Stimulus

Receptor

Nerve Impulse

Brain

These four things must be met for a person to receive the necessary data to experience the world.

They are the conditions of sensory experience.

What are they?

Stimulus

This initiates a response by the nervous system.

It is an agent or act.

Receptor

This must receive a stimulus & convert it to a nerve impulse.

It is the sense organs; ears, eyes, skin, taste, smell

Nerve Impulse

This is conducted along nervous pathways from receptor/sense organs to the brain.

The pathways must be intact for this to work.

Brain

This must receive & translate an impulse into a sensation. 

 Must be able to interpret and analyze.

Visual

Auditory

Olfactory

Guistatory

Tactile

These things are the external sensory senses,

where sensory reception occurs

Kinesthesia

Stereognosis

Sensory Perception

These things are the internal environment and are essential for growth & development

What are they?  (3)

Kinesthesia

Awareness of positioning of your body parts and body movement

Stereognosis

A sense that perceives the solidity of objects, their shape, size and texture.

Sensory

Perception

This is selecting, organizing & interpreting data from the senses into meaningful information.

It is influenced by past experiences, knowledge and attitude.

(Ex: the barking dog/biting)

Reticular

Activating

System

(RAS)

This is a network that extends from the hypothalamus to the medulla.

It mediates arousal of the brain.

It's like a watchdog for impulses.

This is an arousal mechanism.  For the brain to respond appropriately, it must be alert and aroused.

Stimulus coming from your senses must be variable or irregular in order to evoke a response.

• Normal Consciousness
• Confusion
• Delirium
• Somnolence
• Chronic Vegetative State
• Dementia

There are various conscious states of awareness.

They are??????

Asleep

Stupor

Coma

What are the unconscious states???

Normal Consciousness

Aware of self and our external environment, well-oriented, responsive

Which state of awareness is this?

Confusion

Reduced awareness, easily distracted, easily startled by sensory stimuli, alternates between drowsiness and excitability, and resembles minor form of delirium state.

Which state of awareness is this?

Chronic Confusion

This is irreversible, long standing, there are intellect and personality changes, it is progressive.

It is a specific type of confusion. 

Acute

Confusion

This is temporary, has an abrupt onset.

The causes of it are: changes in environment, concussion, medications, someone who has just had general anesthesia, glucose level changes, electrolyte imbalances.

Which type of confusion is this?

Delirium

Signs of this would be disorientation, restlessness, confusion, hallucinations, agitation, alternating with other conscious states. 

This can also be caused by medications or overdose.

Somnolence

This is characterized by extreme drowsiness, but the person will respond normally to stimuli.

This can be caused by medication, sedation, a big weiner and illness.

Chronic

Vegetative

State

The person is conscious but unresponsive, no evidence of cortical function.

Which state of awareness is this?

Dementia

This is characterized by difficulties with spatial orientation, memory, language, and changes in personality.

Which state of awareness is this?

 Asleep

When you are aroused by light touch, stimuli or sound, you are????

Stupor

When you need to be aroused by more extreme stimuli, you are in a ???

coma

Coma

COMA

When a person cannot be aroused and cannot respond to stimuli, they are in which state of awareness?

Sensory Overload

Sensory Deprivation

Sleep Deprivation

Cultural Care Deprivation

What are the factors of severe

sensory alteration?

(4)

Sensory Overload

A condition that results when a person experiences so much sensory stimuli that the brain is unable to either respond meaningfully or ignore the stimuli.

This alters their ability to process things.

Ex: All the sounds you hear while in the hospital, monitors beeping, people coming in and out of your room, call light, IV pumps, a pain in the ass roommate.

Sensory

Deprivation

This results when a person experiences decreased sensory input or input that is monotonous, unpatterned, or meaningless.

People at risk: patients in isolation, an inmate in solitary confinement, a patient who is NPO (lack of taste and smell)

Sleep

Deprivation

When you have this, your sight, sound, smell and coordination is altered.  You have a decreased ability to concentrate and control thought processes.  You have inappropriate responses, panic and mood swings.

At risk:  New moms, Hospitalized patients, Cross country truck drivers.

People who are sleep deprived have similar reactions to someone who is intoxicated - sluggish.

Cultural Care

Deprivation

These patients have firm roots in culture and they sometimes feel removed from their culture's ways. 

Examples:  Cultures that meditate every morning and now they are unable to do that because they are a patient in the hospital.  Also, maybe it is in their culture to eat certain foods at specific times.

What is this called - What are these patients experiencing?

Assessment Considerations 

Developmental

Cultural

Personality/Lifestyles

Stress

Illness & Meds

There are several assessment considerations

a nurse has to keep in mind.

What are some of them (5)?

Acute or Chronic Confusion

Impaired Memory

Disturbed Sensory Perception

Disturbed through processes

Risk for Injury

Self-care Deficit

Knowledge Deficit

Impaired Verbal Communication

Imbalanced Nutrition: Less than Body Requirements

What are some nursing diagnoses that are related to sensory issues?

Organic

Brain

Syndrome

This is a general term referring to a physical disorder, usually not psychiatric disorders.

These disorders cause a decrease in mental function 

Dementia

This is a loss of brain function. It is not a single disease, but it is a group of illnesses that involve a loss in memory, behavior, learning and communication.

The problems are progressive, they slowly get worse.

There are 2 major causes: Alzheimer's & Vascular Dementia

Vascular

Dementia

Loss of brain function due to a series of small strokes that change the way we behave.

