SENSATION, PERCEPTION, AND

COGNITION
Physiology Of Sensation, Perception, And Cognition
Sensation is the ability to receive and process stimuli
through the sensory organs.

There are two types of stimuli:

1. External stimuli are received and processed through
the sight (visual), hearing (auditory), smell (olfactory),
taste (gustatory), and touch (tactile) modes.
2. Internal stimuli are received and processed through
kinesthetic (an awareness of the position of the body)
and visceral (feelings originating from large organs
within the body) modes.
• Perception is the ability to experience, recognize,
organize, and interpret sensory stimuli.

• Sensory perception is the ability to receive sensory

impressions and, through cortical association, relate
the stimuli to past experiences and to form
impressions of the nature of the stimuli.

• Perception is closely associated with cognition, the

intellectual ability to think.

• The processes of organizing and interpreting stimuli are

dependent on a person’s level of intellectual
functioning.
• Cognition includes the elements of memory,
judgment, and orientation.

• The well-being of an individual is dependent

on the functions of sensation, perception, and
cognition because it is through these
mechanisms that the person fully experiences
and interacts with the environment.

• Sensation, perception, and cognition are

neurological functions.
The nervous system is composed of two major subsystems:
1. The central nervous system (CNS)
2. The peripheral nervous system (PNS), which consists of
the somatic and autonomic nervous systems (see Figure
38-1).

The CNS and PNS act in unison to accomplish three purposes:

1. Collection of stimuli from the receptors at the end of the
peripheral nerves,
2. Transport of the stimuli to the brain for integration and
cognitive processing,
3. Conduction of responses to the stimuli from the brain to
responsive motor centers in the body.
• The CNS is composed of the brain and spinal cord.

• The brain, the most complex of the body’s organs, is composed of

three basic structures: the cerebrum (which consists of the
temporal, frontal, parietal, and occipital lobes), the cerebellum, and
the brain stem (see Figure 38-2).

• Sensory perception involves the function of both the cranial and

peripheral nerves.

• The cranial nerves arise from the three structures of the brain and
govern the movement and function of various muscles and nerves
throughout the body (see Figure 38-3).

• The peripheral nerves connect the CNS to other parts of the body
(see Figure 38-4).
Components Of Sensation And Perception
The sensory system is a complex network that
consists of
• Afferent nerve pathways (ascending pathways
that transmit sensory impulses to the brain),
• Efferent nerve pathways (descending
pathways that send sensory impulses from the
brain), the spinal cord, the brain stem, and the
higher cortex (cerebral lobes).
Components Of Cognition
• Cognition includes the cerebral functions of memory, judgment, and emotion. In
order for higher functions (e.g., memory, affect, judgment, perception, and
language) to occur, consciousness must be present.

Consciousness
• Consciousness is a state of awareness of self, others, and the surrounding
environment.

• It affects both cognitive (intellectual) and affective (emotional) functions.

• The components of consciousness provide a foundation for behavior and

emotional expression, thereby contributing to the uniqueness of each individual’s
personality.

• Consciousness depends on the functioning of the reticular activating system (RAS),

which is located within the midbrain and thalamus, as well as connective fibers
between these structures and areas within the cerebral cortex.

• The RAS controls activities such as sleep and wakefulness and monitors the
selective transmission of stimuli to other parts of the neurosensory system.
The primary components of consciousness are arousal and
awareness
Arousal
• The degree of arousal, a component linked closely to the
appearance of wakefulness and alertness, is indicated by a person’s
general response and reaction to the environment.

Awareness
• Awareness is the capacity to perceive sensory impressions and
react appropriately through thoughts and actions.

• An essential element in awareness is orientation, the perception of

self in relation to the surrounding environment.

• Changes in a client’s orientation to time, place, and person are

often early indicators of an altered level of consciousness (LOC).
Memory
There are three types of memory: immediate, recent, and
remote.
1. Immediate memory is the retention of information
for a specified and usually short period of time. An
example of this function is the recall of a telephone
number long enough to dial it.
2. Recent memory is the result of events that have
occurred over the past 24 hours. An example of
recent memory is the remembrance of foods eaten
for dinner the previous night.
3. Remote memory is the retention of experiences that
occurred during earlier periods of life, such as an
adult’s memories of childhood. The ability to learn is
dependent on remote memory.
Affect
• Affect (mood or feeling) is an important component of cognition in that
variations of mood can influence one’s thinking ability.

• For example, depression may affect the client’s concentration and

attention.

Judgment
• Judgment, the ability to compare or evaluate alternatives to life situations
and arrive at an appropriate course of action, is closely related to reality
testing and depends on effective cognitive functioning.

Perception
• Cognitive perceptions are considered in the context of the individual’s
awareness of reality.

• Misperceptions of reality can occur in the form of an illusion (an

inaccurate perception or misinterpretation of sensory stimuli) or a
hallucination (a sensory perception that occurs in the absence of external
stimuli and is not based on reality).
Language
• Language is one of the most complex cognitive
functions, involving not only the spoken word
but also reading, writing, and comprehension.

• Each of these skills is controlled by specific areas

located in the cerebral cortex (see Figure 38-6).

• Characteristics of speech are fluency (ability to

talk in a steady manner), prosody (melody of
speech that conveys meaning through changes in
the tempo, rhythm, and intonation), and content.
Factors Affecting Sensation, Perception, And
Cognition
The functions of sensation, perception, and
cognition are influenced by many factors, including
1. Age,
2. Environment
3. Lifestyle
4. Stress
5. Illness
6. Medications
Sensory, Perceptual, And Cognitive Alterations
• According to the individual’s ability to process the stimuli, confusion
(or disorientation) may occur.

Sensory Deficits
• A sensory deficit is a change in the perception of sensory stimuli.
• These deficits can affect all five senses.

