSORY PROCESS
Impulse conduction
Impulse travels along nerve pathway
either to spinal cord or directly to brain
Perception
Awareness and interpretation of stimuli,
takes place in brain

16. Arousal mechanism
 To receive and interpret stimuli brain
must be alert referred as arousal
 RAS mediate arousal (2 components)
REA – reticular exciting area
RIA – reticular inhibitory area

17. SENSORISTASIS
The state in which a person is in
optimal arousal.

18. Awareness
Ability to perceive internal and
external stimuli and respond
appropriately through thought and
action.

19. States of awareness
State Description
Full consciousness Alert; oriented to time,
place, person; understand
written and verbal words
Disoriented Not oriented to time, place,
person
Confused Reduced awareness;
easily bewildered; poor
memory; misinterprets
stimuli; impaired judgment

20. States of awareness
State Description
Somnolent extreme drowsiness
but respond to
stimuli
semicomatose Can be aroused by
extreme or repeated
stimuli
Coma Will not respond to
verbal stimuli

22. 1. DEVELOPMENTAL STAGE / AGE
Infants – congenital anomalies
Adolescents – use of glasses
Adult – after 40
Elderly – age related changes,
proprioceptive changes, tactile
changes

23. 2. Culture
Perception of stimuli – hugging,
kissing
Language
Certain diseases – diabetic
retinopathy, macular degeneration ,

24. 3. Stress
 Increased stress – sensory
overload
 Decreased sensory perception
 Reluctant to unnecessary stimuli -
noise

25. 4. Social interaction
 Absence of visitors – isolation, lonliness,
anxiety, depression

26. 5. Environmental factors
 Occupation – factory workers , airport
job
 Chemical factory job – eye injury, skin
damage
 IT professional – carpal tunnel
syndrome
 Recreational activities – loud noise,
sports , hunting ,

27. 6. Life style and personality
 Influences quantity and quality of stimuli

28. SENSORY ALTERATIONS

30. SENSORY ALTERATIONS
Sensory deprivation
Sensory overload
Sensory deficits

31. Sensory deprivation
A decrease in or lack of meaningful
stimuli
Balance in reticular system is
disturbed.
Person becomes more acutely aware
of remaining stimuli

32. Clinical manifestations
 Excessive yawning
 Decreased attention span
 Difficulty in concentrating
 Decreased problem solving
 Impaired memory

33. Clinical manifestations
 Periodic disorientation
 Preoccupation with somatic
compliants
 Hallucinations, delusion
 Crying, depression
 Apathy
 Emotional liability

34. Clients at risk of sensory
deprivation
Clients who:
 are confined in a non stimulating or
monotonous environment in home or
hospital
 Have impaired vision or hearing
 Have mobility restrictions such as
quadriplegia, paraplegia, with bed rest traction

35. Clients at risk of sensory
deprivation
Clients who:
 are unable to process stimuli (brain
death)
 have emotional distress (depression)
 have limited social contact ( isolation)

36. PREVENTING SENSORY
DEPRIVATION
 Encourage the Client to use
eyeglasses and hearing aids.
 Address the client by name and
touch the client while speaking if this
is not culturally offensive.

37. PREVENTING SENSORY
DEPRIVATION
 Communicate frequently with the client
and maintain meaningful interactions
(e.g., discuss current events).
 Provide a telephone, radio and/or TV,
Clock, and calendar.
 Provide murals, pictures, sculptures,
and wall hangings.

38. PREVENTING SENSORY
DEPRIVATION
 Have family and friends bring freshly cut
flowers and plants.
 Consider having a resident pet such as
fish, a cat, or a bird or make arrangements
for pets to visit on a regular basis.
 Include different textured objects to feel
such as a sheepskin pillow, silk scarf, soft
blanket, or other inanimate object.

39. PREVENTING SENSORY
DEPRIVATION
 Increase tactile stimulation through
physical care measures such as back
massages, hair care, and foot soaks.
 Encourage social interaction through
activity groups or visits by family and
friends.
 Encourage the use of crossword puzzles

40. PREVENTING SENSORY
DEPRIVATION
 Encourage environment changes such as
a walk through a mall, or for an
immobilized Client, sitting near a window
or at a place on the nursing unit where the
client can watch local traffic.
 Encourage the use of self-stimulation
techniques such as singing, humming,
whistling, or reciting.

