Family member present



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tarix09.02.2017
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#8092



Family member present

  • Family member present

  • Vaccination

  • Major injuries

  • Childhood illnesses

  • Family

  • Present illness



Pain

  • Pain

    • Location
    • Quality
    • Severity
    • Duration
    • Precipitating factors
    • Associated symptoms
    • Exasperation / diminished pain
    • Onset




Multiple causes

  • Multiple causes

  • Not a good indicator of neuro trouble



Sensation of moving around in space or objects moving around them

  • Sensation of moving around in space or objects moving around them

  • Assoc symptoms



Definition



Diplopia

  • Diplopia

  • Clarity

  • Nystagmus



Thinking

  • Thinking

  • Memory

  • Personality



Projectile

  • Projectile



Mental status

  • Mental status

  • Intellectual function

  • Thought content

  • Emotional status

  • Perception

  • Motor ability

  • Language ability



Level of consciousness

  • Level of consciousness

    • Rostral-claudal Progression
      • Dullness 
      • Confusion 
      • Lethargy 
      • Stupor 
      • Coma


Alert

    • Alert
      • Open eyes spontaneously
      • Responds appropriately, briskly
      • Oriented


Lethargic

  • Lethargic

    • Opens eyes to verbal stimuli
    • Slow to respond, but appropriate
    • Short attention span
    • Obtunded
      • Sleepy


Stupor

  • Stupor

    • Responds to stimuli (usually physical) with moans and groans
    • Never fully awake
    • Confused
    • Conversation unclear


Semi Comatose

  • Semi Comatose

    • Responds to painful stimuli
    • Conversation:
      • none
    • Protective reflexes
      • present


Coma

  • Coma

    • Unresponsive except to severe pain
    • Protective reflexes absent
    • Pupils fixed
    • No voluntary movement


Non-medical word

  • Non-medical word

  • Ranges from stupor to coma



No cognitive brain function

  • No cognitive brain function

  • Wake sleep cycles

  • Very poor prognosis (if > 3-6 months)



No brain function

  • No brain function

  • Only reflexive movements



Voice

  • Voice

  • Touch

  • Shaking

  • Voice + Shaking

  • Noxious/painful stimuli



Eye opens

  • Eye opens

  • Remove stimuli

  • Abnormal posturing

  • No response



Eye Opening

  • Eye Opening

    • Spontaneous – 4
    • To speech – 3
    • To pain – 2
    • Nil – 1


Best Motor Response

  • Best Motor Response

    • Obeys -6
    • Localizes – 5
    • Withdraws – 4
    • Abnormal flexion – 3
    • Extension response – 2
    • Nil - 1


Verbal response

  • Verbal response

    • Oriented – 5
    • Confused conversation – 4
    • Inappropriate words – 3
    • Incomprehensible sounds – 2
    • Nil - 1


A strong predictor of outcome

  • A strong predictor of outcome

  • 13: mild brain injury

  • 9-12: Moderate brain injury

  • < 8: Severe brain injury (coma)



The nurse is caring for an adult client who was admitted unconscious. The initial assessment utilized the Glasgow Coma Scale. The nurse knows that the Glasgow Coma Scale is a systemic neurological assessment tool that evaluates all of the following EXCEPT

  • The nurse is caring for an adult client who was admitted unconscious. The initial assessment utilized the Glasgow Coma Scale. The nurse knows that the Glasgow Coma Scale is a systemic neurological assessment tool that evaluates all of the following EXCEPT

      • Eye opening
      • Motor response
      • Pupillary reaction
      • Verbal performance


The nurse is caring for an adult client who was admitted unconscious. The initial assessment utilized the Glasgow Coma Scale. The nurse knows that the Glasgow Coma Scale is a systemic neurological assessment tool that evaluates all of the following EXCEPT

  • The nurse is caring for an adult client who was admitted unconscious. The initial assessment utilized the Glasgow Coma Scale. The nurse knows that the Glasgow Coma Scale is a systemic neurological assessment tool that evaluates all of the following EXCEPT

      • Eye opening
      • Motor response
      • Pupillary reaction
      • Verbal performance


Give 5 questions you might ask a neuro patient who is complaining about a headache during an intake assessment

  • Give 5 questions you might ask a neuro patient who is complaining about a headache during an intake assessment

  • Identify the rostral-caudal progression of consciousness

  • Identify the differences in patients in each of the stages of consciousness

  • What is the lowest score a patient can get on a Glasgow coma scale?

  • What is the highest score a patient can get on a Glasgow Come Scale?

  • What is the most sensitive indicator on the Glasgow Coma Scale?



How do they look?

  • How do they look?

    • Grooming
    • Dress
    • Aids
    • Eye deviation
    • Skin


Signs of trauma, wounds, scrapes, ecchymosis etc.

  • Signs of trauma, wounds, scrapes, ecchymosis etc.



Bruising over the Mastoid

  • Bruising over the Mastoid

    • Where’s the mastoid?


Bruising over the Mastoid

  • Bruising over the Mastoid



Bruising over the Mastoid

  • Bruising over the Mastoid



Bruising over the Mastoid

  • Bruising over the Mastoid



Bruising over the Mastoid

  • Bruising over the Mastoid



Bruising over the Mastoid area

  • Bruising over the Mastoid area

  • Suggests

    • Basal skull fracture


Periorbital edema and bruising

  • Periorbital edema and bruising



Periorbital edema and bruising

  • Periorbital edema and bruising

  • Suggests:

    • Frontal-basal fracture


Drainage of CSF from the nose

  • Drainage of CSF from the nose

  • Suggests

    • Fracture of the cribiform with torn meninges


Drainage of CSF from the ear

  • Drainage of CSF from the ear

  • Suggests:

    • Fracture of the temporal bone with torn meninges


Flexed Posturing

  • Flexed Posturing

    • Flexed arm/elbow
    • Flexed wrists/fingers
    • Adducted arms
    • Legs with internal rotation
    • Foot: Plantar flexed


Suggests

  • Suggests

    • Damage to the cortico-spinal tract
  • More favorable than decerebrate posture



Extension posturing

  • Extension posturing

    • Extended arm/elbow
    • Flexed wrist/fingers
    • Adducted arm
    • Pronation of arm
    • Foot: Plantar flexed


Suggests



x 3

  • x 3

    • Person
    • Place
    • Time


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