Unit 8

Cognition & Perception

By Kasaye Getahun ( RN, BSC PHO,

Hidar 2015 E.C

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Cognition & perception
 Cognition & perception are one of the
component of the Eleven Functional Health Pattern
1. Health Perception & Management
2. Exercise & Activity
3. Nutrition & Metabolism
4. Elimination
5. Sleep & Rest
6. Self Perception & Concept
7. Roles & Relationships
8. Coping & Stress Tolerance
9. Sexuality & Reproductive Pattern
10.Values & Belief Pattern
11.COGNITION & PERCEPTION
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Cognitive & perception process
Learning objectives: At the end you will be able to:
• Identify components of cognitive & thought processes
• Describe normal characteristic's of cognition
• Recognize factors affecting normal cognitive function
• Identify manifestations of altered thought process
• Use nursing process for clients experiencing altered
thought process

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Terms in Cognition & Perception:
• Cognition: Systemic way in which person
thinks, reasons, & uses language
• Thought: Each instant of awareness
(consciousness)
• Memory: Capability of recalling thought at
least once & usually again
• Learning: Capability of nervous system to
store memories
 NB: The cerebral cortex coordinates
consciousness, thoughts, memories & learning
which are inseparable functions

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Cognition Versus perception
Cognition:
 It is a number of mental processes/ intellectual ability
such as attention, memory, thinking, motivation, Visual
& spatial processing, motor, reasoning & problem
solving
 It assist us to remember, think, know, judge, solve
problems, which can include both conscious &
unconscious processes
Perception:
 It is a cognitive skill or ability, which assists in enhancing
the quality of cognitive abilities through organization,
identification & interpretation
 It is organizing sensory information to interpret & give a
meaning
 It is the process by which we interpret things around
us/environment through our 5 sensory stimuli like sight, 5
Perception…
 In perception when we receive sensory
information, we not only identify it but also
respond to the environment accordingly
 In daily life, we rely greatly on this sensory
information for even the minute tasks
 E.g before crossing the road from a pedestrian
crossing, we usually tend to look both ways
before crossing the road
 It is the sensory information gained through
sight & sound that gives the signal for us to
cross the road
 This skill or ability does not require much effort
from the side of the individual as it is one of
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the simplest processes of cognition
Both cognition & perception:
Helps to identify impairments in motor &
sensory functions
 Evaluate cognitive comfort, pain, language &
communication
Deficit in any of these areas may increase the
person’s susceptibility to injury & interference
with the ability to live independently
Cognition & perception are divided into three
areas:
1.Cognitive function
2.Sensory/pain function
3.Motor function
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Anatomic & Physiologic Function of cognition &
perception:
• Information perception precedes information
processing
•Perception of information enters persons awareness
through special senses & use 4 cognitive processes:
consciousness, thoughts, memory & learning
• Intact structures & perceptual functioning of cerebral
cortex are needed for information processing
• Major sensory input is through eyes & ears
•Visual information is carried to the visual cortex by
neural axons from retinal ganglion cells w/c form optic
nerve
• Sound is transmitted through auricle & ear canal to
tympanic membrane then through ossicles w/c continue
transmission to the inner ear
•Sound moves through fluid of inner ear to the apex of8
Perception of information
• Perception of reality includes: the awareness
of time, the situation & the self
• Perception is a complex phenomenon w/c
depends on: functioning sense organs,
neurotransmission & intact central
processing
• Senses contributing to perception:
Vision, Hearing, Touch, Taste & Smell

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Classification of Sensory receptors:
1. Extero-ceptors: Distance senses, include
vision & hearing
2. Proprio-ceptors: Near senses, include
somatic senses (touch, temperature & pain),
taste & smell
3. Intero-ceptors: Deep senses & arise from
the viscera (internal organs) of the body &
deeper tissues like bones

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Cognitive Process
1. Consciousness:
• A state of awareness & full responsiveness to
stimuli
• Depends on intact reticular activating system
divides in to facilitatory & inhibitory areas
o Facilitatory area is active & produce
substances that increase muscle tone
o Inhibitory area causes opposite effect and
hence sleep
• Consciousness is achieved well when the two
areas are in equilibrium

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• The Glasgow Coma Scale (GCS) was
developed as a standardized tool to
assess LOC objectively.

