Alterations in Sensory Processes and Cognitive Functions

sensory reception

process of receiving data of external and internal environment via the senses

visual, auditory, gustatory, tactile, olfactory, kinesthetic, stereognosis

what are all the types of sensory reception? (7)

taste

gustatory

kinesthetic

awareness of body position and movement

stereognosis

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

touch

stereognosis is done through _______

reception, perception, and reaction

there are 3 main functions in the process of interpreting stimuli:

reception

stimuli that elicits a reaction; ex. hand on a burner

perception

body interpreting stimuli; ex. its hot

reaction

what does the body do in response? ex. remove hand

reticular activating system (RAS)

poorly defined network extending from the hypothalamus to the medulla that mediates arousal, monitors and regulates incoming sensory stimuli, and determines which stimuli is important vs not important

RAS

this monitors and regulates incoming sensory stimuli

sensoristasis

optimal arousal state; middle ground between sensory overload and deprivation

RAS

this is the system that filters or blocks what it perceives to be unimportant stimuli

somnolent

extreme drowsiness, but will respond normally to stimuli (lethargic)

stupor

unconscious but can be aroused by extreme and or repeated stimuli

coma

unconscious and cannot be aroused and does not respond to stimuli

alert, aware, and responsive

normal awareness/neurological arousal is ____, _____, and _______

sensory deprivation

reduction in or absence of usual and accustomed stimuli

anxiety, depression, boredom, unsettled feeling, hallucinations

signs and symptoms of sensory deprivation (5)

altered sensory reception or deprived environments

causes of sensory deprivation (2)

isolation or contact precautions

how might someone in the hospital experience a deprived environment potentially causing sensory deprivation?

spinal cord injuries, brain damage, or sleep deprivation can cause changes to your sensory perception

what are examples of things that can cause altered sensory reception

• identify cause

• increase meaningful stimuli

• increase visitation

• music/pet therapy

• increase daylight

• clock

What are some interventions we can use for sensory deprivation? (6)

sensory overload

one or more of the senses are overloaded

agitation, racing thoughts, confusion

what are the signs and symptoms of sensory overload (3)

internal stimuli (pain, nausea, anxiety, lack of sleep), external stimuli (roommate, environment, new smells), or other things (taking in new information, starting a new med, etc)

what are the causes of sensory overload (3+examples)

treat internal stimuli or stressor, eliminate any other unnecessary stimuli

interventions for sensory overload (2)

sensory deficit

impairment, or lack, of senses (vision, hearing, taste, smell, or tactile perception)

things to help them overcome the deficit like announce your presence and orient to time of day for vision loss, educate to check over oneself for lack of touch sensation, etc.

interventions for sensory deficit

sensory processing disorder

difficulty in the way the brain receives sensory information, or the way the brain organizes and uses that information; leads to challenges interacting in the environment

age, culture, personality/lifestyle, stress/illness, medication

factors affecting sensory function (5)

50%

of those age 75+, ___% have hearing loss

cultures vary on their acceptable levels of sensory stimuli

how does culture relate to sensory function?

introverts vs extroverts, huggers vs nonhuggers, etc

how does personality and lifestyle relate to sensory function?

stress and illness can affect your emotions as well as how you perceive sensory information

how does stress and illness relate to sensory function?

pulling tubes, hallucinations, delusions

these 3 things are common with ICU psychosis

altered thought processes

nursing dx for delusions

antibiotics, opioids

_______ can be ototoxic and ________ can decrease awareness (both meds)

RAS

____ makes interpretation of stimuli very subjective as some noise can be blocked as background noise while over or under stimulation can affect perception, cognition, and problem solving

presbyopia

age related farsightedness

cataracts

clouding of the lens

50%

___% of the 80+ population has cataracts

glaucoma

increased intracranial pressure; causes irreversible damage to the optic nerve

retinopathy

noninflammatory damage to retina; typically due to uncontrolled diabetes

macular degeneration

loss of vision in center of visual fields

presbycusis and cerumen accumulation

common hearing sensory alterations

presbycusis

age related hearing loss

cerumen accumulation

lots of earwax blocking ear canal

peripheral neuropathy

damage to peripheral NS caused by disease of nerves or side effect of illness; ex. diabetes, alcohol excess, shingles, vitamin deficiencies

peripheral neuropathy and CVA

common neurological sensory alterations

risk of injury

a decrease in sensation causes an increase in _______

• thorough history (recent injury, falls, any noticeable changes)

• mental status (A&O)

• physical assessment/self care abilities (disheveled, unkempt)

• health promotion (receiving routine exams)

• safety (what risk factors do they have?)

