Sensory Perceptual Alteration

 

Instructions: Fill out this form, print it, and hand it in with your assessment to your instructor. When you click on Next at the bottom of the page, you see the data you submitted. Please follow the instructions on how to save the data on the next page.

AOL users: Read this instruction.

Definition: A state in which an individual experiences a change in the amount or patterning of incoming stimuli, accompaned by a diminished , exaggerated, distorted, or impaired response to such stimuli 

1. Your initials (required): 


2. Defining Characteristics- check those that apply to your client:

None- high risk diagnosis  auditory distortions  visual distortions  change in sense of taste  change in sense of smell decreased or absent sensation (specify body part) 
altered communication patterns  change in response to usual stimuli  measured change in sensory acuity 


3. Related Factors- check those that apply to your client:

sensory organ alteration  neurological impairment  fluid and electrolyte imbalance  impaired oxygen transport  stress  surgery  medications
 



4. Goal (ultimate, long term) 

5. Outcome Criteria (short term) 


6. Evaluation: Was the outcome criteria met? 

Yes- Give Evidence: 

No- Explain how you would change the plan: 


7A. Interventions 

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7B. Rationale for each intervention
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