Sensory Case Study

Sensory Case Study Misa Carter is a 56-year-old patient in the neuro/trauma ICU. She suffered a head injury in a motor vehicle crash. Sustained injuries include her right ear, right occipital lobe, right temporal lobe, and parts of her diencephalon. She has the following sensory deficits: hyposmia, inability to hear high-frequency sounds, and left hemianopia. 1. Define each of the patient’s identified sensory deficits in detail. a. Hyposmia is defined as a reduced ability to smell (Hummel et al., 2011). This does not detail the qualitative aspects of the sense of smell, but rather like a sensitivity scale that has been turned down to three or four. Anosmia would be a complete cessation in the ability to smell, or zero. Hyperosmia would be like turning the sense of smell up to eleven. b. The patient’s inability to hear high-frequency sounds describes a deficit in her total hearing register. The average adult tends to hear sounds registering between 20 and 20,000 Hertz (Hz) (Chou et al., 2011). This ability to hear higher frequencies means that the patient may have trouble interpreting some of the sounds she hears, along with losses as it pertains to children’s voices, birds, and electronic means of entertainment and communication, such as television and telephones (Noise-induced Hearing Loss, 2015). c. Hemianopia is defined as loss of half of the field of vision (Goodwin, 2014). There are varying scales of loss that range from total loss of half of the field of vision to partial loss. This definition is traditionally used in cases of traumatic injury to the brain. 2. Discuss the assessment techniques used to diagnose each of the patient’s sensory deficits. Include detailed rationale. a. The olfactory nerves are not usually primary points of concern in trauma assessment (Clark et al., 2020). However, once the patient is out of immediate danger it would be beneficial to test all deficits. In order to test the loss of sense of smell, one methodology would be to have the patient close their eyes and hold up escalating scents, from the absolute weakest to absolute strongest smells. This is used to test the baseline level that the patient can smell. Given the patients TBI, it would also be beneficial to have the patient occlude one nostril and go through the sensory test and then switch scents and conduct the test with the other nostril (Wrobel & Leopold, 2004). b. In order to diagnose the severity of the damage to the hearing function, audiometry would need to be utilized through automated high-frequency testing or through subjective audiometry, through which the patient responds with a button click when they hear a tone through a pair of headphones. Currently, subjective audiometry is the preference for detecting perceptive hearing loss (Hoth & Baljić, 2017), as it not only utilizes multiple frequencies and multiple decibels, but it also allows the audiologist to gauge the patient’s perception to the noises and how they react to long silences. Given that the patient shows hearing losses in the higher frequency ranges, this testing would allow for a detailed understanding of the loss. c. Testing the patient’s visual field is actually the simplest to conduct, and it would only require standing in front of the patient and having them cover one of their eyes and describe held objects or screening tools; and then by having the patient switch eyes (Clark et al., 2020). Once the hemianopia has been confirmed, further diagnostic tools can be used to gauge the visual level in the unaffected eye and ask the patient to subjectively compare their current status to their usual quality of sight. 3. Provide accurate, detailed pathophysiology incorporating all of patients identified sensory deficits. a. Outside of tinnitus related frequency losses due to traumatic noises, this patient’s high frequency hearing loss is likely related to traumatic brain injury (TBI) to the temporal lobe, in the vicinity of the auditory cortex (Kreuzer et al., 2012). Advanced age can also reduce the volume of the brain, which can impede neural pathways and distort auditory input. Fortunately for this patient, when the same pathology is caused by trauma, the disruption of the auditory processing neural pathway, it tends to be less permanent (Rigters et al., 2017). This is what is known as cortical hearing loss, where the patient’s ability to hear is damaged without anatomical damage to the structural auditory bones or membranes (Brody et al., 2013). An injury to the right ear could potentially cause hearing project if the structural integrity of the bones or membranes were damaged as well, but that would not likely bilateral hearing loss of higher frequencies. b. As with hearing loss, there are a number of potential pathophysiologies for hyposomnia. Injury or severing of the olfactory nerves can cause a reduction in the ability to smell, however, considering that this patient obviously suffered from a TBI, it might behoove the healthcare provider to look into the damage to the right temporal lobe to verify that damage to the olfactory cortex located medial temporal lobe. The medical provider should also look into damage to the frontal lobe’s primary olfactory cortex (Howell et al., 2018). c. The likely cause of the patient’s left sided hemianopia is the damage to the primary visual cortex located in the occipital lobe. The damage is likely only partial, rather than bilateral, as the patient has vision in her right eye, which might indicate that the damage was to the right visual cortex (Lin & Yen, 2020). 