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Questions and Answers
Which of the following terms refers to the disruption of the reticular activating system (RAS)?
What abnormal posturing is typically present when there is metabolic depression?
In a state of unconsciousness, what is the likely status of the corneal reflex?
Which condition may present with frontal headaches and local seizures?
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What is a common feature of Extraocular Movements in someone who is awake and aware?
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What is a common characteristic of a confused person?
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In a person experiencing disorientation, what might be a symptom they exhibit?
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What is a potential sign of delirium in a person with a 'mark deficit in attention'?
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Which type of lesions are associated with structural manifestations that could lead to coma?
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What does 'Hemi-Paresis/plegia' refer to in the context of comatose states?
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Which condition is most likely indicated by a Siriraj Stroke Score total score of (+2)?
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What is a common clinical feature associated with aneurysms and AVMs?
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Which diagnostic method is particularly useful for assessing cerebral edema and increased ICP?
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What symptom is often associated with vascular lesions that lead to headache, specifically in the occipital area?
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What is the main purpose of pharmacotherapy involving osmotic diuretics in stroke management?
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Which type of stroke accounts for 85% of all strokes?
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In the context of Siriraj Stroke Score interpretation, what does a total score that is less than (-)2 most likely indicate?
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What is the most lethal type of stroke?
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Which type of edema involves an increase in the extracellular fluid volume due to increased permeability of the blood-brain barrier to proteins?
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Which demographic group has a higher risk of stroke, with Blacks being more at risk compared to Caucasians?
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Where does intracerebral hemorrhage commonly occur in hypertensive individuals?
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What is the main pathological process in cellular edema, resulting in swelling of all cellular elements in the brain?
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Which statement best describes a person in a somnolent state?
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What is a common characteristic of a person in a comatose state?
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What does brain death refer to?
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What might be a symptom of brain death according to the text?
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What is a key characteristic of stupor according to the text?
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Which nursing management action is NOT recommended for a patient with increased intracranial pressure?
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Study Notes
Levels of Consciousness
- Decreased alertness and slowed psychomotor responses are characteristics of disoriented patients.
- Somnolent patients show excessive drowsiness and respond to stimuli only with incoherent mumbles or disorganized movements.
- Obtunded patients have decreased interest in their surroundings, slowed responses, and sleepiness.
- Comatose patients are in a sleep-like state and cannot be aroused.
- Stuporous patients only respond to pain stimuli by grimacing or drawing away.
Brain Death
- Irreversible damage to the cerebrum and brainstem defines brain death.
- Criteria for brain death include:
- Unresponsive coma
- Varying response to painful stimuli
- No voluntary movement
- Altered respiratory patterns
- Altered pupillary response to light
- No blinking
Coma
- Unresponsive coma with no motor/sensory reflex response
- No spontaneous respiration
- No Doll's eye or Caloric test with fixed and dilated pupils
- Persistence of symptoms for 30 minutes to 1 hour after onset of coma/apnea
- No cerebral perfusion studies
Motor Responses
- Most powerful predictor of outcome in patients with severe impairment
- Spontaneous movement vs response to stimuli
Increased Intracranial Pressure
- Increased pressure exerted in the cranium by its content
- Vital signs:
- Widening pulse pressure
- Hypo/hyperthermia
- Tachy/bradypnea
- Tachy/bradycardia
- Cushing's changes/triad
- Nursing management:
- Maintain skin integrity
- Maintain patent airway
- Maintain muscle tone and joint movement
- Pneumonia and aspiration precautions
- Oral care
- Maintenance of nutrition
- Protection from injury
- Promote adequate cerebral perfusion
Cerebral Perfusion Pressure (CPP)
- 70-90/120 mmHg
- CPP = MAP - ICP
Medical Management
- Goal: Improve or correct the cause of altered LOC
- Management:
- Maintain skin integrity
- Maintain patent airway
- Maintain muscle tone and joint movement
- Pneumonia and aspiration precautions
- Oral care
- Maintenance of nutrition
- Protection from injury
- Promote adequate cerebral perfusion
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Description
Test your knowledge on disorders affecting consciousness, wakefulness, awareness, and unconsciousness in the nervous system. Explore topics like disruptions in the reticular activating system, metabolic depression, abnormal posturing, absent or present reflexes, and structural and behavioral changes associated with nervous system disorders.
