The nurse is assessing a client for possible sensory deprivation. ...

[WWatsford]

The nurse is assessing a client for possible sensory deprivation. What findings would indicate the client is at risk for developing this sensory disorder?
 
  1. Client has severe pain.
  2. Client has impaired vision.
  3. Client is unable to ambulate.
  4. Client is on medication that alters sensory perception.
  5. Client has no family in the immediate area.

Question 2

The nurse is identifying diagnoses appropriate for a client recovering from cataract surgery who lives alone. Which diagnosis would be the priority for this client?
 
  1. Social Isolation
  2. Risk for Impaired Skin Integrity
  3. Disturbed Sensory Perception
  4. Risk for Injury

[Sammyo]

Answer to Question 1

Correct Answer: 2, 3, 4, 5
Rationale 1: Severe pain increases a client's risk for sensory overload.
Rationale 2: Impaired vision increases a client's risk for developing sensory deprivation.
Rationale 3: Mobility restrictions increase a client's risk for developing sensory deprivation.
Rationale 4: Medications that affect the central nervous system increase a client's risk for developing sensory deprivation.
Rationale 5: Limited social contact with family and friends increases a client's risk for developing sensory deprivation.

Answer to Question 2

Correct Answer: 4
Rationale 1: Social Isolation would be appropriate for the client with long-term vision changes but not one with an acute change as in cataract surgery.
Rationale 2: Risk for Impaired Skin Integrity is used to describe clients who have altered tactile sensation.
Rationale 3: Disturbed Sensory Perception is used to describe clients whose perception has been altered by physiological factors such as pain, sleep deprivation, immobility, disease states such as CVA, or brain trauma.
Rationale 4: Because the client lives alone and is recovering from cataract surgery, the client's risk for injury is great.

[WWatsford]

Gracias!

[CAPTAINAMERICA]

Excellent