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The visual, auditory and olfactory systems are distance senses, bringing information about our environment to our perception. Each system detects the intensity and quality of stimuli, encodes and processes this information, and transmits it to the cerebral cortex. Together these senses provide much of the available information about our environment
NEURAL PATHWAYS
SENSORY IMPULSES TRAVEL TO THE BRAIN VIA 2 ASCENDING NEURAL PATHWAYS SPINO-THALAMIC TRACT & POSTERIOR COLUMNS IMPULSES ORIGINATE IN THE AFFERENT FIBERS OF THE PERIPHERAL NERVES, ARE CARRIED THROUGH THE POSTERIOR DORSAL ROOT INTO THE SPINAL CORD
POSTERIOR COLUMNS
POSITION VIBRATION FINE TOUCH
Input of Senses
Sensory function begins with reception of stimuli by the senses. Externally, the senses receiving stimuli are; Vision, hearing, smell, taste, and touch. Receptor organs are The eyes, ears, olfactory receptors in the nose, taste buds of the tongue, and nerve endings in the skin. Internally, the kinaesthetic and visceral senses receive stimuli. These receptors are nerve endings in the skin and body tissues. The kinaesthetic sense influences awareness of the placement and action of body parts. The visceral sense receives stimuli that affect awareness related to the body's large interior organs. Vision, hearing, smell, and taste are termed, special senses. Touch, kinesthetic sensation, and visceral sensation are termed somatic senses. After stimuli are received, they are perceived with the help of the RAS. Sensory perception is a consociates process of selecting, organizing, and interpreting sensory stimuli requiring intact and functioning sense organs, nervous pathways, and the brain.
Normal Sensory Pattern Sensor stasis Each person has his or her own comfort zone. This comfort zone varies from person to person and is the range at which a person performs at his or her peak. Sensor stasis is a state of optimum arousal-not too much and not too little. The RAS is viewed by some theorists as a monitor for sensor static balance. Adaptation Beyond the point of sensor stasis, sensory adaptation occurs. Sensory receptors adapt to repeated stimulation by responding less and less. Lead time and after burn are two necessary time periods crucial to helping a person deal with new stimuli.
Lead time is the time each person needs to prepare for an event emotionally and physically. After burn is the time needed to think about, evaluate, and come to terms with the activity after it happens. The necessary amount of lead time and after burn is different for each person. Lead time and after burn helps person process stimuli so he or she can respond appropriately without becoming overwhelmed
Factors Affecting Sensory Perception Environment Sensory stimuli in the environment affect sensory perception. For example, a teacher may not notice the noise in a consistently noisy environment, such as the school cafeteria. But the same teacher may perceive a loud television set very differently in his or her own home, which is usually quiet. Previous Experience It affects sensory perception in that people become more alert to stimuli that evoke a strong response. For example, a person may drive to work by the same route each day, noticing little along the way. A person may listen to the radio inattentively until a favourite song is played, then listen to every word. A new experience, such as hospitalization, may cause a client to perceive a barrage of threatening new stimuli.
Lifestyle and Habits It affects sensory perception. One person may enjoy a lifestyle surrounded by many people, frequent changes, bright lights, and noise. Another person may prefer less contact with crowds, less noise, and a slow-paced routine. People with different lifestyles perceive stimuli differently. Cigarette smoking causes atrophy of taste buds, decreasing sensory perception of taste. Chronic alcohol abuse may lead to peripheral neuropathy, a functional disorder of the peripheral nervous system those results in sensory impairment. Illness Certain illnesses affect sensory perception. Diabetes and hypertension cause changes in blood vessels and nerves, leading to visual deficits and decreased sensation of touch in the extremities. Cerebrovascular disorders impair blood flow to the brain, possibly blocking sensory perception. Pain, fatigue, and stress caused by illness also affect perception of stimuli.
Medications Some antibiotics, including streptomycin and gentamicin, can damage the auditory nerve, impairing hearing. Central nervous system (CNS) depressants, such as narcotic analgesics, decrease awareness and impair perception of stimuli. Variations in stimulation If a person experiences more sensory stimulation than he or she is used to or can make sense of, distress and sensory overload may occur. On the other hand, if a person experiences less than the usual stimulation, that person is below his or her optimum state of arousal and may be at risk for sensory deprivation. Reactions to sensory overload or sensory deprivation are special challenges that nurses frequently encounter in themselves and clients. Sensory overload and deprivation can lead to perceptual, cognitive, and decisional problems. When the RAS is overwhelmed with input, a person may experience sensory overload and feel confused, anxious, and unable to taken constructive action . When the RAS fails to recognize a stimulus because it is below the threshold level or lacks relevant meaning to the person, sensory deprivation may occur, and the person experiences depression, restlessness, and hallucinations
Sensory overload
It occurs when a person is unable to process or manage the intensity or quantity of incoming sensory stimuli. The person feels out of control and overwhelmed by the excessive input from the environment. Routine activity in the health setting can contribute to sensory overload in clients. These activities fall into three main categories:
internal factors, information, and environment .
Internal Factors; such as thinking about surgery or the meaning of a medical diagnosis, can contribute to anxiety and cognitive overload so that the person cannot process additional stimuli. Pain, medication, lack of sleep, worry, and brain injury also can contribute to a person's vulnerability to sensory overload.
