• Intact Neurological System
  -Brain (cerebral function, cerebellum)
  -Nerves (cranial, peripheral)
• Sensory Function
• Cognition

1. Stimulus
2. Reception
3. Perception
4. Arousal Mechanisms

• sight
• sound
• taste
• pain
• visceral
• kinesthetic (sense of position in space)

-converts a stimulus to a nerve impulse and transmits the impulse along sensory neurons to the central nervous system (CNS)
-mechanoreceptors, thermoreceptors, proprioceptors, photoreceptors, chemoreceptors

the ability to interpret the impulses transmitted from the receptors and give meaning to the stimuli

• Level of Consciousness
• Orientation
• Mental Status
  
  

Reticular Activating System

controls consciousness and alertness.

• Adaptation
• Intensity
• Contrast
• Pervious Experience
• Illness and Medications
• Stress
• Pain
• Personality and Lifestyle
• Culture
• Age

• Structural changes affect sensory organs
• Cognitive changes that affect perception
• Normal aging does NOT affect intelligence
• Medications
• Nutrition
• Disease
• Psycholgical Factors

All structures of the eyes undergo changes:
-The vitreous humor becomes thinner, and “ floaters” appear in the visual field.
-The lens becomes discolored and opaque; the pupil becomes smaller. Therefore, less light reaches the retina, limiting vision.
-The lens becomes less flexible and less able to focus on near objects.
-The ciliary body contracts and the lens thickens, bringing loss of visual acuity, decreased ability to accommodate to distance and sudden changes in illumination, and decreased night vision.
-Decreased peripheral vision
-Decreased tear production

• Cerumen is drier and more solid, creating hearing loss.
• Scarring ( e. g., from previous inflammation over the life span)
• Hearing changes commonly include presbycusis (hearing loss of high- frequency tones) and decreased speech discrimination.

• Taste buds atrophy and decrease in number, decreasing the ability to perceive tastes, especially sweetness.
• Dry mouth may alter the sense of taste.

Atrophy and loss of olfactory neurons decreases the ability to perceive smell (which may also alter the sense of taste).

• Sensory Deprivation
• Sensory Overload
• Sensory Deficits

A state of RAS depression caused by lack of meaningful stimuli. Causes include:

• Impaired Sensory Reception or Perception
  -dementia, depression, neurological injury, sensory losses or deficits, CNS depression
• Environmental Conditions
  -Restricted mobility
  -Nonstimulating, monotonous environment
  -Cultural or Language Barriers

• Sensory Overload: Environmental or Internal (pain, stress) Stimuli is more than sensory system can process
• Hospitalized patients have physical discomfort in addition to unfamiliar, noisy hospital environment
• Medications that stimulate CNS
• Neurological or psychiatric disorders

• Vision
• Hearing
• Taste
• Smell
• Tactile
• Kinesthetic Sense

(when one sense is impaired, others might become enhanced)

• myopia (nearsightedness)
• presbyopia (can't read small print)
• cataracts
• glaucoma
• macular degeneration
• diabetes or hypertension leading to retinopathy

• Presbycusis (progressive hearing loss caused by deterioration of the hair cells in the cochlea with aging)
• Impacted Cerumen
• Otosclerosis (small bones in ear become arthritic)
• Medications (furmosemide [Lasix], ASA [aspirin], gentamycin) may be ototoxic
• Otitis Media (middle ear infection)

• Xerostomia (dry mouth)
• Medications (antibiotics, anticonvulsants, antihistamines and decongestants, antihypertensives, cardiac medications, chemotherapy drugs, antipsyhcotics, antidepressants, statins, muscle relaxants)
• Upper Respiratory Tract Infections (URIs)
• Smoking
• Vitamin B12 or Zinc deficiency
• Injury to mouth, nose or head
• Poor nutrition, poor oral hygiene

• Hands and Face have to most receptors
• Ability to perceive: light touch, pressure, hot and cold, pain
• Risk for Injury - can't feel extremes of temperature, skin breakdown, eg. diabetic neuropathy

• Proprioceptors
• Deficits can be caused by:
  -Problems of te Inner Ear
  -Neurological Disorders
  -CVA
  -Certain medications

• Can be assessed while interacting, performing care, getting other history
• Comprehensive or Focused Assessment on patients at increased risk as in
  -Older adults
  -Limited Mobility
  -ICU patients
  -Patients with known sensory deficits, especially if change is acute
• Includes assessing usual environment vs. current situation
• Assess Sensory Function, Impaired Function, Cognitive Status, and Pain