42. Sensory over load
Person is unable to process or
manage the amount or
intensity of sensory stimuli.

43. Sensory over load - factors
1. Increased quantity or quality of
internal stimuli eg ; pain
2. Increased quantity or quality of
external stimuli eg ; noise,
diagnostic studies

44. Clinical manifestations
 Fatigue, sleeplessness
 Irritability, anxiety, restlessness
 Disorientation
 Reduced problem solving, task
performance
 Increased muscle tension
 Scattered attention

45. Clients at risk of sensory
overload
Clients who
 have pain, or discomfort
 are acutely ill and have been admitted
to acute care facility
 are being closely monitored in ICU
 have decreased cognitive ability

46. Preventing sensory overload
 Minimize unnecessary light, noise,
and distraction. Provide dark glasses
and earplugs as needed.
 Control pain as indicated at the level
desired by the client, on a scale of 0
to 10.

47. Preventing sensory overload
 Introduce yourself by name, and
address the client by name.
 Provide orienting cues, such as
clocks, calendars, equipment, and
furniture in the room.
 Provide a private room.

48. Preventing sensory overload
 Limit visitors.
 Plan care to allow for uninterrupted
periods of rest or sleep. Schedule a
routine of care so the Client knows
when and what to expect (post the
schedule for the client wherever
possible).

49. Preventing sensory overload
 Speak In a low tone of voice and In an
unhurried manner.
 Provide new information gradually to
enable the client to process the meaning.
 When providing information, ask the client
to repeat it so that there are no
misunderstandings.

50. Preventing sensory overload
 Describe any tests and procedures to the
client beforehand.
 Reduce noxious odors.
 Empty a commode or bedpan immediately
after use, keep wounds clean and
covered, use a room deodorizer when
indicated, and provide good ventilation.

51. Preventing sensory overload
 Take time to discuss the client’s
problems and to correct
misinterpretations.
 Assist the client with stress-reducing
techniques.

52. Sensory deficit
A deficit in normal function of
sensory perception.
Impaired reception ,perception or
both of one or more of the senses

53. Sensory deficit
When sensory loss is gradual the
individual adapt behaviours to
compensate for loss.
Either adaptive or maladptive

54. Sensory deficit
Clients are at risk of sensory
overload and sensory
deprivation

55. Nursing management
History collection
Physical examination
Implementation
evaluation

56. History collection
Assess
 current sensory perception
 Usual functioning
 Potential problems
 Mental status
 Level of consciousness
 Orientation
 Memory
 Attention span

57. Physical examination
Assess
 Senses are impaired or not
 All senses
 Perception of heat, cold, touch, pain ,
in the limbs
 Communication methods

58. Physical examination
Assess
 Use of assistive devices
 Social support
 Environmental hazards
 Health promotion habits
 Ability to perform self care activities

59. Specific sensory tests
 Visual acuity – snellen chart, news
paper, visual fields
 Hearing acuity – observe client
conversation with others, whisper test,
rinne test, Weber test.
 Olfactory sense – identify specific
aromas

60. Specific sensory tests
 Gustatory sense – identify 3 taste
lemon, salt,sugar
 Tactile sense – light touch, sharp,
two point discrimination

61. Ability to perform self care
 Assess functional abilities
 Ability to perform feeding,
dressing, grooming, toileting
activities

62. Health promotion habits
 Assess daily routine
 Eye , ear care as a part of daily
hygiene
 Use of safety glasses (sports, job)
 Use of assistive devices
 Adherence to routine health screening

63. Environmental hazards
 Uneven cracked walkways,
 Extension and phone cords on
way
 Low lighting

64. Use of assistive devices
 Use of hearing aids, glasess
 Assess if patient think it is beneficial
 Patients method of cleaning aids
 Patients knowledge of what to do
when problem arises