Information;
It is Imparting information to a client may lead to sensory overload. Some examples include teaching a client about a procedure, informing a client about a diagnosis, making requests of a client, or helping the client solve a problem. Anxiety related to medical diagnosis, prognosis, and treatment can contribute to sensory overload. Lights and frequent activity may cause sensory overload in a premature newborn in the neonatal intensive care unit.
Environment;
The environment of the healthcare agency provides a higher than usual amount of sensory stimulation. A client newly admitted to the hospital, for example, may have to cope with adjusting to a new roommate, having the television on more than usual, bright lights, paging systems, meeting many staff members, having the bed move up and down at someone else's bidding, waiting for someone to answer the call light, uncontrolled pain, and having strangers touch and not respect private body areas. Clients in intensive care units often exhibit symptoms of sensory overload because of the high degree of light, noise, and activity around the clock.
Sensory Deprivation
Although sensory deprivation can be thought of as the opposite of sensory overload, they share many elements. Sensory deprivation generally means a lessening or lack of meaningful sensory stimuli, monotonous sensory input, or an interference with the processing of information.
Altered sensory reception Occurs in such conditions as spinal cord injury, brain damage, changes in receptor organs, sleep deprivation, and chronic illness. The person does not receive adequate sensory input because of an interference with the nervous system's ability to receive and process stimuli. Deprived environments It can have negative effects on a person's sensor stasis. A person who is immobilized or isolated for any reason is deprived of the usual amount of stimulation and may show manifestations of sensory deprivation
Manifestations of Altered Sensory Perception Function Anxiety Cognitive Dysfunction, which is a Disturbance in remembering, reasoning, and problem solving may occur with sensory overload. Hallucination and Delusions (beliefs not based in reality) reflect an unconscious need or fear Sensory Deficit Depression and withdrawal
SENSORY DEFICITS:
Impaired or absent functioning in one or more senses are termed as sensory deficits Eg: impaired sight and hearing, altered taste, numbness and paralysis that results in altered tactile perception, and impaired kinaesthetic sense
Impaired vision:
Vision occurs when light rays that focus on the retina trigger a nerve impulse that is transmitted to the visual area of brain in the occipital region. Visual deficits may results from trauma or diseases of the eye, microvascular problems, or CNS disorders. Common causes of visual deficits include refractive errors, orbital trauma, cataracts, glaucoma, diabetic or hypertensive retinopathy, or loss of visual field after stroke.
Impaired hearing : Hearing occurs when sound waves entering the ear canal are converted to vibrations and transferred from the middle ear to the inner ear. Vibrations cause the hair cells in the cochlea to bend, generating impulses that are carried by cranial nerveVIII to the brain. The auditory area in the brain is located in the temporal lobes. The auditory area interprets the sound and and allows you to determine from which direction the noise is coming.
IMPAIRED HEARING
Hearing deficits may result from injury or diseases in the structures of the ear, the nerves or the brain. Inability to hear decreases the ability to communicate and hampers social interaction. It may interfere with a persons ability to understand instructions from health care professionals and create a safety hazard due to inability to hear warnings.
IMPAIRED TASTE
Impaired smell
The sense of smell is triggered when chemo
receptors in the upper nasal cavities detect vaporized chemicals. Chemo receptors generate impulses carried by the olfactory nerve (CN I) into the olfactory area in the temporal lobes. Vaporized molecules can be detected from a far distance, so the sense of smell can serve as an early warning system for detection of smoke and noxious chemicals.
ASSESSMENT
SCATTER STIMULI OVER THE DISTAL AND PROXIMAL PART OF ALL EXTREMITIES AND TRUNK TO COVER MOST OF THE DERMATOMES. ABNORMAL SYMPTOMS MAY INDICATE NEED TO TEST THE ENTIRE BODY SURFACE. PAIN NUMBNESS TINGLING
Assessment contd.
COMPARE SENSATION ON SYMMETRIC PARTS OF THE BODY IF DECREASE IN SENSATION SYSTEMATIC TESTING FRON POINT OF DECREASED SENSATION TOWARD SENSITIVE AREA NOTE WHERE SENSATION CHANGES MAP BORDERS OF DEFICIENT AREA
Assessment contd..
NOTE, IF THE PATTERN OF SENSORY LOSS IS DISTAL GLOVE AND STOCKING (HANDS & FEET) DERMATONES C3-FRONT OF NECK T10-UMBILICUS C6-THUMB L1-INGUINAL
Diagnostic Statement:
Sensory/Perceptual Alterations Definition; Sensory/perceptual alteration is a state in which a person experiences a change in the amount or patterning of oncoming stimuli, accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli (NANDA, 1999) .
Nurse-Client Interaction
It promotes sensory health function. Clients at risk for sensory deprivation may need frequent interaction initiated by the nurse. In any case, provide appropriate: stimuli, such as addressing The Client by name, explaining all activities, and, when leaving, acknowledging client that the nurse will return. Length, tendency, and content of interactions should he based on individual needs. Talking to the client, showing the client equipment or articles used in care, encouraging the client to smell and taste food that is served, and touching the client are appropriate stimuli during interactions
Nursing Interactions for Altered Sensor- Perception function Stimulation Providing meaningful external stimuli can help a client overcome sensor' deprivation or sensory deficit as; playing the television or the radio occasionally. playing tennice, Encouraging use of a clock and calendar, Encouraging the client to dress or the day's activities, putting till pictures, Encouraging visitors, opening the drapes, and turning on lights. Plan: the bed or chair so the client can see or hear activities in the area.