Sensory Deficits

A deficit in the normal function of sensory reception and perception is a sensory deficit. A person loses a sense of self with impaired senses. Initially he or she withdraws by avoiding communication or socialization with others in an attempt to cope with the sensory loss. It becomes difficult for the person to interact safely with the environment until he or she learns new skills. When a deficit develops gradually or when considerable time has passed since the onset of an acute sensory loss, a person learns to rely on unaffected senses. Some senses may even become more acute to compensate for an alteration. For example, a blind patient develops an acute sense of hearing to compensate for visual loss.

Sensory Deprivation

Sensory Overload

When a person receives multiple sensory stimuli and cannot perceptually disregard or selectively ignore some stimuli, sensory overload occurs. Excessive sensory stimulation prevents the brain from responding appropriately to or ignoring certain stimuli. Because of the multitude of stimuli leading to overload, a person no longer perceives the environment in a way that makes sense. Overload prevents meaningful response by the brain; the patient’s thoughts race, attention scatters in many directions, and anxiety and restlessness occur. As a result, overload causes a state similar to that produced by sensory deprivation. However, in contrast to deprivation, overload is individualized. The amount of stimuli necessary for healthy function varies with each individual. People are often subject to environmental overload more at one time than another. A person’s tolerance to sensory overload varies with level of fatigue, attitude, and emotional and physical well-being.

The acutely ill patient easily experiences sensory overload. The patient in constant pain or who undergoes frequent monitoring of vital signs is at risk. Multiple stimuli combine to cause overload even if the nurse offers a comforting word or provides a gentle back rub. Some patients do not benefit from nursing intervention because their attention and energy are focused on more stressful stimuli. Another example is a patient who is hospitalized in an intensive care unit (ICU), where the activity is constant. Lights are always on. Patients can hear sounds from monitoring equipment, staff conversations, equipment alarms, and the activities of people entering the unit. Even at night an ICU is very noisy.

It is easy to confuse the behavioral changes associated with sensory overload with mood swings or simple disorientation. Look for symptoms such as racing thoughts, scattered attention, restlessness, and anxiety. Patients in ICUs sometimes resort to constantly fingering tubes and dressings. Constant reorientation and control of excessive stimuli become an important part of a patient’s care.

Age

Meaningful Stimuli

Meaningful stimuli reduce the incidence of sensory deprivation. In the home meaningful stimuli include pets, music, television, pictures of family members, and a calendar and clock. The same stimuli need to be present in health care settings. Note whether patients have roommates or visitors. The presence of others offers positive stimulation. However, a roommate who constantly watches television, persistently tries to talk, or continuously keeps lights on contributes to sensory overload. The presence or absence of meaningful stimuli influences alertness and the ability to participate in care.

Amount of Stimuli

Excessive stimuli in an environment causes sensory overload. The frequency of observations and procedures performed in an acute health care setting are often stressful. If a patient is in pain or restricted by a cast or traction, overstimulation frequently is a problem. In addition, a room that is near repetitive or loud noises (e.g., an elevator, stairwell, or nurses’ station) contributes to sensory overload.

Social Interaction

The amount and quality of social contact with supportive family members and significant others influence sensory function. The absence of visitors during hospitalization or residency in an extended care facility influences the degree of isolation a patient feels. This is a common problem in hospital intensive care settings, where visitation is often restricted. The ability to discuss concerns with loved ones is an important coping mechanism for most people. Therefore the absence of meaningful conversation results in feelings of isolation, loneliness, anxiety, and depression for a patient. Often this is not apparent until behavioral changes occur.

