Chapter 38 SENSORY PERCEPTION Kozier Erbs Fundamentals of

Chapter 38 SENSORY PERCEPTION Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Sensory Process • Sensory reception – Receiving stimuli or data • Sensory perception – Conscious organization and translation of data into meaningful information Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Sensory Process • • Stimulus Receptor Impulse conduction Perception Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Factors Influencing Sensory Function • • • Developmental stage Culture Level of stress Medications and illness Lifestyle and personality Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Sensory Alterations • Sensory deprivation • Sensory overload • Sensory deficits Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Assessment of Sensory-Perceptual Function • Nursing history • Mental status examination • Physical examination – Identification of clients at risk • Client’s environment • Social support network Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

NANDA Nursing Diagnoses • Disturbed Sensory Perception (Specify: Visual, Auditory, Kinesthetic, Gustatory, Tactile, Olfactory) • Acute Confusion • Chronic Confusion • Impaired Memory Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Outcome Criteria • Prevent injury • Maintain the function of existing senses • Develop an effective communication mechanism • Prevent sensory overload or deprivation • Reduce social isolation • Perform activities of daily living independently and safely Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Implementing • • • Promoting healthy sensory function Impaired vision Impaired hearing Impaired olfactory Impaired tactile Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Group Work • You are caring for a client with sensory alteration. Will this deficit affect your nursing care? How? What can you do to provide optimal nursing care to this client? What teaching should be done regarding safety at home? • The sensory alterations are Impaired vision, hearing, olfactory, tactile Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Manage Acute Sensory Impairments • • • Encourage use of sensory aids Promote the use of other senses Communicate effectively Ensure client safety Prevention of sensory overload/deprivation Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Box 38 -4 Preventing Sensory Overload Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Box 38 -5 Preventing Sensory Deprivation Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

The Confused Client • Acute confusion (delirium) • Chronic confusion (dementia) • Promoting a therapeutic environment – Box 38 -6 pg. 917 Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

QUESTIONS? ? Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.