NUR 243: Module D-Neuro
Level of Consciousness (LOC)
state of awareness of self and environment; earliest sign of improvement and
worsening.
-Full consciousness
-Confusion
-Disorientation
-Lethargy
-Obtunded
-Stupor
-Coma
-Persistent Vegetative state
Obtunded (LOC)
Arousable with stimulation
Stupor (LOC)
Remains in a deep sleep, responsive to vigorous and repeated stimulation
Coma (LOC)
No motor or verbal response to noxious painful stimuli.
persistent vegetative state (LOC)
Permanent lost function of cerebral cortex.
Eyes follow only by reflex or attracted by loud sound. Limbs are spastic, but
can withdraw to painful stimuli, the face can grimace, can groan or cry, but no
words.
Pediatric Glasgow Coma Scale
Three part assessment:
-Eyes
,-Verbal response
-Motor response
Score of 15: unaltered LOC
Score of 3: extremely decreased LOC
(Many times <8 = definition of a coma)
Increased Intracranial Pressure (ICP)
Increased pressure in the skull; often occurs as complication of a neurological
injury.
As pressures increases the signs and symptoms become more pronounced and
the level of consciousness begins to deteriorate.
Causes:
-Trauma
-Hydrocephalus
-Brain tumor
-Intracranial infection
Increased ICP S/S (infants)
S/S:
-Irritability and restlessness
-Tense, bulging fontanel
-Separated cranial sutures
-Drowsiness
-Increased sleeping
-High-pitched cry
-Increased front-occipital circumference
-Distended scalp veins
, -Poor feeding
-Crying when disturbed
-Setting-sun eyes
Increased ICP S/S (children)
S/S:
-Headache (especially upon awakening)
-Nausea
-Forceful Vomiting
-Diplopia or blurred vision
-Seizures
-Drowsiness
-Decline in school performance
-Diminished physical activity
-Increased sleeping
-Inability to follow simple commands
-Lethargy
[Can tell you what hurts or what's happening]
Late signs of increased ICP
S/S:
-Bradycardia
-Decreased motor response to command
-Decreased sensory response to painful stimuli
-Alterations in pupil size and reactivity
-Extension and flexion posturing (Decerobate or decorticate)
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