This document discusses sensory deprivation and unconsciousness. It begins by defining sensory deprivation as a reduction in usual external stimuli that can cause psychological distress. It then describes the components of sensory experience, including reception and perception. The document outlines different levels of unconsciousness, from alert to coma, and their causes and assessments. It also discusses types of sensory deprivation and overload. Finally, it provides guidance on managing sensory issues in unconscious patients, including coma stimulation techniques targeting different senses. The overall goal is to prevent sensory deprivation and adequately meet patients' sensory needs.

1. Sensory deprivation in
unconsciousness

2. OBJECTIVES
• To define sensory deprivation and unconsciousness.
• To describe the component of sensory experience
• To know the characteristics of normal sensory perception
• To list down the level of unconsciousness, its causes and clinical
assessments
• List down the sensory issues
• Types of sensory deprivation
• Management:-
 coma stimulation: Rationale, Goals, principles, techniques
 Nursing Diagnosis
 Nursing management
 Complications

3. INTRODUCTION
• People are unique , because they are to sense a variety of
meaningful stimuli
• These allow a person to learn about environment and are
necessary for development
• Stimulation comes from inside and out side the body through
senses
• When sensory function is altered, the person’s ability to relate
to and function within the environment changes drastically
• AS A NURSE WE MUST HAVE UNDERSTAND AND HELP TO MEET
THE NEED OF PATIENT WITH SENSORY ALTRATION

4. DEFINITION
• SENSORY DEPRIVATION:-
• Diminution or absence of usual external stimuli or
perceptual experiences is called sensory deprivation
• Sensory deprivation is a condition in which an individual
receives less than normal sensory input.
• The reduction or absence of usual external stimuli or
perceptual opportunities commonly resulting in psychological
distress and in sometimes unpleasant hallucination
by- Houghton Mifflin company

5. UNCONSCIOUSNESS
Unconsciousness is a state of complete loss of consciousness
with interruption of awareness of oneself and ones
surroundings.
Unconsciousness is a state which occurs when the ability to
maintain an awareness of self and environment is lost.

6. COMPONENTS OF SENSORY EXPERIENCE
Reception Perception
RECEPTION: sensory reception is the process of
receiving data from the internal or external
environment through the senses
PERCEPTION: Conscious process of selecting, organizing
and interpreting data received from the senses into
meaningful information.

7. • Perception:

8. Relationship among sensory inputs, arousal
and outcome
Normal sensory perception depends on the sensory receptors
,RAS {Reticular activating system}, and functioning pathway
to the brain
R.A.S
STIMULATED
PERCEPTION
ADEQUATE
SENSORY
INPUTS
ADAPTIVE
BEHAVIOR

9. SENSORY PROCESS FROM A SYSTEM PRESPECTIVE
INPUT THROUGHPUT OUTPUT
Input Response
Stimulus
Sensory receptors
Neural pathways
Cerebral decoding
RAS

10. INADEQUATE
SENSORY
INPUTS
R.A.S
NOT
STIMULATED
ADEQUATELY
DISORIENTATION
CONFUSION
BOREDOM
DROWSINESS
SLEEP

11. 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
. 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.

12. UNCONSCIOUSNESS

13. DEFINITION :-
Loss of Consciousness
Loss of consciousness is apparent in patient who is not
oriented, does not follow commands, or needs persistent
stimuli to achieve a state of alertness. A person who is
unconscious and unable to respond to the spoken words can
often hear what is spoken.
Consciousness
Consciousness is a state of being wakeful and aware of self,
environment and time
Unconsciousness
Unconsciousness is an abnormal state resulting from
disturbance of sensory perception to the extent that the patient
is not aware of what is happening around him.

