b.Reception: Assess for anything that may inter-
fere with sensory reception and prescribe any
corrective devices the patient uses for sensory
impairment.
c. Transmission–perception–reaction: High-risk
patients include confused patients and patients
with nervous system impairments. Assess the
patient’s abilities to transmit, perceive, and
react to stimuli during everyday interactions.
13.Sample answers:
a.Visually impaired patients: Acknowledge your
presence in the patient’s room, identify yourself
by name, and speak in a normal tone of voice.
b.Hearing-impaired patients: Avoid excessive
noise, avoid excessive cleaning of ears, and
know the symptoms of hearing loss.
c. Unconscious patients: Be careful of what is said
in the patient’s presence, assume the person
can hear you, and speak to the person before
touching him.APPLYING YOUR KNOWLEDGE
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
Sample Answers
1.What nursing interventions might be appropriate
for Mr. Pirolla?
Sensory deprivation can lead to perceptual,
cognitive, and emotional disturbances. Therefore,
the nursing plan of care should include sensory
stimulation for Mr. and Mrs. Pirolla. The nurse
should also investigate if hearing aids would help
Mr. Pirolla with his hearing loss. The nurse should
assess both Mr. Pirolla and his wife to see how they
are coping with the changes in their social environ-
ment. Safety in the home and community is also an
issue that needs to be addressed. The nurse should
incorporate knowledge of the guidelines for
communicating both with persons with reduced
vision and hearing when developing a teaching
plan to assist Mrs. Pirolla in dealing with her
husband’s condition
2.What would be a successful outcome for this
patient?
By next visit, Mr. Pirolla states that he is adapting to
his condition and receiving new sensory
stimulation from his environment.
3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?
Intellectual: knowledge of the arousal mechanism
and how the body responds, including sensoristasis
and adaptation; ability to integrate knowledge of
sensory alterations, including factors contributing
to disturbed sensory perceptions
Interpersonal: demonstration of the ability to
empathize and communicate with patients with
sensory deficits and interact effectively with
patients and their caregivers.4.What resources might be helpful for Mr. Pirolla?
Social services, printed materials on sensory deficits,
community services
PATIENT CARE STUDY
1.Objective data are underlined; subjective data are in
boldface.
George Gibson, an 81-year-old, married, African
American man, reluctantly reports, after much prod-
ding from his wife, that he is not hearing as well as
he used to be. “I don’t know what the trouble is,”
he tells you. “I’m in perfect health, always have
been. More and more, people just seem to be
mumbling instead of talking.”You notice he is
seated on the edge of his chair and bends toward
you when you speak to him. His wife reports that he
has stopped going out and pretty much stays in his
room whenever people come to visitbecause he is
embarrassedby his inability to hear. “This is really
a shame, because George was always the life of the
party,“ she says. You ask Mr. Gibson if he has ever
had his hearing evaluated, and he tells you no, until
now, he’s been trying to convince himself that
nothing’s wrong with his hearing.
2.Nursing Process Worksheet
Health Problem: Sensory/perceptual alteration:
auditory
Etiology:Reluctance to accept that he has an
auditory problem and to seek help
Signs and Symptoms: Leans forward to hear speaker;
attempts to deny hearing loss and attributes
problem to others who are “mumbling”; has greatly
reduced opportunities for conversation; has not
sought help until now
Expected Outcome: After medical evaluation of hear-
ing loss and treatment, patient demonstrates better
coping skills by increasing amount of time he
spends socializing.
Nursing Interventions:
a.Explain that hearing loss often accompanies
aging and that a medical evaluation is important
to provide proper treatment.
b.Help patient make an appointment for evaluation.
c. Explore strategies for improving his communica-
tion skills and preventing social isolation.
Evaluative Statement: 12/5/11: Goal partially met—
hearing aid has enabled patient to comprehend
most one-to-one conversations, but ability to hear
well in groups is still impaired. Is willing to investi-
gate possibility of learning to lip-read. No longer
avoids company, especially if it is only one or two
people.—D. Mason, RN
3.Patient strengths: Healthy until now; wife is support-
ive; previous history of strong interactional skills
Personal strengths: Recognize significance of
sensory/perceptual alterations; able to distinguish
changes in perceptual abilities normally related to
aging from those indicating treatable medical prob-
lems; able to establish trusting relationship with
older patientsCopyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:418 ANSWER KEY
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