Stressors that affect Cognition &Perception Sensory Sleep

1. Stressors that affectCognition &PerceptionSensorySleep NUR101 FALL 2008 LECTURE # 18 K. BURGER 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. Consider this…. Sensory Adaptation • Stimulus must be variable to create a response, otherwise it is gradually ignored. • Think about when you are in a client’s room on the clinical unit to which you are assigned:Do you hear all the overhead pages?Do you hear all the beeping IV pumps?Do you hear the rattling of garbage pails being emptied?Do you hear the roommate’s TV? • Important! Nurses adapt to unit noises and may not realize stimuli affecting their clients.

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

6. Think-Pair-Share • Think about some of the unit noises we discussed on the Consider this… Slide • Which noises bother YOU the most?What could you do to decrease this sensory overload? • Share your experience with a classmate and discuss other interventions.

7. 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

8. 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

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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? RISK FOR INJURY

16. 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

17. 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

18. 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

19. Which of the following are guidelines that should be followed when caring for visually impaired clients? (select ALL that apply) • Wait for the person to sense your presence in the room before identifying yourself • Speak in a normal tone of voice • Explain the reason for touching the person after doing so • Orient the person to the arrangement of the room and its furnishings • Assist with ambulation by walking slightly behind the person • Sit in the person’s field of vision if he or she has partial or reduced peripheral vision

20. Which of the following are guidelines to follow when caring for clients with hearing impairments (select ALL that apply) • Increase the noise level in the room • Clean ears on a daily basis • Position yourself so that the light is on your face when you speak • Talk to the person from a distance so that he/she may read your lips • Demonstrate or pantomime ideas you wish to express • Write any ideas that you cannot convey to the person in another manner.

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

22. 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?

23. 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

24. 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

25. 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

26. 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)

27. 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

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

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

30. 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

31. 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”

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

33. 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

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

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