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Stressors that Affect Cognition &Perception Sensory Sleep. NUR101 FALL 2008 LECTURE # 18 K. BURGER PPP By Sharon Niggemeier RN MS. Sensory Needs. Senses- needed for survival, growth & development and bodily pleasure Give meaning to events in the environment

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stressors that affect cognition perception sensory sleep

Stressors that AffectCognition &PerceptionSensorySleep


FALL 2008




Sharon Niggemeier RN MS

sensory needs
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
sensory experience
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)
factors affecting sensory functioning
Factors Affecting Sensory Functioning
  • Developmental level
  • Culture
  • Stress
  • Meds
  • Illness & Therapies
  • Personality
sensory alterations
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
sensory overload
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
assessment sensory overload
Assessment: Sensory Overload
  • Unrealistic perceptions, ineffective coping
  • Acts bewildered,disoriented, difficulty concentrating, muscle tension
  • Reduced problem-solving ability, scattered attention, racing thoughts
interventions sensory overload
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
sensory deprivation
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
sensory deficits
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
assessing sensory deprivation
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
assessment sensory deficit
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
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?

  • 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
interventions sensory deprivation
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
interventions sensory deficit
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
communication methods for clients with special needs
Communication MethodsforClients with Special Needs
  • Review Box 24-10 in Potter & PerryPage 357
evaluation sensory alterations
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?
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
  • 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
sleep stages
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
sleep requirements
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)
factors affecting sleep
Health/illness (CAD pain, GI secretions increased in REM sleep,


Exercise and Fatigue


Emotional stress

Stimulants/Alcohol (decrease Delta & REM sleep)





Factors Affecting Sleep
sleep disorders
Sleep Disorders
  • Insomnia
  • Narcolepsy
  • Sleep apnea
  • Parasomnias
assessing sleep
Assessing: Sleep
  • Pattern
  • Quality
  • Energy level
  • Sleeping aids
  • Sleep disturbances-nature-onset-causes-symptoms (Do you snore? Do you wake up with HA?)
assessing sleep26
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
nursing dx
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”
nursing diagnoses with sleep deprivation as etiology
Nursing Diagnoses with Sleep Deprivation as etiology
  • Anxiety r/t
  • Activity intolerance r/t
  • Ineffective coping r/t
  • Risk for injury r/t
outcome criteria
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
implementing promote sleep
Implementing: Promote Sleep
  • Restful environment
  • Comfort/relaxation
  • Bedtime rituals
  • Sleep pattern
  • Medications
pharmacological approaches
Pharmacological Approaches
  • Herbals: Melatonin, Chamomile
  • Sedatives: Temazepam (Restoril) Triazolam ( Halcion ) Zolpidem ( Ambien) Alprazolam ( Xanax) Diazepam ( Valium )