• communication (how well are they interacting with you? senses seem intact)

• support system

• other factors (economic)

assessment of sensory alterations (8)

deficit, deprivation, or overload? is there an underlying disease process?

things to consider when diagnosing a sensory alteration

is this a permanent or temporary change? are we helping them get back to baseline or adjust to their new normal?

things to consider during planning with sensory alteration

• health promotion (check ups)

• screening

• safety (staying safe with sensory alteration)

• promoting stimulation and communication (prevent isolation)

implementation with sensory alteration (4)

all of the above

Which of the following people are likely to experience sensory alteration? Choose all that apply.

A. 80YO man with cerumen impaction

B. 24YO women who has been in the ICU for 15 days

C. 12YO who is in 10/10 pain and vomiting and needs surgery

D. nurse with 2 years of experience who is floated to an unfamiliar unit to work a 12 hour shift

cognition

the systematic way in which a person thinks, reasons, and uses language

cognition

the mental process of knowing, including aspects such as awareness, perception, reasoning, and judgement.

safety

a decrease in cognitive function = a decrease in _____

cognition

all the thinking processes that allow knowledge to be gained, manipulated, and expressed; allows one to meaningfully interact with others

counsciousness

awareness and responsiveness that we have; ex. respond to painful stimuli, alert and interact

consciousness

an intact RAS is required for what?

attention

required in order for you to acquire and express information; you focus on some stimuli and ignore others

memory

ability to retain some information and forget others

sensory

memory is often linked to ______ experiences

learning

stimuli must be meaningful and often linked to previous knowledge

comprehension and application

storing and recalling new information requires _________ and ________

communication

verbal and nonverbal cues

cognition, consciousness, attention, memory, learning, and communication

normal cognitive processes (6)

intelligence, reality perception, orientation, judgement, recall and recognition, and language

characteristics of normal cognition (6)

reality perception

people know that their interactions are real

judgement

ability to interpret stimuli and act appropriately

language

choice of words and sentence construction; spoken or written

False

True or False: when caring for an unconscious patient, the nurse should speak loudly and assume that the patient can hear the nurse

• age

• nutrition and metabolism

• sleep and rest

• self concept

• infectious processes

• degenerative processes

• head trauma

• pharmacologic agents

• environmental factors

• culture, values and beliefs

factors affecting cognitive function (10)

False, cognitive impairment not normal

True or False: sensory and cognitive impairment is just a part of age

O2, lytes, buildup of waste, etc. can cause changes to your cognitive function

how does nutrition and metabolism effect cognitive function?

insufficient sleep causes irritability, difficulty concentrating, decreased problem solving and memory

how does sleep and rest effect cognitive function?

cognitive changes with illness is much more drastic in elderly, might relate to ACh

how does infectious process affect cognitive function?

20%

___% of individuals 75+ have some degree of dementia

Brief Confusion Assessment Method (bCAM)

this is a flow sheet used outside of the ICU to help evaluate delerium

clock drawing test

easy and common test for cognitive function

polypharmacy

using multiple medications at once; applies to both script and nonscript meds; most common in elderly; may lead to drug interactions

Beers Criteria

list of medications that should not be used (or should be used cautiously) in adults over the age of 65

oxygen saturation and lab values

diagnostic testing for impaired mental function

hypoxia can cause impaired mental function

how does oxygen saturation relate to mental function?

anxious, restless, agitated

symptoms of acute hypoxia (3)

glucose, sodium, calcium, ammonia, urea, WBC, Hgb, Hct, drug toxicity

what lab values are helpful with mental function? (9)

25%

the brain consumes about ____% of body glucose levels

low

there are changes in mental status when glucose is…

70-110

normal glucose levels

135-145

normal sodium levels

high or low, but especially when its a quick drop or over 120

when are we worried about sodium levels?

8.5-10.5

what are normal calcium levels?

>14

a calcium level of ____ causes drowsiness and confusion

ammonia

byproduct of the protein metabolism that can become toxic to the brain and cause alterations to cognitive function

ammonia and urea

both of these often increase with changes to liver and kidney functions

infections can cause changes and infections can cause mental alterations

how does WBC relate to mental status?

anemia = low O2 = poor mental function

how do Hgb and Hct relate to mental function?