Environmental Factors

A person’s occupation places him or her at risk for hearing, visual, and peripheral nerve alterations. Individuals who have occupations involving exposure to high noise levels (e.g., factory or airport workers) are at risk for noise-induced hearing loss and need to be screened for hearing impairments. Hazardous noise is common in work settings and recreational activities. Noisy recreational activities that weaken hearing ability include target shooting and hunting, woodworking, and listening to loud music. Individuals who have occupations involving risk of exposure to chemicals or flying objects (e.g., welders) are at risk for eye injuries and need to be screened for visual impairments. Sports activities and consumer fireworks also place individuals at risk for visual alterations. Occupations that involve repetitive wrist or finger movements (e.g., heavy assembly line work) cause pressure on the median nerve, resulting in carpal tunnel syndrome. Carpal tunnel syndrome alters tactile sensation and is one of the most common industrial or work-related injuries. Patients at risk for carpal tunnel need to be carefully assessed for numbness, tingling, weakness, and pain.

Cultural Factors

Through the Patient’s Eyes

When conducting an assessment, value the patient as a full partner in planning, implementing, and evaluating care. Patients are often hesitant to admit sensory losses. Therefore start gathering information by establishing a therapeutic rapport with the patient. Elicit his or her values, preferences, and expectations with regard to his or her sensory impairment. Many patients have a definite plan as to how they want their care delivered. Some patients expect caregivers to recognize and appropriately manage and adjust their environment to meet their sensory needs. This includes helping the patient learn and adapt to a changed lifestyle based on the specific sensory impairment. Determine from the patient which interventions have been helpful in the past in the management of limitations. Assess the patient’s expertise with his or her own health and symptoms. Always remember that patients with sensory alterations have strengthened their other senses and expect caregivers to anticipate their needs (e.g., for safety and security).

When assessing a patient with or at risk for sensory alteration, first consider the pathophysiology of existing deficits and the factors influencing sensory function to anticipate how to approach his or her assessment. For example, if a patient has a hearing disorder, adjust your communication style and focus the assessment on relevant criteria related to hearing deficits. Collect a history that also assesses the patient’s current sensory status and the degree to which a sensory deficit affects the patient’s lifestyle, psychosocial adjustment, developmental status, self-care ability, health promotion habits, and safety. Also focus the assessment on the quality and quantity of stimuli within the patient’s environment.

Persons at Risk

Older adults are a high-risk group because of normal physiological changes involving sensory organs. However, be careful not to automatically assume that a patient’s sensory problem is related to advancing age. For example, adult sensorineural hearing loss is often caused by exposure to excess and prolonged noise or metabolic, vascular, and other systemic alterations. Some patients benefit from a referral to an audiologist or otolaryngologist if assessment reveals serious hearing problems.

Other individuals at risk for sensory alterations include those living in a confined environment such as a nursing home. Although most quality nursing homes or centers offer meaningful stimulation through group activities, environmental design, and mealtime gatherings, there are exceptions. The individual who is confined to a wheelchair, suffers from poor hearing and/or vision, has decreased energy, and avoids contact with others is at significant risk for sensory deprivation. If the environment creates monotony, the individual is less able to learn and think. Patients who are acutely ill are also at risk because of an unfamiliar and unresponsive environment. This does not mean that all hospitalized patients have sensory alterations. However, you need to carefully assess patients subjected to continued sensory stimulation (e.g., ICU settings, long-term hospitalization, or multiple therapies). Assess the patient’s environment within both the health care setting and the home, looking for factors that pose risks or need adjustment to provide safety and more stimulation.

Sensory Alterations History

During the history it is useful to assess the patient’s self-rating for a sensory deficit by asking, “Rate your hearing as excellent, good, fair, poor, or bad.” Then, based on the patient’s self-rating, explore his or her perception of a sensory loss more fully. This provides an in-depth look at how the sensory loss influences the patient’s quality of life. In the case of hearing problems, a screening tool such as the Hearing Handicap Inventory for the Elderly (HHIE-S) effectively identifies patients needing audiological intervention. The HHIE-S is a 5-minute, 10-item questionnaire that assesses how the individual perceives the social and emotional effects of hearing loss. The higher the HHIE-S score, the greater the handicapping effect of a hearing impairment.

Mental Status

Physical Assessment