4. Explain how the patient’s sensory deficits may affect her pain with detailed rationale. a. The sensory aspects of pain are centered around the patient’s perception of the pain, the severity of the pain, usually measure on a scale of 1-10; localization of the pain, where it is; the duration of the pain and what makes the pain worse (Talbot et al., 2019). As it pertains to the patient’s sensory deficits and her pain levels, her inability to process highfrequency sounds via her auditory cortex might impede her ability to localize pain caused by high-frequency noises that are causing damage to the structural membranes and bones of her hearing organ. b. Loss of one half of the field of vision and a reduced ability to smell may not cause physical pain to the pain, but the stress of the losses could cause stress, anxiety, and depression, which could potential convert to physical pain if it is not addressed as part of this patient’s course of treatment. 5. What disciplines can you expect to be involved in the patients care and why? Include detailed rationale. a. Neurology/Neurosurgery i. The patient likely has traumatic brain injuries and may need surgical and therapeutic interventions in order to prevent further degradation of the sensory deficits. b. Occupational Therapy i. If the patient’s current deficits are going to be long-term or permanent, they will need to be able to learn how to cope and compensate for the sensory losses. c. Behavioral Health i. This patient may be experiencing a loss as traumatic as amputation and will need to be counselled on methods for dealing with those losses. d. Ophthalmology i. If the patient requires surgery of the eyes and further treatment of her visual senses and the underlying disease processes, she will need care beyond that available at her local optometrist’s office. e. Otorhinolaryngology i. If the patient requires surgery or further treatment of the injuries to her head and neck. Practitioners of specialty are colloquially known as Ear, Nose, and Throat Surgeons. 6. What are three patient safety concerns and why? Include detailed rationale. a. This patient has a disruption in her visual field, which makes her a fall risk, as she may not see or perceive obstacles on her affected side. Until the patient learns to perform sweeping scans of her path, she will be at high risk for tripping and falling. Disruption of her hearing register can also cause disorientation or dizziness, which also increases the patients risk for fall. b. This patient’s combined sensory deficits put her at a higher risk for inability to detect hazards, which increases the patient’s chance or injury. The reduced sense of smell means that the patient may not detect chemicals that pose danger. Reduction in her visual field means that the patient might miss physical hazards. The hearing loss of higher frequencies might cause the patient to be unable to process sounds or words that could indicate danger. c. Another safety concern for this patient is regarding her mental health. This patient is at extremely high risk for depression associated to her sensory losses. Depression can impact the patient’s ability to care for herself, which will in turn impact the patient’s healing process and overall health. Older adults who experience significant sensory loss are also at higher risk for suicidal ideation and attempts (Cosh et al., 2018). 7. Identify three patient goals that correlate with your stated safety concerns. Include detailed rationale. a. The patient will demonstrate selective prevention methods in order to reduce the risk for fall. In order to do this, the patient should note their current level of dizziness upon standing to determine if further locomotion can be attempted, or if a stabilization period is needed prior to moving. The patient should also perform sweeping scans of her path in order to reduce the likelihood of tripping on unseen objects or changes in topography. b. In order to address the patient’s impacted ability to detect hazards, the patient should indicate a willingness to utilize tools and safety equipment in order to compensate for their sensory losses. For the reduced sense of smell, installing carbon dioxide / chemical sensors in their home would help them identify air born hazards. The patient could also utilize a walking stick and perform sweeps of her affected side to compensate for her reduced visual field (Sahoo et al., 2019). c. In order to address the risks for depression and suicidal ideation, the patient needs to agree to participate in physical and emotional therapy in order to concurrently develop coping mechanisms for their lost sensory input. The patient needs to also make an agreement with their family, healthcare providers, and themselves that they will communicate declines in their emotional state related to their loss. 8. What are specific education needs for this patient upon discharge? Include detailed rationale. a. This patient needs education on sensory aid equipment. The patient will also need education on the benefits of continuing her therapeutic regimens for learning how to compensate and cope with her losses. This patient might also be a good candidate for personal or animal-based companionship and should be educated about those programs as well. The patient would also benefit from education about their disease processes and the potential outcomes of treatments.