65. Social support
 Determine if patient lives alone
 Assess patients social skills
 Level of satisfaction from friends
 Ability to solve problems with
others

66. Communication methods
 Trouble in speaking and
understanding
 Aphasia – inability to speak, interpret
and understand language
 Expressive aphasia- inability to name
common objects express ideas

67. Communication methods
 Receptive aphasia- inability to
understand written or spoken
language
 Global aphasia – inability to
understand language or communicate
orally

68. Other factors affecting
perception
Medication
Pain

69. NURSING DIAGNOSIS
Acute confusion
Chronic confusion
Impaired memory
Risk for cute confusion

70. Acute confusion
Abrupt onset of reversible
disturbance of consciousness,
attention, cognition, and
perception that develops over a
short period of time

71. Chronic confusion
Irreversible long standing, and
progressive deterioration of intellect and
personality characterized by decreased
ability to interpret environmental stimuli;
decreased capacity for intellectual
thought process and manifested by
disturbance of memory, orientation, and

72. Impaired memory
Inability to remember or recall bits
of information or behaviour skills

73. NURSING DIAGNOSIS
 Impaired home maintenance r/t sensory
perception disturbance ( declining
visual abilities)
 Impaired verbal communication r/t
sensory perception disturbance
( specify)
◦ Altered level of consciousness
◦ Hearing impairment
◦ Sensory overload
◦ Sensory deprivation

74. NURSING DIAGNOSIS
 Risk for impaired skin integrity r/t sensory
perception disturbance ( altered tactile
stimulation )
 Risk for injury r/t sensory perception
disturbance ( specify)
◦ Visual impairment
◦ Neurology or circulatory alterations
◦ Decreased sense of smell
◦ Hearing impairment

75. NURSING DIAGNOSIS
Social isolation
◦ Impaired vision
◦ Impaired hearing

76. OUTCOME IDENTIFICATION
 Prevent injury
 Maintain the function of existing senses
 Develop an effective communication
mechanism
 Prevent sensory overload and sensory
deprivation
 Reduce social isolation
 Perform activities of ADL independently and

77. PLANNING
 Cognitive stimulation
 Communication enhancement
 Nutrition management
 Environment management
 Fall prevention
 Body mechanics promotion
 Peripheral sensation management
 Emotional support

78. Implementation
 Promoting healthy sensory function
◦ Preventing sensory disturbances
 Managing acute sensory
impairments
 Adjusting environmental stimuli

79. Promoting healthy sensory
function
 Early screening and routine auditory testing for
 Infants should be screened for hearing loss by 1 month
of age, and preferably before hospital discharge.
 Children
 people who live or work in an environment where there
are high noise

80. Promoting healthy sensory
function
 Prenatal testing for syphilis and
confirmation of a positive rubella titer,

81. Promoting healthy sensory
function
 Periodic vision screening of all newborns
and children is recommended to detect
congenital blindness, strabismus, and
refractive errors.

82. Promoting healthy sensory
function
 Environmental stimuli that provide
appropriate sensory input.
 Various colors, sounds,
textures, smells,
body positions

83. Promoting healthy sensory
function
 Teach parents to stimulate infants and
children,
 Teach family members to stimulate an older
person and others in the home with sensory
deficits.
 Social activities often help stimulate the
mind and the senses.

85. Promoting healthy sensory
function
 Getting regular eye examinations and
controlling chronic diseases such as
diabetes

86. Promoting healthy sensory
function
 Have regular health examinations.
 Have regular eye examinations
 For clients ages 40 and over, a medical eye
examination is generally recommended every
3 to 5 years, or every 1 to 2 years if there is a
family history of glaucoma.

87. Promoting healthy sensory
function
 Seek early medical attention
(a) if signs suggesting visual impairment
(b) if the child complains of an earache or has
an ear infection
(c) for persistent eye redness, discharge or
increased tearing, growths on or near the eye,
pupil asymmetry or other irregularity, or any
pain or discomfort.

88. Promoting healthy sensory
function
 Obtain regular immunizations of Children
against diseases capable of causing
hearing loss (e.g., rubella, mumps, and
measles .