14. Levels of Unconsciousness
1. Alert :
-Normal consciousness
2. Automatism :
Aware of surroundings
May be unable to remember actions later
Possible abnormal mood, may show defects of memory and
judgment
3. Confusion :
Loss of ability to speak and think in a logical coherent fashion
Responds to simple orders
May be disorientated for time and space

15. 4.Delirium/Acute confusion with agitation :
Characterized by restlessness and possible violence
Not capable to rational thought
May be troublesome and not comply with simple
orders
5. Stupor :
Quite and uncommunicative
Remains conscious but sits or lies with a glazed
expression
Does not respond to orders
Bladder and rectal incontinence occur
More serious than the previous wild stage

16. 6. Semi-coma :
A twilight stage
Patients often pass fitfully into unconsciousness
May be aroused to the stuporosed state by vigorous
stimulation
7. Coma :
Patient deeply unconscious
Can not be roused and does not wake up with vigorous
stimulation

17. CAUSES OF UNCONSCIOUSNESS
• Head Injury
• Skull Fracture
• Asphyxia
• Fainting
• Extremes of Body Temperature
• Cardiac Arrest
• Blood Loss
• CVA
• Epilepsy
• Infantile Convulsions
• Hypoglycemia
• Hyperglycemia
• Drug Overdose
• Hypothermia
• Poisonous Substances and Fumes

18. Pathhophysiology
• Disruption in the basic functional units (neurone) or
neurotransmitters results in faulty impulse
transmission, impending communication within the
brain or from the brain to other parts of the body
• These disruptions are caused by cellular edema and
other mechanisms such as antibodies disrupting
chemical transmission at receptor sites.

19. Clinical manifestations
• Changes in pupillary responses, eye opening,
verbal response and motor response.
• Initially – restlessness
|
Pupil round and reactive
|
sluggish
|
Fixed
No eye opening and verbal response

20. CLINICAL ASSESSMENT
• Laboratory tests
• Evaluation of mental status.
• Cranial nerve functioning.
• Reflexes.
• Motor and sensory functioning.
• Scanning, imaging, tomography, EEG.
• Glasgow coma scale.

21. GLASGOW COMA SCALE
• GCS was published in 1974 by GRAHAM TEASDALE
& BRYAN J. JENNET, professor of neurosurgery at
the university of Glasgow’s institute of Neurological
Sciences
• The GCS is a neurological scale which aims to give a
reliable and objective way of recording the
conscious state of a person for initial as well
subsequent assessment

22. GLASGOW COMA SCALE
• Eye opening
• spontaneous -4
• to speech -3
• to pain -2
• no response -1
• Verbal response
• oriented -5
• confused -4
• inappropriate words -3
• incomprehensible sounds-2
• no response -1
• Motor response
• Obeys commands -6
• Localizes -5
• Withdraws -4
• Flexes -3
• Extends -2
• No response -1
• TOTAL SCORE: 3-15

23. SENSORY DISTURBANCES
CLASSIFICATION:
1. Sensory deprivation
2. Sensory overload
3. Sensory deficit

24. Sensory deprivation
Sensory deprivation is a state in which the overall quantity
or diversity of sensory input is decreased. People often
compensate for an over all reduction in stimuli by
increasing internal stimuli such as by day dreaming.

25. Clinical signs of sensory deprivation
• Excessive yawning, drowsiness
• Reduced attention span
• Impaired memory and problem solving ability
• Periodic disorientation, general confusion
• Hallucinations
• Feeling of boredom
• Apathy, annoyance about small matters

26. Factors that place a client at risk for
sensory deprivation
• A non stimulating or monotonous
environment
• Inability to process environmental stimuli
• Inability to receive environmental stimuli

27. SENSORY OVERLOAD
Sensory overload is a state in which the degree and nature
of sensory inputs exceeds the tolerance level of the
individual resulting in feeling of distress and hyper arousal
with impaired thinking and problem solving ability

28. Factors contributing to sensory
overload
• Increased quantity or quality of internal stimuli for example
pain, intravenous lines, catheters
• Increased quantity or quality of external stimuli, for example
busy health care setting, intrusive procedure
• Inability to disregard stimuli selectively, for example as a
result of nervous system disturbance or medication that
arousal mechanism.