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Descriptive terms for levels of
consciousness
A.Alert : The patient is awake, motor & verbally
responsive
B.Lethargic: The patient is sleepy or drowsy and
will awaken and respond appropriately to
command
C.Stupor: The patient becomes unconscious
spontaneously and is very hard to awaken
D.Semi coma: The patient is not awake but will
respond purposefully to deep pain
E.Coma: The patient is completely unresponsive

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2. Thoughts:
• It is instant of awareness (consciousness)
• Result of stimulation of many parts of the
Nervous System simultaneously
• The stimulation involves: cerebral cortex,
thalamus, rhinocephalon & the upper reticular
formation of the brain
3. Memory:
• It is capability of recalling thought at least
once & usually again

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Three types of memory:
1. Immediate/Short term/Temporary
memory:
• It is the retention of information for a
specified/ short period of time
• Information recorded is brief, shallow & easily
dissipated before it imprinted in to long-term
memory
• Example - the recall of a telephone number
long enough to dial it
2.Recent memory:
• It is the result of events that have occurred
over the past 24 hours
• 01/30/25
Example - the remembrance of foods eaten15
Three types of memory …
3.Long-term/Long lasting/Remote memory:
• It is the retention of experiences that occurred
during earlier periods of life
• Provides long term storage of cognitive data &
holds up well with aging process
• Example an adult’s memories of childhood or
school days. The ability to learn is dependent
on remote memory
• Pippocampus, a brain part located in temporal
lobes & part of limbic system, a great role in
creating memories by preventing saved data
from dissipating
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Characteristics of Normal Cognitive function:
1.Intelligence
• Measurable product of intellectual functioning
• Consists memory, comprehension & concentration
•Intelligence is difficult to measure
•Intellectual functioning is maintained in part by a
stimulating environment
o Crystallized intelligence (the application of
life experiences & learned skills to solve
problems; also called acquired knowledge)
generally increases with age
o Fluid intelligence (ability to acquire new
concepts and adapt to unfamiliar situations;
mental activities based on organizing
information) decreases over time 17
Characteristics of Normal Cognitive function
…
2. Reality perception (orientation)
•Awareness of time, place, situation & the self
•Depends on intactness of sense organs,
neurotransmission, & central processing
3. Communication
• Use of language to store, process, and
communicate (share) contents of thought

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4. Judgment (Insight):
• Ability to process incoming stimuli & determine
complex meaning that include many aspects of
situation
• It is the ability to compare or evaluate alternatives to
life situations & arrive at an appropriate course of
action
• It is closely related to reality testing & depends on
effective cognitive functioning
• It is process of reasoning
5. Recall & Recognition:
• Recall is ability to retrieve data directly or by relating
to other information
• Recognition is ability to accurately relate something
currently in the environment with what is in the
memory
• Both are skills that can be learned and need to be 19
Normal cognitive functional pattern
I. Perceiving
• Process of recognizing & interpreting sensory
stimuli that function as a basis for
understanding, knowing or learning
• 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 or a hallucination
II. Thinking
• Process of sorting, organizing & categorizing
information to form mental concepts or
perception
• Process of forming ideas or arriving at
conclusions 20
Two types of thinking:
1. Concrete thinking
• Thinking that involves objects or group of
things that can be perceived by senses
• E.g. 1+1 = 2 can be proofed by attaching
the numbers to objects
2. Abstract thinking
• High level of thinking that involves a thought
or idea that is apart from any material object

