Alteration in Sensory Perceptual

(_)Actual (_) Potential

Related To:
[Check those that apply]
(_) Amputation
(_) Bedrest
(_) Cast
(_) Hearing
(_) Immobility
(_) Impaired oxygen transport
(_) Medications
(_) Metabolic alterations
(_) Neurological alterations
(_) Pain
(_) Paraplegia
(_) Physical isolation
(_) Social isolation
(_) Stress
(_) Traction
(_) Visual
(_) Other:_____________________________


As evidenced by:
[Check those that apply]
Must be present)
(_) Inaccurate interpretation of environmental stimuli.
(_) Negative change in amount or pattern of incoming stimuli.
May be present)
(_) Disoriented about person, place, or time.
(_) Altered problem solving ability.
(_) Altered behavior or communication pattern.
(_) Sleep pattern disturbances.
(_) Restlessness.
(_) Reports auditory or visual hallucinations.
(_) Fear.
(_) Anxiety.
(_) Apathy.


Date &
Plan and Outcome
[Check those that apply]
Nursing Interventions
[Check those that apply]
The patient will:(_) Demonstrate optimal contact with reality.(_) Demonstrate an increase in self care activities.

(_) Experience decreased symptoms of sensory overload.

(_) Other:

(_) Assess ability of patient to accurately interpret sensory stimuli.(_) Monitor electrolytes, adequacy of BP.(_) Organize nursing care to provide uninterrupted sleep at night.

(_) Reduce unessential stimuli, if possible. Orient to person, place, and time with every nurse/patient contact.

(_) Encourage interaction with familiar persons.

(_) Explain all nursing care.

(_) Other:________________


Patient/Significant other signature


RN signature