Cognitive and Sensory Chapter 31 ATI Ch.

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Senses Involved in Sensory Reception
 Visual (vision)
 Auditory (hearing)
 Olfactory (smell)
 Gustatory (taste)
 Tactile (touch)
 Proprioception (sense of body movements)

Four Conditions to Receive Data

 Stimulus
 Receptor
 Nervous pathway to the brain
 Functioning brain to receive and translate impulse into a sensation
Sensory Overload
 The patient experiences so much sensory stimuli that the brain is unable to respond meaningfully or ignore
stimuli.
 The patient feels out of control and exhibits manifestations observed in sensory deprivation.
 Nursing care focuses on reducing distressing stimuli and helping the patient gain control over the
environment.
Sensory Deprivation
 Environment with decreased or monotonous stimuli
 Client who is unable to process environmental stimuli
 May result in change in cognitive behaviors, mood, and perception
 Nursing Interventions:
o Visual Stimulation
o Auditory Stimulation
o Gustatory and Olfactory Stimulation
o Tactile and Cognitive Stimulation
o Emotional Stimulation
Sensory Deficits
 Impaired or absent functioning in one or more senses.
o Reversible or permanent
o Develop or born with
 Must be assessed for to create plan of care.
 Sensory Processing Disorders
Question
Which patient 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
Answer to Question
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.

Contributing Factors to Altered Sensory Perception

 Vision Impairment: Presbyopia, cataracts, glaucoma, diabetic retinopathy, macular degeneration, infection,
inflammation, injury, brain tumor.
 Hearing Loss: obstruction, tympanic membrane injury, infection, exposure to loud noises, ototoxic drugs
 Taste Deficits: Xerostomia (dry mouth extreme), anorexia, COVID
 Neurological Deficits: neuropathy
 Stoke- visual, cognitive, verbal, and tactile
Preventing Sensory Alterations
 Control patient discomfort whenever possible.
 Offer care that provides rest and comfort.
 Be aware of need for sensory aids (available and in working order) 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.
o Auditory, Visual, Tactile, Olfactory, Gustatory
 Utilize Orientation Tools such as clocks, calendar
Safe from Injury
  Call light and personal belongings are close, Bed in low position
 Clear path, clean floor, Night lights
 Orient to the room
 Learn client’s preferred method of communication and use it.
 Home
o Paint edge of steps, remove throw rugs, appropriate lighting
o Smoke and carbon monoxide detectors are working
o Ensure food is not spoiled
o Change temp on water heater
Visually Impaired
 Teach patient self-care behaviors to maintain vision and prevent blindness.
 Acknowledge your presence in the patient’s room and when leaving
 Speak in a normal tone of voice.
 Explain the reason for touching the patient before doing so.
 Keep the call light within reach.
 Orient the patient to sounds in the environment.
 Describe the arrangement of food on the tray and the position of items
Visually Impaired Patients
 Orient the patient to the room arrangement and furnishings.
 Assist with ambulation by walking slightly ahead of the patient.
 Stay in the patient’s field of vision if he or she has partial vision.
 Provide diversion using other senses.
 Indicate conversation has ended when leaving room.
Hearing-Impaired Patients
 Teach measures to prevent hearing problems.
 Orient the patient to your presence before speaking.
 Decrease background noises before speaking.
 Check the patient’s hearing aids.
 Position yourself so that light is on your face.
 Talk directly to the patient while facing him or her.
 Use pantomime or sign language as appropriate.
 Write any ideas you cannot convey in another manner.
 DO NOT shout
 Utilize Interpretation
Question
Which measure is appropriate when caring for a patient who is hearing impaired?
A. Speak to the patient before making your presence known.
B. Increase noises in the background to stimulate the senses.
C. Position yourself so that light is on your face.
D. Do not use pantomime to express messages to avoid embarrassment.
Answer C. Position yourself so that light is on your face
Rationale: Positioning yourself so that light is on your face allows the patient to see your lips and
expressions. The patient should be oriented to your presence before you speak. Background noises should be
reduced and pantomime and sign language can be used as appropriate.

Communicating With a Patient Who is Confused

 Use frequent face-to-face contact to communicate the social process. Use client’s name
 Speak calmly, simply, and directly to the patient.
 Orient and reorient the patient to the environment.
 Orient the patient to time, place, and person.
 Communicate that the patient is expected to perform self-care activities.
 Offer explanations for care.
 Reinforce reality if the patient is delusional.
 Address pain management and sleep needs
Communicating With an Unconscious Patient
 Be careful what is said in the patient’s presence; hearing is the last sense that is lost.
 Assume that the patient can hear you and talk in a normal tone of voice.
 Speak to the patient before touching.
 Keep environmental noises at a low level.

Question
Tell whether the following statement is true or false.
When caring for an unconscious patient, the nurse should speak loudly and assume that the patient can
hear the nurse.
A. True
 B. False
Answer B. False
Rationale: When caring for an unconscious patient, the nurse should speak in a normal tone of voice and
assume that the patient can hear the nurse.
Aphasia Patient
• Loss of ability to understand or express speech
• Interventions:
• Greet clients and use names
• Only one person should speak at a time
• DO NOT shout
• Pause to allow comprehension
• Assess for comprehension
• Ask questions that only need a yes or no answer
• Consult speech therapy