Coma, Seizures, Confusion,

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coma

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a state of unresponsiveness in which an individual cannot be aroused by verbal, physical, or powerful pain stimuli

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5 levels of acute coma

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confusion, disorentation, lethargy, obtundation, stupor, coma

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confusion

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loss of ability to think rapidly and clearly; impaired judgment and decision making

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disorentation

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beginning loss of consciousness; disorentation to time followed by disorentation to place and impaired memory; lost last is recognition of self

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lethargy

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limited spontaneous movement or speech; easy arousal with normal speech or touch; may not be oriented to time, place, or person

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obtundation

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mild to moderate reduction in arousal with limited response to the environment; falls asleep unless stimulated verbally or tactiley; answers questions with minimum response

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stupor

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a condition of deep sleep or unresponsiveness from which the person may be aroused or caused to open eyes only by vigorous and repeated stimulation; response is often withdrawal or grabbing at stimulus

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no verbal response to the external environment or to any stimuli; noxious stimuli such as deep pain or suctioning yield motor movement

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coma

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there are 3 types of coma

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light coma, coma, deep coma

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light coma/type 1

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associated with purposeful movement on stimulation

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coma/type 2

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associated with nonpurposeful movement only on stimulation

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deep coma/type 3

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associated with unresponsiveness or no response to any stimulus

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5 areas of assessment of coma

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level of consciousness, pattern of breathing, papillary changes, oculomotor responses, motor responses

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2 types of patterns of breathing

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hemispheric and brain stem

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3 types of hemispheric breathing patterns

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normal, posthyperventilation apnea, cheyne-stokes respirations

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5 types of brain stem breathing patterns

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central reflex hyperapnea, apneusis, cluster breathing, ataxic breathing, gasping breathing pattern (agonal gasps)

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normal hemishperic breathing pattern

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after a period of hyperventilation that lowers the arterial carbon dioxide pressure, the individual continues to breath regularly but with a reduced depth

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posthyperventilation apnea (PHVA) hemispheric breathing pattern

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respirations stop after hyperventilation has lowered the arterial carbon dioxide pressure level below normal. Rhythmic breathing returns when the PCO2 level returns to normal

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cheyen-stokes respirations (CSR) hemispheric breathing pattern

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the breathing pattern has a smooth increase in the rate and depth of breathing, which peaks and is followed by a gradual smooth decrease in the rate and depth of breathing to the point of apnea when the cycle repeats itself; the hyperpenic phase lasts longer than the apenic phase

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central reflex hyperpnea (central neurogenic hyperventilation [CNH]) brain stem breathing pattern

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a sustained deep rapid, but regular pattern (hyperpnea) occurs, with a decreased PCO2 and a corresponding increase in pH and increased PO2.

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apneusis brain stem breathing pattern

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a prolonged inspiratory cramp (a phase a full inspiration) occurs. A common variant of this is a brief end-inspiratory pause of 2 or 3 seconds, often alternating with an end-expiratory pause

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cluster breathing brain stem breathing pattern

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a cluster of breaths has a disordered sequence with irregular pauses between breaths

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ataxic breathing brain stem breathing pattern

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completely irregular breathing occurs, with random shallow and deep breaths and irregular pauses. often the rate is slow

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gasping brain stem breathing pattern (agonal gasps)

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a pattern of deep "all-or-none" breaths accompanied by a slow respiratory rate

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treatment of coma

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treat cause, positioning, nutritional, prevent foot drop, support family

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causes of coma

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internal and external hypoxia, vascular hemmorage, hypoglycemia

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Brain death (brain stem death)

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death of hindbrain and area that controls pulse, respiration, autonomic nervous responses

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cerebral death (irreversible coma)

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death of gray matter

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brain stem death is

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measurable

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in brain stem death you may or may not have

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cerebral death, but usually do

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brain and cerebral death are diagnosed by

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EEG

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in cerebral death there

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is brain activity

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in brain death there is

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no brain activity

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vegetative state (VS)

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a physical condition in which a previously comatose patient continues to be unable to communicate or respond to stimuli, despite at times giving the appearance of wakefulness. the eyes may be open

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minimally conscious state(MCS)

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a condition of severely altered consciousness in which the person demonstrates minimal but defined behavioral evidence of self or environmental awareness

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lock-in syndrome

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both the content of thought and level of arousal are intact, but the efferent pathways are disrupted, thus the individual cannot communicate either through speech or body movement but is fully conscious, with intact cognitive function

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seizures

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a sudden explosive, disorderly discharge of cerebral neurons and is characterized by a sudden, transient alteration in brain function, usually involving motor, sensory, autonomic, or physic clinical manifestations and an alteration in arousal

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epilepsy

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a general term for the primary condition that causes seizures

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in 2/3 of seizures

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the cause or etiology is unknown

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data processing deficits

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agnosia, dysphasia, aphasia

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agnosia has three categories

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tactile, spatial, agraphia

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agnosia

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a defect of pattern recognition--a failure to recognize the form and nature of objects

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the disorder of agnosia involves

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the loss of recognition through one sense, although the object or person may be recognized by other senses

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tactile agnosia

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cannot determine what is what

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spatial agnosia

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cannot say what used for and why it's there

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agraphia agnosia

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inability to write

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dysphasia

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an impairment of comprehension or production of language. comprehension or use of symbols, in either written or verbal language, is distrubed or lost

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aphasia

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loss of the comprehension or production of language

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states of confusion

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delirum (acute), dementia (chronic)

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acute confusional states

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an aquired mental disorder characterizzed by deficits in attention and coherence of thoughts and actions often associated with an altered level of arousal, global cognitive dysfunction, perceptual disturbances, sleep-awake cycle disruption, affective disturbance, and emotional liability

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delirum

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is associated with right middle temporal gyrus or left temporal-occipital junction disruption. these areas recieve extensive input from the limbic areas and modulate motivational and affective aspects of attention

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dementia

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progressive failure of many cerebral functions that is not caused by an impaired level of consciousness.

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the dementias are characterized by

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reduction in cognitive functions (intellectual)

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in dementia

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mental abilities are impaired, with a decrease in orienting, recent memory, remote memory, language, executive attentional functions, and alterations in behavior

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normal intracranial pressure

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5-15 mm Hg or 60-180 cm H2O

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diseases/disorders that can affect ICP

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herniation, hemorrhagic stroke, tumor, hematoma, hydocephalus, cerebral edema

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hypotonia

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decreased muscle tone

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hypertonia

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increased muscle tone