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III. Learning
• Process of acquiring knowledge
• Multidimensional process that depends on
symbols, language, classifications, concepts &
other concrete operations along with abstract
functioning
IV. Remembering
• Process of retrieving data in memory for use
• Content of long-term memory depends on
perceived value & significance of the
event
• Events like wedding & child birth hold
greater value & memory potential
• Short-term memory can easily affected by
emotional stress 22
Factors affecting normal cognitive function:
1.Adequate blood flow
•Adequate oxygenation depends on adequate blood
flow
•Oxygenation depends on three factors: respiratory
function, circulatory function & hemoglobin
production
•Brain alone consumes 20% of the total oxygen up
take by the body & needs constant, ample supply to
support brain cells’ life
2. Nutrition & metabolism
• Brain cells need constant supply of glucose for
metabolic energy, iron for hemoglobin formation &
other nutrients for optimal functioning
•Brain alone consumes 25% of glucose used by the
body 23
3. Fluid & electrolytes balance
• Brain cells require constant extracellular environment of
fluid & electrolytes for optimum functioning
• Blood-brain barrier (BBB) protects brain cells from
substances other than normal fluid & electrolytes that
could cause damage
4. Sleep & rest
• Sleep has restorative function to regain energy for
cognitive functions such as concentrating, organizing,
remembering, & reasoning
• REM (rapid eye movementt) sleep is particularly
important for cognitive functioning
5. Ability of organizing incoming stimuli
• Cognitive processes as perceiving, thinking, reasoning &
remembering depend on ability to receive & organize
stimuli
• Organizing function decline as age increase beyond 24
Potential risks for altered cognitive function
 Inadequate blood flow
 Altered nutrition & metabolism
 Fluid & electrolytes imbalances: Can cause delirium
(mental disorientation) or confusion
 Infectious process: CNS infection, bacteremia, &
septicemia can cause confusion
 Inadequate sleep & rest
 Inability to organize incoming stimuli: Happen
due to emotional stress or discomfort, env’tal
stress & pharmacologic agents
 Degenerative processes:
• Degeneration of brain cells ultimately affect cognitive
processes
• Dementia: Progressive brain deterioration

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Manifestations of altered cognitive
function:
1. Disorganized thinking
• Disturbed thought process as manifested by
regression, hallucinations & delusions
2. Impaired thought processes
• Caused due to attention span deficits,
memory impairments, level of arousal
alterations & sundown syndrome
(disorientation & agitation that occur at night
in institutionalized individuals)

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 ASSESSMENT:
A. Subjective Data:
Functional Pattern Identification
•Gather information on functional pattern of the
client
•Assess patients’ usual cognitive function & its
impact on activities of daily living
•Assess perception of reality (orientation to place,
person & time)
 Risk Identification
•Assess physiologic, psychological &
environmental factors that can increase the
likelihood of experiencing impaired thought
processes 27
A. Subjective data cont’d …
I. Physiologic risk factors:
• Fluid imbalance
• Electrolytes imbalance
• Pain
• Decreased oxygen supply
• Renal or hepatic failure
• Inadequate blood flow
• Neurological impairment
• Systemic infection
• Medication toxicity

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Subjective data cont’d …
II. Psychological risk factors:
• Grief response to loses
• Change in socioeconomic situation
• Depression or anxiety
III. Environmental risk factors:
• Unfamiliar environment
• Altered sensory input
• Mobility restriction
 Dysfunction identification
• Using data from functional pattern & risk identification
• Analyze & determine if dysfunction is present
• Provide clear information on identified 29
 B. Objective data:
Physical assessment
Assess the following:
•Respiratory function
•Cardiovascular function
•Nutritional status
•Medical history
•Sleep & rest function
•Motor activity
•Activities of daily living

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 B. Objective data …
Diagnostic tests:
Physiologic tests
• Arterial oxygen
• Electrolytes
• Serum glucose
• Urea & toxic levels of drugs
Tests of cognitive functions ( The five
senses)

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NURSING DIAGNOSES:
1.Altered thought process:
•It is disruption in cognitive operations & activities
•Characterized by:
o Inaccurate interpretation of environment
o Disorganized thinking
o Distractibility
o Memory deficit/problems
o Self-centeredness
o Attention dysfunction
o Non-reality based thinking

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NURSING DIAGNOSES …
•Related factors
o Physiologic factors
o Psychological/emotional factors
o Environmental factors
•Related nursing diagnoses
o Sensory/perceptual alterations
o Altered nutrition intake: less than body
requirements
o Hypothermia
o Sleep pattern disturbances, etc

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NURSING INTERVENTIONS:
Nursing interventions to promote cognitive health &
function
• Promote healthy lifestyle
• Memory improvement
• Maintenance of learning skills
Nursing interventions for altered cognitive function
• Fluid intake & nutrition
• Mobility
• Safety
• Therapeutic communication
• Reality orientation
• Socialization therapy
• Recreation therapy
• Music therapy 34
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