29. Clinical signs of sensory overload
• Fatigue, sleeplessness
• Irritability, anxiety, restlessness
• Periodic or general disorientation
• Increased muscle tension

30. Clients at risk of sensory overload
• Clients who have pain
• Client who are acutely ill and have been
admitted to an acute acre facility
• Clients who are being closely monitored such
as in an ICU
• Clients who have central nervous system
disturbances

31. SENSORY DEFICIT
• A sensory deficit is impaired function of
sensory reception or perception.
• Blindness and deafness are sensory deficits
• When there is gradual loss of sensory
function, individual often develop behaviours
to compensate the loss, some times these
behaviours are unconscious.

32. 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.
Tactile deprivation-
Tectile deprivation in coma/immobilization, 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.

33. MANAGEMENT
• COMA STIMULATION:-
• Coma stimulation is a technique that has traditionally been
reserved for patients in a rehabilitation setting
• It stimulate the reticular activating system and promoting
brain recognition

34. Rationale and Goals
 May affect the RAS and increase arousal and attention to the level necessary to
perceive incoming stimuli
 May prevent environmental (sensory) deprivation, which has been shown to
retard recovery and the development of central nervous function and further
depress impaired brain functioning
 Allows for frequent monitoring of patient's responsiveness
 May improve the quantity and quality of responses toward purposeful activity
 May provide opportunities for the patient to respond to the environment in an
adaptive way
 May heighten the patients' responses to sensory stimuli and eventually channel
them into meaningful activity

35. PRINCIPLES OF COMA STIMULATION
• Do no harm. Before starting any stimulation, check resting vital signs .
• Avoid or minimize stimulation programs with comatose patients that have a
ventriculostomy when increased intracranial pressure (ICP) and/or cerebral
perfusion pressure (CPP) are still issues; monitor ICP and CPP during and
after treatment if necessary
• Control the environment to eliminate as many distractions as possible. The
environment should be simple , with a limited number of people around the
patient.
• Make sure the patient is as comfortable as possible before starting; tubes,
restraints, etc. may interfere with the stimulation.
• Organize the stimuli, present them in an orderly manner, and involve only 1
or 2 modalities of senses at a time.

36. •Explain to the patient before and while the stimuli are presented
•Allow extra time for the patient to respond (because of slow information
processing). 1 or 2 minutes between the administration of different stimuli
is useful as an initial guide until the length of response delay is
established
•Keep sessions relatively brief - patients can usually tolerate up to 15-30
minutes
•Conduct sessions frequently, allowing patients to respond several times
daily, but alternating periods of stimulation with periods of rest
•Select meaningful stimuli, such as voice of family and friends, favorite
music, etc.
•Verbally reinforce responses to increase the likelihood of obtaining
responses in later sessions
CONT….

37. •Try stimulating all the senses, and vary the stimuli in nature and intensity
to maximize the possibility of increasing arousal. Do an ongoing
evaluation of stimuli to which the patient responds.
•To improve the quality and quantity of responses as responsiveness
increases, direct treatment toward increasing the frequency and rate of
response, the period of time that patient can maintain alertness, the
variety of responses, and the quality of attention to the environment
•Avoid overstimulation, indicated by flushing of the skin, perspiration,
agitation, eye closing, sudden decrease in arousal level, increase in
muscle tone, and prolonged increase in respiration rate, by alternating
periods of stimulation with periods of rest
•Include participation by family and significant others in the coma
stimulation program
CONT..

38. Techniques of Coma Stimulation
Approaching the Patient
Identify yourself
Talk to the patient slowly, and in a normal tone of voice
Keep sentences short and give the patient extra time to
think about what you've said
Orient patient to the date, time, place, and reason for
being in the hospital, and explain to the patient what you
are going to do

39. •Visual Stimulation
•Provide a visually stimulating environment at the bedside, such as colorful,
familiar objects, family photographs (labeled), and TV 10-15 minutes at a time
•
•Provide normal visual orientation, by positioning patient upright in bed, in the
wheelchair, etc. This also helps decrease complications of prolonged bed rest,
such as pressure sores, breathing problems, osteoporosis, and muscle
contractures
•Eliminate distraction to allow patient to focus on visual stimuli, such as a familiar
face, object, photos, and on a mirror
•Attempt visual tracking after focusing is established, i.e. getting the patient to
follow a stimulus with his/her eyes at it moves. Tracking usually begins in the
center or midline.

