Saturday, March 21, 2009

Nursing care plans NANDA Nursing Diagnosis: Disturbed Sensory perception

NANDA Nursing Diagnosis Definition: Change in the amount or patterning of incoming stimuli accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli
Defining Characteristics: Poor concentration, auditory distortions, change in usual response to stimuli, restlessness, reported or measured change in sensory acuity, irritability, disoriented in time, in place, or with people; change in problem-solving abilities; change in behavior pattern; altered communication patterns; hallucinations; visual distortions

NOC Outcomes
  • Body Image
  • Cognitive Orientation
  • Sensory Function: Vision
  • Vision Compensation Behavior
  • Cognitive Orientation
  • Communication: Receptive Ability
  • Distorted Thought Control
  • Hearing Compensation Behavio

Client Outcomes
  • Demonstrates understanding by a verbal, written, or signed response
  • Demonstrates relaxed body movements and facial expressions
  • Explains plan to modify lifestyle to accommodate visual or hearing impairment
  • Remains free of physical harm resulting from decreased balance or a loss of vision, hearing, or tactile sensation
  • Maintains contact with appropriate community resources

NIC Interventions
  • Communication Enhancement: Hearing Deficit
  • Cognitive Stimulation
  • Environmental Management

Nursing Interventions and Rationales
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