89. Promoting healthy sensory
function
 Avoid giving infants and
toddlers toys with long
pointed handles and
keep pointed
instruments (e. g.,
scissors and
screwdrivers) out of

90. Promoting healthy sensory
function
 Supervise preschoolers when they use
scissors.
 Make sure that toddlers do not walk or run
with a pointed object in hand

91. Promoting healthy sensory
function
 Teach preschoolers to walk carefully when
carrying such objects as sticks or toy
weapons.
 Teach school-age children and adolescents
the proper use of sports equipment (e.g.,

92. Promoting healthy sensory
function
 Wear protective eye goggles
 Wear dark glasses with UV protection

93. Promoting healthy sensory
function
Impaired Vision
Orient the client to the arrangement of room
furnishings and maintain an uncluttered
environment.

94. Promoting healthy sensory
function
Impaired Vision
 Keep pathways clear and do not rearrange
furniture without orienting the client.
 Ensure that housekeeping personnel are
informed about this.

95. Promoting healthy sensory
function
Impaired Vision
 Organize self-care articles within the
client’s reach and Orient client to his or her
location.
 Keep the call light within easy reach and
place the bed in the position.

96. Promoting healthy sensory
function
Impaired Vision
 Assist with ambulation by standing at the
client’s side about 1 foot ahead, and
allowing the person to grasp

97. Promoting healthy sensory
function
Impaired Hearing
 Clients with hearing impairments need to
be asses frequently.
 They can be taught to use their Visual
senses to identify kinks in the IV tubing or a
loose ECG lead, and so on.

98. Promoting healthy sensory
function
Impaired Hearing
 For home safety, Hashing lights to sounds
such as a doorbell, phone, smoke detector,
crying baby, or burglar alarm.

99. Promoting healthy sensory
function
|mpaired Olfactory Sense
 Taught about the dangers of cleaning and
working with chemicals.
 Strong chemicals such as ammonia used in
confined spaces such as a bathroom may
affect the client before they are smelled.

100. Promoting healthy sensory
function
Impaired Olfactory Sense
 Keep gas stoves and heaters in good
working order.
 Food poisoning is a concern

101. Promoting healthy sensory
function
Impaired Tactile Sense
 Not be aware of hot temperatures, which
can cause burns, or pressure on bony
prominences, which can produce
pressure ulcers.

102. Promoting healthy sensory
function
Impaired Tactile Sense
 Temperature adjusted on their hot water
heater and test water temperature with a
thermometer before bathing.
 Change their position frequently.

103. Managing Acute Sensory
Impairments
When assisting clients who have a sensory
impairment, a nurse needs to
(a) encourage the use of sensory aids to
support residual sensory function,
(b) promote the use of other senses,
(c) communicate effectively, and
(d) ensure client safety.

104. Encouraging the Use of Sensory
Aids
VISUAL AIDS
 Eyeglasses of the correct prescription,
clean and in good repair
 Adequate room lighting, including night-
Iights
 Sunglasses or shades on windows to
reduce glare
 Bright contrasting colors in the
environment
 Magnifying glass

105. Encouraging the Use of Sensory Aids
VISUAL AIDS
 Phone dialer with large numbers
 Clock and wristwatch with large numbers
 Color code or texture code on stoves,
washer, medicine containers, and so on
 Colored or raised rims on dishes
 Reading material with large print
 Braille or recorded books
 Service dog

106. Encouraging the Use of Sensory
Aids
HEARING AIDS
 Hearing aid in good order
 Lip reading
 Sign language
 Amplified telephones
 Telecommunication device for the deaf
(T DD)
 Amplified telephone ringers and
doorbells Flashing alarm Clocks
 Flashing smoke detectors

107. Promoting the Use of Other
Senses
A radio, audiotapes of music or books,
clocks that chime, music boxes, and wind
chimes provide auditory stimulation.
Diets that include a variety of flavors,
temperatures, and textures stimulate the
gustatory sense.

108. Promoting the Use of Other Senses
 Taking sips of water between
foods
 Fresh flowers, scented candles
(safely used),
 providing a hug, massage, hair
brushing, grooming,

109. Ensuring Client Safety
safety precautions in health care settings
keeping the bed in the lowest position
and placing the call light within reach.