40. Auditory Stimulation
Provide regular auditory stimulation at the patient's bedside. All hospital
staff should be encouraged to speak to the patient as they work in the room
or directly with the patient. An information sheet can be posted in the room
with information about the patient's likes and dislikes
Permit only one person to speak at a time
Use radio, TV, tape recording of a familiar voice, etc. for 10-15 minutes at
intervals throughout the day
Direct work to focusing and localizing sound and look for patient's response
when you change the location of a sound, e.g. call the patient's name, clap
you hands, ring a bell, whistle, etc. 5-10 seconds at a time
Avoid stimulation that evokes a startled response. This type of stimulation is
counterproductive.

41. Touch Stimulation –
Tactile input can be encourage a desired response or inhibitory
(discourage/interfere with a desired response). For example, pain and light
touch to the skin tend to produce an inhibitory response, while maintained
touch, pressure to the oral area, and slow stroking of the spine tend to produce
a facilitatory response. The face, and especially the lips and mouth area, are the
most sensitive. Use a variety of textures, such as personal clothing, blankets,
stuffed animals, lotions, etc.
Use a variety of temperatures, such as warm and cold cloths or metal spoons
dipped for 30 seconds in hot or cold water
Vary the degree of pressure - firm pressure is usually less threatening or
irritating to the patient than light touch. Examples include grasping a muscle and
maintaining the pressure for 3 -5 seconds, stretching a tendon and maintaining
the stretch for a few seconds, and rubbing the sternum
Use unpleasant stimuli, such as a pinprick, with caution. Avoid ice to face or
body, as it may trigger a sympathetic nervous system response, i.e. increased
blood pressure, heart rate, and salivation and decreased gastrointestinal activity

42. •Movement Stimulation
•Use range of motion exercises, changes in body position
such as a single or repetitive roll, a tilt table to bring the
patient to a more upright position, and movement activities
on a therapy mat
•Watch for early physical protective reactions or delayed
balance reactions during these activities

43. POSITION STIMULATION:-
• Slow changes in position tend to be inhibitory, while faster
movement patterns tend to facilitate arousal Monitor the
patient's blood pressure (and ICP if appropriate) during this
stimulation
• Use position changes that are meaningful and familiar, such
as rolling, rocking in a chair or on a mat, and moving from
lying down to sitting
• Avoid spinning, which may trigger seizures, and mechanical
input, such as raising and lowering the hospital bed, which
has little functional meaning and produces limited response

44. Smell Stimulation
Use after shave, perfume, favored extracts, coffee grinds, shampoo,
and favorite foods
Provide the stimuli for no more than 10 seconds
Use garlic and mustard as noxious stimuli
Avoid vinegar and ammonia because they irritate the trigeminal
nerve

45. •Taste and Oral Stimulation
•Provide taste stimulation, unless patient is prone to aspiration - Use a cotton
swab dipped in a sweet, salty, or sour solution, but avoid sweet tastes if the
patient has difficulty managing oral secretions since sweet tastes increase
salivation
•Provide oral stimulation during routine mouth care, unless patient demonstrates
a bite reflex
•Use a sponge-tipped or glycerin swab or a soft toothbrush to diminish
hypersensitivity and abnormal oral/facial reflexes
•Use a flavored cleansing agent, such as mint or lemon, to increase oral
stimulation during routine mouth care.
•Provide stimulation to the lips and area around the mouth. If patient
demonstrates defensiveness to touch, such as pursing lips, closing mouth, or
pulling away from the stimulus, gently continue with stimulation techniques to
decrease defensive reactions and increase level of awareness. Do not attempt
feeding of patients in coma.

46. Nursing Diagnosis
Ineffective airway clearance related to altered level of
consciousness
Risk for injury related to decreased level of consciousness.
Risk for impaired skin integrity related to immobility
Impaired urinary elimination related to impairment in sensing and
control.
Disturbed sensory perception related to neurologic impairment.
Interrupted family process related to health crisis.
Risk for impaired nutritional status.

47. Potential complications
• Respiratory distress
• Pneumonia
• Aspiration
• Pressure ulcer

51. Thank you