• Medical and Psychological History
• History of trauma, loss of consciousness
• Memory/Confusion/Communication
• Recent changes in sensory perception/stimulation
• Use of sensory or ambulatory assistive devices
• Ability to perform ADLs
• Medications/Substance Use
• Stress and Pain
• Numbness, tingling, balance
• Focuse examination of vision, hearing, taste, smell, touch, and balance (subjective and objective data)

• Level of Consciousness
• Orientation
• Mental Status

• Based on the type of stimuli required to produce a response: Auditory, Tactile, Painful
• A person's LOC can be described as Alert, Lethargic, Obtunded, Stuporous, or Comotose
• Glasgow Coma Scale and the Full Outline of UnResponsiveness
  

Orientation to:
-Time
-Place
-Person

(always reorient patient if not oriented)

• Assess behavior, appearance, communication ability, memory and judgement
• Alert: patient is awake and aware of the environment and himself, speaking clearly and making eye contact
• Confused: reduced awareness, easily bewildered, poor memory, misinterpretation of stimuli, impaired judgement. Actions and speech are inapropriate
• A+O X 3

• Irritability
• Confusion
• Reduced attention span
•  Decreased problem- solving ability
• Drowsiness
• Depression
• Preoccupation with somatic complaints ( e. g., heart palpitations)
• Delusions ( misinterpretations of external stimuli)
• Hallucinations ( seeing, hearing, feeling, tasting, or smelling something that is not there)

• Irritability
• Confusion
• Reduced attention span
• Decreased problem- solving ability
• Drowsiness ( due to insomnia)
• Muscle tension
• Anxiety
• Inability to concentrate
• Decreased ability to perform tasks
• Restlessness
• Disorientation

• Disturbed Sensory Perception
• Acute or Chronic Confusion
• Impaired Memory
• Unilateral Neglect
• Knowledge Deficit

• Risk for Injury or Falls
• Self Care Defcit
• Imbalanced Nutrition, less than body requiresments
• Anxiety
• Social Isolation

• Visual
  -Sensory Function: Vision
  -Vision Compensation Behavior
• Kinesthetic
  -Balance
  -Body Positioning - Self-Initiated
  -Coordinated Movement
  -Sensory Function: Proprioception
• Acute Confusion
  -Cognitive Orientation
  -Information Processing

• Patient identifies significant others
• Patient identifies current place, time and season
• Patient positions self to promote optimal vision
• Patient remends others to use technique that facilitates improved hearing
• Patient uses supportive hearing device

• Make sure eyeglasses are clean and in good repair
• Provide an uncluttered environment
• Orient to new surroundings
• Provide good lighting, avoid glare
• Place commonly used objects within patients reach
• Magnifying lens or large-print books for patients with presbyopia
• Announce yourself when you come in the room, explain procedures before beginning
• Inspect home for safety

• Encourage proper use of hearing aids
• Inspect for wax build-up
• Position yourself on the "good side", face patient when speaking
• Do not shout, use a lower pitch
• Keep background noise to a minimum
• Install blinking lights for doorbell, smoke detector, smoke alarm

• Perform frequent oral hygiene
• Assess for sores or open areas in the mouth
• Make dining experience appealing
• Make meals visually appealing
• Use spices and seasonings liberally, unless contraindicated
• Teach to eat foods separately

• Allow more time for teaching skills
• Look for open areas, cuts, abrasions, or areas of erythema
• Turn and Position frequently
• Give back rub, brush hair, etc. to stimulate sense of touch
• Safe guard home against burns

• Introduce yourself
• Orient/Reorient to day, date, time
• Make them feel secure and comfortable
• Face patient and speak slowly, calmly, simply and directly
• Try to respond to the person's feelings instead of the content of their words
• Consider music therapy

• Concentrated extracts of roots, leaves, or blossoms
• Essential Oils are either inhaled, used as massage oils, or put into bathwater, lotions or dressings
• Olfaction has been shown to play a role in memory, mood and safety
• Believed to activate the amygdala and hippocampus, the storage sites for emotions and memories
• Used for stress reduction, mood regulation, sleep enhancement, immune support, first aid, enhanced energy, reduction of pain, and accelerated wound recovery

• Eucalyptus - respiratory, boost immone system, relieve muscle tension
• Ylang ylang - relaxation, reduce muscle tension, antidepressant
• Geranium - balance hormones in women, antidepressant, acne, oily skin
• Peppermint - headaches, sinuitis, vertigo, digestive disorders
• Lavender - relaxation
• Lemon - uplifting, disinfectant
• Clary sage - natural painkiller, muscle aches and pains
• Tea tree - antifungal oil, boost immune system
• Roman chamomile - relaxation, helps with sleeplessness and anxiety
• Rosemary - uplifting, promotes mental stimulation

• T'ai chi, dance, yoga
• Aerobic activities
• Strength training
• Flexibility activities
• Balance Conditioning
• Range of Motion