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:_____________________________
____________________________________
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As evidenced by:
[Check those that apply]
Major:
(
Must be present)
(_) Inaccurate interpretation of environmental stimuli.
(_) Negative change in amount or pattern of incoming stimuli.
Minor:
(
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 &
Sign.
Plan and Outcome
[Check those that apply]
Target
Date:
Nursing Interventions
[Check those that apply]
Date
Achieved:
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