Medical-Surgical Nursing 2: Nervous System Disorders of Consciousness Quiz

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28 Questions

Which of the following terms refers to the disruption of the reticular activating system (RAS)?

Unconsciousness

What abnormal posturing is typically present when there is metabolic depression?

Decorticate

In a state of unconsciousness, what is the likely status of the corneal reflex?

Unequal, maybe absent

Which condition may present with frontal headaches and local seizures?

Behavioral Changes

What is a common feature of Extraocular Movements in someone who is awake and aware?

Normal Awake, aware

What is a common characteristic of a confused person?

Impairment in judgment and decision making

In a person experiencing disorientation, what might be a symptom they exhibit?

Restlessness and hallucinations

What is a potential sign of delirium in a person with a 'mark deficit in attention'?

Agitation and restlessness

Which type of lesions are associated with structural manifestations that could lead to coma?

Infratentorial Lesions

What does 'Hemi-Paresis/plegia' refer to in the context of comatose states?

Partial paralysis on one side of the body

Which condition is most likely indicated by a Siriraj Stroke Score total score of (+2)?

Hemorrhage

What is a common clinical feature associated with aneurysms and AVMs?

Photophobia

Which diagnostic method is particularly useful for assessing cerebral edema and increased ICP?

CT Scan

What symptom is often associated with vascular lesions that lead to headache, specifically in the occipital area?

Blurred vision

What is the main purpose of pharmacotherapy involving osmotic diuretics in stroke management?

Manage cerebral edema

Which type of stroke accounts for 85% of all strokes?

Ischemic Stroke

In the context of Siriraj Stroke Score interpretation, what does a total score that is less than (-)2 most likely indicate?

Infarction

What is the most lethal type of stroke?

Hemorrhagic Stroke

Which type of edema involves an increase in the extracellular fluid volume due to increased permeability of the blood-brain barrier to proteins?

Vasogenic Edema

Which demographic group has a higher risk of stroke, with Blacks being more at risk compared to Caucasians?

Blacks

Where does intracerebral hemorrhage commonly occur in hypertensive individuals?

Putamen

What is the main pathological process in cellular edema, resulting in swelling of all cellular elements in the brain?

Increased Intracellular Water

Which statement best describes a person in a somnolent state?

Displays excessive drowsiness and responds with incoherent mumbles

What is a common characteristic of a person in a comatose state?

Responds by grimacing or drawing away from pain stimuli

What does brain death refer to?

Irreversible damage to the cerebrum and brainstem

What might be a symptom of brain death according to the text?

Altered respiratory patterns

What is a key characteristic of stupor according to the text?

Unable to move voluntarily

Which nursing management action is NOT recommended for a patient with increased intracranial pressure?

Increase body temperature

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

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.

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