Neurologic Dysfunctions and Altered Level of Consciousness

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Questions and Answers

What is the primary reason for assessing a patient's level of consciousness?

To evaluate the effectiveness of pain management

To monitor for respiratory failure

To document brain functional level after brain surgery (correct)

To determine the patient's risk for pressure ulcers

What is the Glasgow Coma Scale score of a patient who is fully awake and oriented?

15 (correct)

What is the most common complication associated with altered levels of consciousness?

Pneumonia

Respiratory failure (correct)

Deep vein thrombosis

Aspiration

A patient is described as lethargic. What can be expected of this patient?

The patient can be aroused from sleep but falls back to sleep when stimulation ceases Signup and view all the answers

What is the primary goal of management in patients with altered levels of consciousness?

Maintain a patent airway and provide oxygenation Signup and view all the answers

What is the primary cause of neurologic dysfunction in patients with altered levels of consciousness?

Neurologic disorders, such as head injury or stroke Signup and view all the answers

What is the term for a patient who is moderately reduced in alertness and needs repeated stimulation to maintain attention?

Obtunded Signup and view all the answers

What is the primary concern in patients who are comatose?

Risk for aspiration Signup and view all the answers

What is the primary goal of maintaining cerebral perfusion?

To reduce metabolic demands Signup and view all the answers

What is the most common diagnostic test used to diagnose hydrocephalus?

CT Scan and MRI Signup and view all the answers

What is the purpose of inotropic agents in treating hydrocephalus?

To increase cardiac output Signup and view all the answers

What is the effect of fever on cerebral edema?

It increases the rate of cerebral edema formation Signup and view all the answers

What is the purpose of antipyretics in treating hydrocephalus?

To reduce fever and prevent further cerebral edema formation Signup and view all the answers

What is the purpose of craniotomy in treating hydrocephalus?

To surgically relieve pressure on the brain Signup and view all the answers

What is the earliest sign of increased intracranial pressure?

Changes in level of consciousness Signup and view all the answers

What is the purpose of barbiturates in treating hydrocephalus?

To induce sedation and reduce cerebral oxygen demands Signup and view all the answers

What is the purpose of a ventriculostomy?

To monitor ICP and drain CSF Signup and view all the answers

What is the purpose of elevating the head of the bed to 15-30˚?

To reduce intracranial pressure Signup and view all the answers

What is the purpose of administering 100% oxygen?

To improve oxygenation Signup and view all the answers

What is the purpose of administering mannitol?

To reduce ICP Signup and view all the answers

What is Cushing's triad?

Increased ICP, bradycardia, and hypertension Signup and view all the answers

What is the purpose of preventing Valsalva maneuver?

To prevent straining during defecation Signup and view all the answers

What is the purpose of administering corticosteroids?

To decrease cerebral edema Signup and view all the answers

What is the Monro-Kellie hypothesis?

The idea that the skull is a rigid container Signup and view all the answers

What is the primary purpose of the Glasgow Coma Scale?

To define the level of consciousness Signup and view all the answers

What is the characteristic of a patient in a stupor state?

Unconscious most of the time but makes spontaneous movements Signup and view all the answers

What is the primary goal of maintaining skin and joint integrity in a comatose patient?

To prevent contractures and maintain range of motion Signup and view all the answers

What is the underlying cause of increased intracranial pressure in a patient with a brain tumor?

All of the above Signup and view all the answers

What is the purpose of providing oral care to a comatose patient?

To maintain oral hygiene Signup and view all the answers

What is the characteristic of a patient in a coma state?

Unconscious with no response to stimuli Signup and view all the answers

What is the goal of limiting fluid intake in a patient with increased intracranial pressure?

To reduce edema surrounding the tumor Signup and view all the answers

What is the purpose of providing sensory stimulation to a comatose patient?

To prevent sensory deprivation Signup and view all the answers

What is the primary effect of administering mannitol and hypertonic saline to a patient?

Dehydration of brain tissue and reduction of cerebral edema Signup and view all the answers

What is the primary characteristic of a patient in a persistent vegetative state?

Resumes sleep-wake cycle but lacks cognitive function Signup and view all the answers

What is the term for a state of unresponsiveness to the environment in which a patient makes no voluntary movement?

Akinetic mutism Signup and view all the answers

What is the approximate volume of brain parenchyma in the cranium?

1400 ml Signup and view all the answers

What is the approximate percentage of CSF in the cranium?

10% Signup and view all the answers

What is the clinical state of unarousable, unresponsive in which there are no purposeful responses to internal or external stimuli?

Coma Signup and view all the answers

Study Notes

Altered Level of Consciousness

Altered level of consciousness is often assessed after brain surgery
Documented as E4V5M6, with three numbers added together to reflect brain functional level
Fully awake person scores 15, while a score of 7 or less indicates coma

Etiology

Neurologic: head injury or stroke
Toxicology: drug overdose, alcohol intoxication
Metabolic: hepatic or kidney injury, diabetic ketoacidosis

Levels of Consciousness

Alert: fully awake, oriented, and responsive to external stimuli
Lethargic: mild reduction in alertness, somnolent, and indifferent to surroundings
Obtunded: moderate reduction in alertness, needs repeated stimulation to respond
Stupor: unconscious, makes spontaneous movements, and responds to strong, continuous, noxious stimuli
Coma: absence of voluntary response to stimuli, including painful stimuli

Complications

Respiratory failure
Pneumonia (risk for aspiration)
Pressure ulcers (due to immobility)
Aspiration
DVT (due to immobility)

Management

Maintain patent airway and provide oxygenation
Promote safety
Adequate nutrition and fluid balance (NGT, TPN)
Provide oral care
Maintain skin and joint integrity (passive ROM exercises)
Maintain corneal integrity (cotton soaked with NSS)

Increased Intracranial Pressure

Causes: head injury, brain hemorrhage, infection, tumors, localized abscess, and accumulation of excessive CSF
Diagnostic tests: CT scan, MRI, cerebral angiography, and PET scan
Management: osmotic diuresis, corticosteroids, and craniotomy

Nursing Management

Maintain patent airway
Elevate head to 15-30˚
Prevent Valsalva maneuver
Administer 100% oxygen
Administer medications as prescribed
Monitor ICP

Other Terminologies

Coma: clinical state of unarousable, unresponsive, with no purposeful responses to internal/external stimuli
Akinetic mutism: state of unresponsiveness to the environment, with no voluntary movement, but unconscious awareness
Persistent vegetative state: condition in which the patient, after coma, resumes sleep-wake cycle but is devoid of cognitive or affective mental function

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Description

This quiz covers patients with neurologic dysfunctions, focusing on altered levels of consciousness, including the use of the Glasgow Coma Scale (E_V_M).