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Sensory deprivation

This document provides information about sensory perception and alterations. It discusses how people normally receive sensory stimulation through sight, sound, touch, smell, and taste. When sensory function is altered, through deprivation, overload, or deficits, a person's ability to relate to their environment changes. The effects of sensory deprivation can include hallucinations and cognitive and emotional disturbances. Nursing care for patients experiencing sensory alterations includes thorough assessment of their perception abilities and risks, and providing an optimal level of meaningful stimulation.

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SENSORY DEPRIVATION Presenter ; Ganesh.K Moderator ; Ms.Rachel Andrews Lecturer,CON,AIIMS
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.
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).
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.
NORMAL PERCEPTION  Sensation; The conscious and unconscious awareness of external and internal stimuli.  Perception: The conscious awareness and the interpretation of meaning of sensation.
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.
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.
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
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
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.
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.
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.
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.
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.
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.
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
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..
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.
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.
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.
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
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.
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.
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 .
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.
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.
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.
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.
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.
SENSORY ALTERATIONS a) sensory overload b) sensory deprivation c) sleep deprivation, d) cultural care deprivation.
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.
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
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)
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.
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.
CONTD...  Emotional responses  Inappropriate emotional responses. including apathy,anxiety,fear,anger,panic or depression and rapid mood changes.
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.
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.
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.
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.
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.
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,
CONTD...  confusion  Irritability  Emotional labiality,  Hallucinations(auditory or visual)  depression,  boredom and apathy,  drowsiness  paranoid or irrelevant talk  agitation and violent behaviour
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.
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.
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.
SENSORY OVERLOAD  Contributing factors  Increased internal stimuli  Increased external  Inability perceptually to disregard or selectively ignore some stimuli
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.
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.
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.
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
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
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.
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
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
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
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. .
CONTD...  Also determine whether the client is anxious, depressed, withdrawing from social contact or having any difficulty concentrating, makings or remembering
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
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
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
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
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.
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.
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
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
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.
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
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 .
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
CONTD...  Auditory stimulation  Call parson by name  Conversation that communicates caring as well as orients patient  Reading to the patient  Television ,radio
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
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
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.
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.
HEARING  Hearing aids  Speak slowly and distinctly in the client’s full view  Avoiding background noise.  Headset for telephone communication  Closed caption television
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.
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.
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.
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
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
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.
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.
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.
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.
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
Sensory deprivation