38 Questions
What is the primary reason for assessing a patient's level of consciousness?
To document brain functional level after brain surgery
What is the Glasgow Coma Scale score of a patient who is fully awake and oriented?
15
What is the most common complication associated with altered levels of consciousness?
Respiratory failure
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
What is the primary goal of management in patients with altered levels of consciousness?
Maintain a patent airway and provide oxygenation
What is the primary cause of neurologic dysfunction in patients with altered levels of consciousness?
Neurologic disorders, such as head injury or stroke
What is the term for a patient who is moderately reduced in alertness and needs repeated stimulation to maintain attention?
Obtunded
What is the primary concern in patients who are comatose?
Risk for aspiration
What is the primary goal of maintaining cerebral perfusion?
To reduce metabolic demands
What is the most common diagnostic test used to diagnose hydrocephalus?
CT Scan and MRI
What is the purpose of inotropic agents in treating hydrocephalus?
To increase cardiac output
What is the effect of fever on cerebral edema?
It increases the rate of cerebral edema formation
What is the purpose of antipyretics in treating hydrocephalus?
To reduce fever and prevent further cerebral edema formation
What is the purpose of craniotomy in treating hydrocephalus?
To surgically relieve pressure on the brain
What is the earliest sign of increased intracranial pressure?
Changes in level of consciousness
What is the purpose of barbiturates in treating hydrocephalus?
To induce sedation and reduce cerebral oxygen demands
What is the purpose of a ventriculostomy?
To monitor ICP and drain CSF
What is the purpose of elevating the head of the bed to 15-30˚?
To reduce intracranial pressure
What is the purpose of administering 100% oxygen?
To improve oxygenation
What is the purpose of administering mannitol?
To reduce ICP
What is Cushing's triad?
Increased ICP, bradycardia, and hypertension
What is the purpose of preventing Valsalva maneuver?
To prevent straining during defecation
What is the purpose of administering corticosteroids?
To decrease cerebral edema
What is the Monro-Kellie hypothesis?
The idea that the skull is a rigid container
What is the primary purpose of the Glasgow Coma Scale?
To define the level of consciousness
What is the characteristic of a patient in a stupor state?
Unconscious most of the time but makes spontaneous movements
What is the primary goal of maintaining skin and joint integrity in a comatose patient?
To prevent contractures and maintain range of motion
What is the underlying cause of increased intracranial pressure in a patient with a brain tumor?
All of the above
What is the purpose of providing oral care to a comatose patient?
To maintain oral hygiene
What is the characteristic of a patient in a coma state?
Unconscious with no response to stimuli
What is the goal of limiting fluid intake in a patient with increased intracranial pressure?
To reduce edema surrounding the tumor
What is the purpose of providing sensory stimulation to a comatose patient?
To prevent sensory deprivation
What is the primary effect of administering mannitol and hypertonic saline to a patient?
Dehydration of brain tissue and reduction of cerebral edema
What is the primary characteristic of a patient in a persistent vegetative state?
Resumes sleep-wake cycle but lacks cognitive function
What is the term for a state of unresponsiveness to the environment in which a patient makes no voluntary movement?
Akinetic mutism
What is the approximate volume of brain parenchyma in the cranium?
1400 ml
What is the approximate percentage of CSF in the cranium?
10%
What is the clinical state of unarousable, unresponsive in which there are no purposeful responses to internal or external stimuli?
Coma
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
This quiz covers patients with neurologic dysfunctions, focusing on altered levels of consciousness, including the use of the Glasgow Coma Scale (E_V_M).
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