110. Adjusting Environmental Stimuli
Prevent either sensory overload or
sensory deprivation.

111. Preventing Sensory Overload
 Reduce the number and type of
environmental stimuli.
 blocking unnecessary stimuli and by
helping the client organize and alter
responses to the stimuli that cannot be
blocked.

112. Preventing Sensory Overload
 Dark glasses
 window shade or drape can reduce visual
stimulation.
 Earplugs reduce auditory stimuli,
 The odor from a draining wound can be
minimized by keeping the dressing dry and
clean.

113. Preventing Sensory Overload
Other methods of blocking stimuli are
 to reduce novelty and surprise,
 to cluster care activities to provide rest
intervals free of interruptions.
 Sometimes the number of visitors and
the length of visits must be restricted.

114. Preventing Sensory Overload
Other methods of blocking stimuli are
 By explaining sounds in the environment,
 When clients understand their meaning,
stimuli may be less confusing and more
easily ignored.

115. Preventing Sensory Overload
Other methods of blocking stimuli are
 Clients can employ relaxation techniques to
reduce anxiety and stress despite continual
sensory stimulation .

116. Preventing Sensory Deprivation
 Newspapers, books, music, and television
can stimulate the Visual and auditory
senses.
 Providing objects that are pleasant to
touch such as a pet to stroke,

117. Preventing Sensory Deprivation
 Clocks can help orient a client to time.
 The olfactory sense can be stimulated by the
presence of fresh flowers or plants.

118. Communicating Effectively
Communication with clients who have
sensory impairments should
 convey respect,
 enhance the person’s self-esteem,
 ensure the exchange of correct
information.

119. Communuication with sensory
impaired client
 VISUAL IMPAIRMENT
 HEARING IMPAIRMENT

120. VISUAL IMPAIRMENT
 Always announce your presence when
entering the client’s room
 Identify yourself by name.
 Stay in the client’s side of vision if the
client has a partial vision loss.
 Speak in a warm and pleasant tone of
voice.
 Some people tend to speak louder than
necessary when talking to a person who is
blind.

121. VISUAL IMPAIRMENT
 Always explain what you are about to do
before touching the person.
 Explain the sounds in the environment.
 Indicate when the conversation has ended
and when you are leaving the room.

122. HEARING IMPAIRMENT
 Before initiating conversation, convey your
presence by moving to a position where
you can be seen or by gently touching the
person.
 Decrease background noises (e.g.,
television) before speaking.
 Talk at a moderate rate and in a normal
tone of voice.

123. HEARING IMPAIRMENT
 Shouting does not make your voice more
distinct and in some instances makes
understanding more difficult.
 Address the person directly. Do not turn
away in the middle of a remark or story.
 Make sure the person can see your face
easily and that it is well lighted.

124. HEARING IMPAIRMENT
 Avoid talking when you have something in
your mouth, such as chewing gum.
 Avoid covering your mouth with your hand.

125. HEARING IMPAIRMENT
 Keep your voice at about the same
volume throughout each sentence,
without dropping the voice at the end of
each sentence.
 Always speak as clearly and accurately
as possible.

126. HEARING IMPAIRMENT
 Articulate consonants with particular
care.
 Do not “overarticulate”; mouthing or
overdoing articulationis just as
troublesome
 write ideas, or use sign language or
finger spelling as appropriate.

127. HEARING IMPAIRMENT
 Use longer phrases,
 Word choice is important: “Fifteen cents”
and “fifty cents” may be confused, but
“half a dollar” is clear.

128. HEARING IMPAIRMENT
 Pronounce every name with care. Make a
reference to the name for easier understanding
 Change to a new subject at a slower rate,
making sure that the person follows the change
to the new subject.
 A key word or two at the beginning of a new
topic is a good indicator.

129. Promoting self care

130. Socialization

131. Evaluation
Client demonstrate
 measures to prevent injury
 Uses of existing senses
 Effective communication mechanism
 Reduced isolation
 Perform activities of ADL independently
and safely