1. Stressors that Affect Cognition &Perception Sensory Sleep NUR101 FALL 2009 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 Methods for Clients with Special Needs Review Box 24-10 in Potter & Perry Page 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. Sleep Stages NREM- non-rapid eye movement 75-80% of adult sleep Has 4 stages I – sl. Awareness II- easily aroused III – less easily aroused IV – Delta sleep; arousal difficult REM(Stage V) - rapid eye movement 20-25% of adult sleep Dreaming Eyes darting facial muscles flacid Essential for emotional equilibrium

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. Factors Affecting Sleep 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

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 )