Chapter 34 Sensory Stimulation

1. Chapter 34Sensory Stimulation

2. Senses Involved in Sensory Reception • Visual (vision) • Auditory (hearing) • Olfactory (smell) • Gustatory (taste) • Tactile (touch) • Stereognosis (perceives solidity of objects) • Kinesthetic and visceral (basic internal orienting systems)

3. Four Conditions to Receive Data • Stimulus • Receptor • Nervous pathway to the brain • Functioning brain

4. Question Which of the following interventions would be appropriate to stimulate the sense of stereognosis in nursing home residents? A. Tape pictures of loved ones on the walls B. Play soft music in the recreation room C. Prepare a fragrant cup of tea D. Provide a soft textured blanket on the bed

5. Answer Answer: D. Provide a soft textured blanket on the bed Rationale: Stereognosis is the sense that perceives the size, shape, and texture of objects, such as, a soft blanket. Taping pictures to the wall stimulates the visual sense. Playing music stimulates the auditory sense (sound). Making tea stimulates the olfactory sense (smell) and the gustatory sense (taste).

6. Factors Affecting Sensory Stimulation • Developmental considerations • Culture • Personality and lifestyle • Stress • Medications

7. Reticular Activating System (RAS) • Poorly defined network • Extends from hypothalamus to medulla • Mediates arousal • Optimal arousal state—sensoristasis • Monitors and regulates incoming sensory stimuli

8. Reticular Activating System

9. States of Awareness • Conscious • Delirium, dementia, confusion, normal consciousness, somnolence, chronic vegetative state • Unconscious • Asleep, stupor, coma

10. Factors Contributing to Sensory Alteration • Sensory overload • Sensory deprivation • Sleep deprivation • Cultural care deprivation

11. Sensory Deprivation • Environment with decreased or monotonous stimuli • Impaired ability to receive environmental stimuli • Inability to process environmental stimuli

12. Effects of Sensory Deprivation • Perceptual • Cognitive • Emotional disturbances

13. Question Tell whether the following statement is true or false. In the drive state of RAS known as sensoristasis, nerve impulses from all the sensory tracts reach the RAS, which then allows certain impulses to reach the cerebral cortex and be perceived. A. True B. False

14. Answer Answer: A. True In the drive state of RAS known as sensoristasis, nerve impulses from all the sensory tracts reach the RAS, which then allows certain impulses to reach the cerebral cortex and be perceived.

15. Sensory Overload • Patient experiences so much sensory stimuli that the brain is unable to respond meaningfully or ignore stimuli • Patient feels out of control and exhibits manifestations observed in sensory deprivation • Nursing care focuses on reducing distressing stimuli and helping patient gain control over environment

16. Patient Outcomes for Sensory Alterations • Developmentally stimulating and safe environment • Level of arousal enabling brain to receive and organize stimuli • Intact functioning of the senses • Orientation to time, place, and person

17. Question Which one of the following patients would be considered at risk for sensory deprivation? A. A patient with AIDS B. A patient in an intensive care unit C. A patient with a disturbance of the nervous system D. A patient with intrusive monitoring

18. Answer Answer: A. A patient with AIDS Rationale: A patient with AIDS may receive an insufficient quantity or quality of stimuli causing sensory deprivation. Patients in intensive care units, patients with a disturbance of the nervous system, and patients who have extensive monitoring are at high risk for sensory overload. This condition is caused by excessive stimuli over which the individual feels little control.

19. Improving Sensory Functioning • Teach patients and significant others method for stimulating the senses • Teach patients with intact and impaired senses self-care behaviors • Interact therapeutically with patients with sensory impairments

20. Stimulating a Patient’s Senses

21. Preventing Sensory Alterations • Control patient discomfort whenever possible • Offer care that provides rest and comfort • Be aware of need for sensory aids and prostheses • Use social activities to stimulate senses and mind • Enlist aid of family members to participate in or encourage activities • Encourage physical activity and exercise • Provide stimulation for as many senses as possible

22. Caring for Visually Impaired Patients • Teach patient self-care behaviors to maintain vision and prevent blindness • Acknowledge your presence in patient’s room • Speak in normal tone of voice • Explain reason for touching person before doing so • Keep call light within reach • Orient person to sounds in environment

23. Caring for Visually Impaired Patients (continued) • Orient person to room arrangement and furnishings • Assist with ambulation by walking slightly ahead of person • Stay in person’s field of vision if he or she has partial vision • Provide diversion using other senses • Indicate conversation has ended when leaving room

24. Question Which of the following is an appropriate measure when caring for a patient who is hearing impaired? A. Speak to the person before making your presence known B. Increase noises in the background to stimulate the senses C. Position self so light is on your face D. Do not use pantomime to express messages to avoid embarrassment

25. Answer Answer: C. Position self so light is on your face Rationale: Positioning self so light is on your face allows the patient to see your lips and expressions. The patient should be oriented to your presence before speaking. Background noises should be reduced and pantomime and sign language can be used as appropriate.

26. Caring for Hearing Impaired Patients • Teach measures to prevent hearing problems • Orient person to your presence before speaking • Decrease background noises before speaking • Check patient’s hearing aids • Position self so light is on your face • Talk directly to the person while facing him • Use pantomime or sign language as appropriate • Write any ideas you cannot convey in another manner

27. Communicating With a Patient Who is Confused • Use frequent face-to-face contact to communicate social process • Speak calmly, simply, and directly to patient • Orient and reorient patient to environment • Orient patient to time, place, and person • Communicate that person is expected to perform self-care activities • Offer explanations for care • Reinforce reality if patient is delusional

28. Question Tell whether the following statement is true or false. When caring for an unconscious patient, the nurse should speak loudly and assume the patient can hear him. A. True B. False

29. Answer Answer: B. False When caring for an unconscious patient, the nurse should speak in a normal tone of voice and assume the patient can hear him.

30. Communicating With an Unconscious Patient • Be careful what is said in person’s presence; hearing is the last sense that is lost • Assume the person can hear you and talk in a normal tone of voice • Speak to the person before touching • Keep environmental noises at low level