N240 Olol - Test 2 - Neurological Assessment Of The Unconscious Client

Front 1

States of Unconsciousness

Back 1

-Coma: unarousable with eyes closed. No evidence of eye opening spontaneously or in response to external stimuli. Does not follow commands, nonverbal, no purposeful behavior or movement.

-Persistent vegetative state: Wakeful but no cognitive function. May posture to pain or become tachycardic, diaphoretic, or have reflex hand grasp. Roving eye movements with no visual tracking.Random movement. Brain stem reflexes intact (oculocephalic, chewing, swallowing).

-Locked in syndrome: arousal and content of thought intact. Efferent pathways disrupted. Cannot communicate verbally or through body movements. Vertical eye movements and blink intact.

Front 2

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Back 2

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Front 3

Pathophysiology of unconsciousness

Back 3

-Consciousness depends on an intact reticular activating system and cognitive ability of the cerebral cortex.

-Cerebral edema, metabolic disturbances, trauma can result in unconsciousness.

Front 4

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Back 4

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Front 5

Assessment of LOC

Back 5

-Awake and alert: appropriate response to environment.
-Oriented: to place, time, and person
-Lethargy: Drowsy but arouses easily. Falls back to sleep if not continuously stimulated.
-Stuporous: Arouses with difficulty for short periods, responds slowly, probably confused, responds to pain.
-Comatose: does not arouse to voice or physical stimuli. May exhibit decerebrate or decorticate posturing to pain. May be flaccid. Pupils may react, gag may be present, may breathe on their own, corneal reflex may be intact.
-Brain death: flaccid, unarousable, No ad lib movement or to pain, no corneal reflex, no gag, pupils dilated and fixed, apnic.

Front 6

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Back 6

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Front 7

Glasgow Coma Scale used for
Assessment of LOC (con't)

Back 7

Important to know per Ms. Schulter

Glasgow Coma Scale – Measures LOC . Patient is scored based on eye opening, verbal response, and motor response. Best score 15, lowest score 3. GCS less than 8 indicates coma.

Front 8

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Back 8

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Front 9

Assessment of Pupils

Back 9

-Remember that the centers of arousal are near the areas that control pupils.
-Record pupil size with a pupil gauge
-Reaction to light as brisk, sluggish or absent. Response should be concensual.
-Round or oval: oval pupil indicates increasing ICP and possible herniation.
Check past medical history for eye surgery that could result in irregular shaped pupils.

Front 10

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Back 10

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Front 11

Pathological reflexes

Back 11

Babinski – extension of the great toe with fanning of the other toes, when the plantar surface of the foot is stroked. Normal in infants up to age 2.

Front 12

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Back 12

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Front 13

Reflex grasp

Back 13

-Reflex grasp – place two fingers into the palm of the patient’s hand. The patient grasps your fingers and will not let you pull away.

-Corneal reflex – blink to cotton wisp applied to cornea of eye.

Front 14

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Back 14

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Front 15

Brainstem assessment

Back 15

-Oculocephalic: Doll’s eyes. And roving eye movements indicate intact brain stem.
Normal response eyes turn together opposite from the direction head is turned.

-Oculocaloric: ice water irrigation to the ear with eyes deviating toward the stimulus.
Always performed by physician.

Front 16

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Back 16

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Front 17

Decerebrate and decorticate posturing

Back 17

Pictures in lecture notes.

-Decerebrate posturing: hyperextension and pronation of arms, extension of legs

-Decorticate posturing: flexion of arms, extension of legs.