Sensory Deprivation
• Sensory deprivation is a state of reduced sensory input from the
internal or external environment, manifested by alterations in
sensory perception.
• Individuals can experience sensory deprivation as a result of illness,
trauma, or isolation.
• A person experiencing sensory deprivation misinterprets the limited
stimuli with a resultant impairment of thoughts and feelings.
The following are factors contributing to sensory
deprivation:
1. Visual or auditory impairments that limit or
prohibit perception of stimuli
2. Drugs that produce a sedative effect on the CNS
and interfere with the interpretation of stimuli
3. Trauma that results in brain damage and
decreased cognitive function
4. Isolation, either physical or social, that results in
the creation of a nonstimulating environment
Individuals who are sensory deprived may exhibit
any of the following characteristics:
1. Inability to concentrate
2. Poor memory
3. Impaired problem-solving ability
4. Confusion
5. Irritability
6. Emotional lability (mood swings)
7. Depression
8. Boredom and apathy
9. Drowsiness
10.Hallucinations (see Table 38-2)
Sensory Overload
Sensory overload is a state of excessive and sustained
multisensory stimulation manifested by behavioral
change and perceptual distortion.

Individuals experiencing sensory overload may exhibit

any of the following characteristics:
1. Anxiety and restlessness
2. Irritability
3. Disorientation
4. Insomnia
5. Fatigue
6. Impaired problem-solving ability
Some factors that contribute to sensory overload are:
1. Pain originating from a heightened quality or quantity
of internal stimuli
2. Invasive procedures that result in an increased
amount of external stimuli
3. Activity-filled, busy environment that contributes to
the amount of stimuli being perceived
4. Medications that stimulate the CNS and prohibit
client from ignoring selective stimuli
5. Presence of strangers, both health care professionals
and others, who contribute to the quantity of stimuli
6. Diseases that affect the CNS and that maximize the
perception of stimuli
Assessment
Health History
• Elements of the health history include the client’s usual level of
functioning, current sensory problems, and potential alterations.

• The nurse should also explore issues such as the client’s current
occupation, home environment, and ability to perform both daily
routines and self-care activities.

Physical Examination
• During the physical examination, the nurse evaluates the client’s
visual, auditory, gustatory, olfactory, and tactile status.

• Physical examination focuses specifically on the client’s ability to

see, hear, taste, smell, perceive heat and cold, and perceive pain.
Assessment of Cranial Nerves
• There are 12 pairs of cranial nerves, most of which have both sensory and motor functions (see
Figure 38-3).

• Assessment of the cranial nerves is done to determine the presence of any neurological deficits.

Mental Status Assessment

• A thorough mental status examination includes a systematic assessment of all the emotional and
cognitive functions.

• Changes in LOC provide clues for underlying disorders, which must be identified and treated early;
see the Safety First display.

• Mental status is usually assessed during the health history interview.

• A more detailed mental status assessment is warranted if the client presents with any of the
following: memory deficit, confusion, aphasia (impairment in language functioning), mood swings,
irritability, excessive headaches, behavioral changes, or seizures.

Levels of Consciousness
• The Glasgow Coma Scale (GCS) was developed as a standardized tool to assess LOC objectively
(Table 38-5).

Functional Abilities
• The nurse needs to have an understanding of the client’s ability to conduct self-care activities.

• Any sensory, perceptual, or cognitive impairments may interfere with the client’s ability to perform
activities of daily living (ADL).
Environment
• A person’s environment can affect sensory, perceptual, and
cognitive status in a variety of ways.

• For example, a nonstimulating environment can lead to sensory

deprivation, whereas an environment that is excessively stimulating
can result in sensory overload.

People who are at increased risk for sensory perceptual deficits

include those who are:
1. Older
2. Living alone
3. Institutionalized
4. Homebound
5. Experiencing chronic illness or physical handicaps
6. Mentally ill
7. Affected by a developmental delay
Diagnosis
• The North American Nursing Diagnosis Association International
(NANDA) diagnostic label that is applicable for many clients
experiencing altered sensory perception and cognition is Disturbed
sensory perception (specify: visual, auditory, kinesthetic, gustatory,
tactile, olfactory).

Planning And Outcome Identification

• The following goals will promote supportive, restorative care for
clients experiencing sensory, perceptual, or cognitive alterations:

The client will:

1. Remain safe and free from injury
2. Experience a level of arousal that promotes the meaningful
perception of stimuli
3. Remain oriented to time, place, person, and situation
4. Demonstrate intact functioning of senses (using assistive devices if
necessary)
5. Perform self-care activities appropriate to own functional
capability
Implementation
• Safety is a major concern of nurses caring for
clients with sensory, perceptual, and cognitive
alterations.

• Actions must be taken to ensure that the

client’s environment is hazard free and, at the
same time, that it provides adequate
stimulation.
Managing Sensory Deficits
A. Tactile Alterations
B. Hearing Deficit
C. Visual Impairment

Managing Sensory Deprivation

It is important to provide an adequate amount of sensory stimulation to
those clients who are at risk for developing sensory deprivation.

The nurse should provide multisensory stimuli for 5–10-minute intervals

throughout the day. Examples of appropriate stimuli are:
1. Taped voices of family or friends
2. Music (familiar to clients)
3. Television
4. Touch (applying lotions, different textures to skin)
5. Frequent position changes
6. Familiar visual stimuli (pictures, personal items)
Allow rest periods with no stimulation (e.g., 30 minutes to 1 hour of
uninterrupted sleep every 2–4 hours) to avoid sensory overload.
Managing Sensory Overload
• Assisting The Confused Client

Caring For The Unconscious client

• Use Of Restraints

Complementary And Alternative Therapies

• Herbals
• Aromatherapy

Evaluation