Stressors that Affect Cognition &Perception Sensory Sleep

1. Stressors that AffectCognition &PerceptionSensorySleep NUR101 FALL 2010 LECTURE # 18 K. BURGER, MSEd, MSN, RN, CNE PPP By Sharon Niggemeier RN MS

2. Sensory Needs • Senses- needed for survival, growth & development and bodily pleasure • Give meaning to events in the environment • Alterations in senses- affect ability to function in the environment

3. Sensory Experience • When we sense things: process of sensory reception (receive stimuli) and sensory perception (organization and transmission of stimuli into meaningful data…influenced by experiences, knowledge, attitudes) • Sensory reception – stimuli can be visual, auditory, olfactory, tactile or gustatory. Also can be kinesthetic, stereognosis or visceral. • RAS(reticular activating system)- responsible for stimulus arousal (monitors & regulates incoming stimuli)

4. Factors Affecting Sensory Functioning • Developmental level • Culture • Stress • Meds • Illness & Therapies • Personality

5. Sensory Alterations • A change in environment can lead to MORE or LESS normal stimuli. • When stimuli is different from what one is used to it leads to sensory alterations. • Hospitalized patients will experience sensory alterations due to different stimuli loads. • Can result in sensory overload or sensory deprivation

6. Sensory Overload • Results from being unable to manage sensory stimuli: (too much stimuli) • Pain, dyspnea, anxiety (internal) • Noise, intrusive procedures, contact with many strangers (external) • Inability to disregard stimuli: for example meds that stimulate the arousal mechanism, may prevent one from ignoring noise

7. Assessment: Sensory Overload • Unrealistic perceptions, ineffective coping • Acts bewildered,disoriented, difficulty concentrating, muscle tension • Reduced problem-solving ability, scattered attention, racing thoughts

8. Interventions: Sensory Overload • Prevent sensory alteration • Reduce environmental stimuli, promote sleep • Establish a routine for care • Speak calmly and slowly with simple explanations • Eliminate personal stimuli

9. Sensory Deprivation • Results from decreased sensory input or meaningless input: (too little stimuli) • Isolation/non-stimulating monotonous environment • Impaired ability to receive and/or send stimuli IE: vision, hearing deficits, speech deficits ( expressive or receptive aphasia) • Inability to cognitively process stimuli-confused, brain injury, meds affecting CNS

10. Sensory Deficits • Impaired reception, perception or both of the senses • Blindness, deafness, loss of taste, smell, touch • One sense may become more acute to compensate for deficit • At risk for sensory overload in the compensated sense or deprivation overall

11. Assessing: Sensory Deprivation • Drowsiness/sleeping/yawning • Decreased attention span, difficulty concentrating, impaired memory • Disorientation, confusion, hallucinations RAS needs stimulus; body may produce hallucinations to maintain optimal arousal • Crying, annoyance over small matters, depression • Apathy, daydreaming, boredom, anger

12. Assessment: Sensory Deficit • Assess loss of one or more senses • Note behaviors to compensate for deficit-always turns right ear toward person speaking to compensate for hearing loss • Assess for diseases that can affect senses, inner ear infection causes loss of kinesthetic sense, neurological disease can effect tactile perception

13. NURSING DIAGNOSIS • Disturbed sensory perception • Social Isolation • OTHERS in which decreased sensory perception may be an etiology? Situational low self-esteem Disturbed thought processes WHAT IS A PRIORITY NURSING DIAGNOSIS for the client with altered sensory perception?

14. PLANNING • Client will:Demonstrate understanding by a verbal, written, or signed response (SENSORY DEFICIT) • Client will:Demonstrate relaxed body movements and facial expressions (SENSORY OVERLOAD) • Client will:Increase and maintain personal interactions(SENSORY DEVICIT) • Client will:Remain free from injury

15. Interventions: Sensory Deprivation • Prevent sensory alteration • Teach self stimulation methods- reading, singing etc. • Provide stimulation – visual, auditory, gustatory, tactile and cognitive • Provide reality orientation • Utilize interpreters for communication barriers

16. Interventions: Sensory Deficit • Deficit may be new- determine ability to compensate • Provide care to facilitate sense • Provide glasses, hearing aids, adaptive equipment etc. to reduce sensory deficit • Utilize all health care team members to assist with sensory deficit…dietary for loss of gustatory sense

17. Communication MethodsforClients with Special Needs • Review Box 24-10 in Potter & PerryPage 357

18. Evaluation: Sensory alterations • Were outcomes met ? • Is patient compensating ? • Sensory deprivation hasn’t become sensory overload? • Does nursing care plan need modifying if goals not met?

19. Sleep/Rest • Essential for health • Illness requires increased need for sleep/rest • Rest – calmness, free from stress/anxiety • Sleep – altered state of consciousness in which reaction and perception is decreased • Effects of sleep on the body not completely understood

20. Sleep • Circadian synchronization- sleep-wake pattern follows the body’s biologic clock • RAS and Bulbar synchronizing region of Pons work together to control sleep/wake cycles • Restores balance to nervous system • Promotes physiological & psychological restoration • Lack of sleep- irritable, poor concentration, difficulty making decisions

21. NREM- non-rapid eye movement 75-80% of adult sleep Has 4 stagesI – sl. AwarenessII- easily arousedIII – less easily arousedIV – Delta sleep; arousal difficult REM(Stage V) - rapid eye movement 20-25% of adult sleep DreamingEyes dartingfacial muscles flacid Essential for emotional equilibrium Sleep Stages

22. Sleep Requirements • Individualized • Less sleep required the older one is…newborns sleep 16-18 hr/day (with more Delta & REM sleep) whereas elders sleep 6 hr/day ( with less Delta & REM sleep)

23. Health/illness (CAD pain, GI secretions increased in REM sleep, Environment Exercise and Fatigue Lifestyle Emotional stress Stimulants/Alcohol (decrease Delta & REM sleep) Diet Smoking Medication Motivation Factors Affecting Sleep

24. Sleep Disorders • Insomnia • Narcolepsy • Sleep apnea • Parasomnias

25. Assessing: Sleep • Pattern • Quality • Energy level • Sleeping aids • Sleep disturbances-nature-onset-causes-symptoms (Do you snore? Do you wake up with HA?)

26. Assessing Sleep What are some objective signs of inadequate sleep the nurse should be observant to? • Physical signs of fatigue: facial drooping, lids swollen, eyes reddened • Behavioral signs: yawning, slowed speech, slumped posture • Also check for obesity, large thickened neck, enlarged tonsils

27. Nursing Dx • Sleep pattern disturbance R/T physical discomfort AEB s/p L hip arthroplasty, positioning restrictions and client statement “I can’t sleep on my back; I like to sleep on my side” • Sleep deficit R/T shift changes at work AEB “ I’m tired going to work but when I get home I can’t fall asleep”

28. Nursing Diagnoses with Sleep Deprivation as etiology • Anxiety r/t • Activity intolerance r/t • Ineffective coping r/t • Risk for injury r/t

29. Outcome Criteria Client will: • Wake up less frequently during the night • Fall asleep without difficulty • Verbalize plan that provides adequate time for sleep • Identify actions that can be taken to improve quality of sleep • Awaken refreshed and be less fatigued during the day

30. Implementing: Promote Sleep • Restful environment • Comfort/relaxation • Bedtime rituals • Sleep pattern • Medications

31. Pharmacological Approaches • Herbals: Melatonin, Chamomile • Sedatives: Temazepam (Restoril) Triazolam ( Halcion ) Zolpidem ( Ambien) Alprazolam ( Xanax) Diazepam ( Valium )