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Discuss the components of the sensory-perception process.
Concepts for Lecture
1. The sensory process involves two components: sensory reception,
2. Four aspects of the sensory process must be present: a stimulus, a
receptor, impulse conduction, and perception.
The stimulus is an agent or act that stimulates a nerve receptor.
A receptor is a nerve cell that acts as a receptor by converting the
stimulus to a nerve impulse. Impulse conduction is the transmission
of the stimulus along the nerve pathways to the spinal cord or
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2
Describe factors that influence sensory function.
Concepts for Lecture
1. A number of factors affect the amount and quality of sensory stimu-
lation, including an individual’s developmental stage, culture, level
of stress, medications and illness, and lifestyle.
An individual’s culture often determines the amount of stimula-
tion that a person considers usual or normal. The normal amount of
stimulation associated with ethnic origin, religious affiliation, and
income level also affects the amount of stimulation an individual
desires and believes to be meaningful. A sudden change in cultural
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SENSORY PERCEPTION
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•
Obtain models of eyes, ears, nose, skin, and
brain and identify anatomical locations
involved in sensory perception.
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• Have the students experience alterations in
sensation by being blindfolded, having their
ears plugged, wearing glasses that simulate
visual disturbances, and wearing gloves.
Assign the students to perform simple activi-
ties and report their feelings related to how
the sensory alteration interfered with the
activities.
monitored carefully. Some medications, if taken over a long period,
become ototoxic, harming the ear and hearing. Certain diseases
restrict blood flow to the receptor organs and the brain, decreasing
awareness and slowing responses. Uncontrolled diabetes mellitus
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3
Identify clinical signs and symptoms of sensory deprivation and overload.
Concepts for Lecture
1. Clinical manifestations of sensory overload include complaints of
fatigue and sleeplessness; irritability, anxiety, and restlessness;
2.
Clinical manifestations of sensory deprivation include excessive yawn-
ing, drowsiness, and sleeping; decreased attention span, difficulty
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4
Describe essential components in assessing a client’s sensory-perception
function.
Concepts for Lecture
1. Nursing assessment of sensory–perceptual functioning includes six
components: nursing history, mental status examination, physical
examination, identification of clients at risk, the client’s environ-
ment, and the social support network.
When conducting the nursing history, the nurse assesses present
sensory perceptions, usual functioning, sensory deficits, and poten-
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• Invite a panel of nurses who practice in
critical care and in nursing home settings to
discuss interventions used to prevent or reduce
sensory overload or deprivation in their
settings.
nursing homes. Have the students note the sit-
uations that could create sensory overload or
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• Have the students select partners and practice
special physical assessments related to sensory
function (e.g., Snellen vision screening, visual
fields, Weber and Rinne tests).
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• Have the students perform a sensory assess-
ment on assigned clients and report findings in
clinical conference.
CHAPTER 38 / Sensory Perception 285
Specific sensory tests include visual acuity (Snellen chart or other
ence of a radio or other auditory device, television, clock or calen-
dar, reading material, number and compatibility of roommates, and
number of visitors. In the client’s home, the nurse notes the presence
of a video/DVD recorder, pets, bright colors, and adequate lighting.
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5
Discuss factors that place a client at risk for sensory disturbances.
Concepts for Lecture
1. Clients at risk for sensory deprivation include clients who are con-
2.
Clients at risk for sensory overload include clients who have pain or
discomfort, are acutely ill and have been admitted to an acute care facili-
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6
Develop nursing diagnoses and outcome criteria for clients with impaired
sensory function.
Concepts for Lecture
1. NANDA includes the following diagnostic label for sensory percep-
tion alterations: Disturbed Sensory Perception (Specify: Visual, Au-
2. Examples of nursing diagnoses for which sensory–perceptual dis-
turbances are the etiology include Risk for Injury, Impaired Home
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• Have the students provide examples of situa-
tions where they have been either over– or
understimulated and how they responded to
these situations.
• Discuss methods the nurse can employ to
prevent sensory overload or deprivation.
• Ask the students to assess the clinical
environment, including the clients’ rooms, for
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• Provide the students with a case study and ask
them to identify nursing diagnoses related to
impaired sensory function.
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286 CHAPTER 38 / Sensory Perception
3.
The overall outcome criteria for clients with sensory-perception altera-
tions are to prevent injury, maintain the function of existing senses,
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Discuss nursing interventions to promote and maintain sensory function.
Concepts for Lecture
1. Nurses can assist clients with sensory alterations by promoting
healthy sensory function, by adjusting environmental stimuli, and by
helping clients to manage acute sensory deficits.
Healthy sensory function can be promoted with environmental
hearing loss, and learning age–appropriate safety measures and use
of dark glasses to protect the eyes from UV rays. Nurses must
implement safety precautions for clients with sensory deficits.
Clients function best when the environment is somewhat similar
to that of individuals’ ordinary lifestyle. Sometimes nurses need to
Measures to prevent sensory deprivation include: encourage use
of eyeglasses or hearing aids, address the client by name and touch
the client if culturally appropriate; communicate frequently and
meaningfully with the client; provide a telephone, TV, radio, clock,
and calendar; provide murals, pictures, wall hangings, and sculpture;
Sensory aids for visual deficits include eyeglasses with appro-
priate prescription; adequate lighting and protection against glare;
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• Using the nursing diagnosis reference book
required by the school or agency, ask the stu-
dents to develop a list of nursing activities to
assist clients who have various sensory im-
pairments (e.g., problems with hearing or vi-
sion).
CHAPTER 38 / Sensory Perception 287
bright, contrasting colors in the environment; magnifying glasses;
phone dialer with large numbers; clock and wristwatch with large
Communicating effectively with an individual who has a visual
deficit includes announcing your presence, staying in the individu-
al’s visual field, speaking in a warm and pleasant tone of voice,
explaining what you are about to do prior to doing it, explaining
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8
Identify strategies to promote a therapeutic environment for the client with
acute confusion/delirium.
Concepts for Lecture
1. The following strategies can be used by the nurse to promote a ther-
apeutic environment for the client with acute confusion/delirium:
wear a readable name tag; address the individual by name and intro-
duce yourself frequently; identify time and place as indicated; ask
the client “Where are you?” and orient the client to place if indicat-
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• Discuss the differences between delirium and
dementia.
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• Assign several students to tour a nursing home
with a unit for clients who have dementia. Ask
the students to make notations of interventions
used in this setting to orient the clients.