Discovered in 1906 by Dr. Alois Alzheimer. There are changes in the brain tissue (plaques & tangles).

Plaques build up between nerve cells, they contain deposits of a protein fragment called beta-amyloid. Tangles from inside dying cells.

 People w/Alzheimer's develop way more plaques & tangles than any other person. They form in a predictable pattern in areas important in learning & memory, then spread to other regions.

Describe Alzheimer's disease

Patients are diagnosed with this after all other confusion factors are ruled out, such as: Anemia, malnutrition or certain vitamin deficiencies, Excess alcohol use, diabetes, certain infections, med side effects, kidney or liver disease, thyroid abnormalities, problems w/heart, lung or blood vessels.

• 4.5 mill americans have it
• 1/10 people over 65 have it
• It is the 3rd most expensive illness (cancer and cardiovascular diseases are 1 & 2)
• Researchers have found a gene on chromosome 10 that is linked to it
• There is no treatment to stop or prevent, just medications to help with the chemical balance

Statistics on Alzheimer's Disease

Recent memory loss, difficulty performing ADLs, problems with language, disorientation to the time and place, poor or decreased judgement, problems with abstract thinking, misplacing things, changes in mood/behavior, loss of initiative

Name some of the warning signs of

Alzheimer's Disease

• Females (40% are women over the age of 85)
• Family history of AD
• Hx of head trauma
• Late life depression over the age of 65
• Vascular Dementia
• Ethnicity (increased risk for AA & Hispanics)
• A lower education level

Who is at risk for Alzheimer's Disease???

Cognitive clock test (6 pts). You gat a point for drawing the circle, putting numbers in the right spot, the arms, etc.

Mini Mental State Exam (MMSE) - the AD patient is asked questions about time and place orientation, repeating 3 words, serials (counting by 5's backwards), reading, writing, comprehension, reception.

There are a few tests that can be done to evaluate the AD patient.

What are they?

Agnosia

Amnesia

Anomia

Aphasia

Apraxia

What are the 5 A's of Alzheimer's

Disease?????

Anomia

What do you call the inability to remember names of things? 

Apraxia

What do you call misuse of an object and failure to identify the object?

Not using an object for what it is supposed to be used for.

Agnosia

This is the inability to recognize familiar objects, tastes, sounds, and other sensations.

Amnesia

Memory loss.

Who am I?

Where am I?

Who are you?

Aphasia

The inability to express oneself through speech

Early - mild

Middle - moderate

Late - severe

Terminal

What are the four stages of Sensory Alteration for Alzheimer's?

• Decrease in knowledge of recent occurrences & current events
• Cannot perform complex mental math (counting back from 100)
• Decreased ability to do comples tasks (managing finances, pay bills)
• Decreased memory of their own personal history
• May become more subdued or withdrawn from social situations

What happens in the early/mild stage of sensory alteration for Alzheimer's?

• Major gaps of memory function
• Disoriented to place and time
• Trouble with less complicated math
• Need assistance with ADLs
• Need assistance with dressing
• They do not need assistance with eating or toileting

What happens during the middle - moderate stage of sensory alteration in

Alzheimer's?

• Memory decreases
• Personality changes
• They don't know their name
• Need assistance w/toileting (flushing/wiping)
• Need assistance with dressing
• They have delusions
• They can be paranoid
• They start wandering

What happens during the late - severe stage of sensory alteration with Alzheimer's?

• Complete loss of all ability to respond to environment
• Don't speak
• No control of any movement
• Swallowing impaired
• Need complete help with care and assistance with ADLs

What happens during the terminal stage of sensory alteration with AD?

Some of the common cholinesterase inhibitors prescribed for AD patients:

• Aricept - treats all stages
• Exelon - for mild to moderate stages
• Razadyne - for mild to moderate stages
• Reminyl
• Cognex

• Prevent breakdown of acetylcholine, a chemical messenger important for learning & memory
• Support communication among nerve cells by keeping acetylcholine levels high
• Delay worsening of symptoms for 6-12 months for half the people who take them
• Some experts believe a small percentage of people may benefit more dramatically

Cholinesterase Inhibitors are given to patients with Alzheimer's disease.

What are some of the things these drugs can do?

• Memantine (Namenda) works by regulating activity of glutamate, a different msgr chemical involved w/learning & memory
• Treats moderate to severe stages of Alzheimer's
• Approved in 2003 for treatment of moderate to severe AD
• Currently the only drug of its type approved to treat Alzheimer's

It helps with memory and

cognition.

It is an antioxidant, a substance that may protect nerve cells from certain kinds of chemical wear and tear.

What does Vitamin E do for Alzheimer's patients?

• Caregiver role strain
• Coping, Compromised family
• Family processes, interrupted
• Knowledge Deficit
• Anxiety

What are some nursing diagnoses for caregiver and family of patients with Alzheimer's?

• Primary - Prevent vascular dementia, no smoking
• Secondary - Identify those at risk for dementia
• Tertiary - Support the patient and caregiver with community support services

Examples of Primary, Secondary & Tertiary levels of prevention are....

Sensoristasis

Optimal arousal state is a general drive state called......

Back rubs, foot soaks, turning and repositioning, passive ROM exercises, hugs and

touching. 

What does tactile

stimulation include/entail??

While speaking to the hearing impaired person, demonstrate and pantomime to assist in communication.

What is an appropriate nursing intervention for speaking to someone who is hearing impaired?