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Altered Level of Consciousness

Published Jan 17, 2013 in
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Presentation Slides & Transcript

Presentation Slides & Transcript

Altered Level of Consciousness

Define Altered Level of Consciousness
Not oriented
Doesn’t follow commands
Needs persistent stimuli to achieve state of alertness

Continuum
Alterations in level of consciousness can be gauged on a contiuum

Fully Alert ?-------------------------? comatose

States of Unresponsiveness
Coma
Akinetic mutism
Persistent vegetative state
Locked-in syndrome

What state?
E.N., a fifty-three-year old male, experienced a severe traumatic brain injury two weeks ago. He is unarousable and has no purposeful response to internal or external stimuli. He does withdraw when the nurse does a sternal rub.

This state would be characterized as?

What State?
It is now week 6 and E.N. remains unresponsive though sleep-wake patterns are identified. There is not indication of cognitive or affective mental function.

This state would be characterized as?

What State?
A 57-year-old man presented with an 18-month history of progressive cognitive impairment leading to immobility and inability to speak. The patient initially developed memory problems and gait instability. Six months after the onset of these symptoms, he was evaluated by a physician who described the patient as withdrawn and unable to follow complex commands.
This state would be characterized as?

What State?
Following a hemorrhagic stroke in the area of the pons, 67-year-old K.D. experienced quadriplegia and anarthria. The staff noted preservation of consciousness and during assessment found K.D. could control the upper eyelids and vertical eye movement.
This state would be characterized as?

Altered Level of Consciousness
Pathophysiology:
Not a disorder itself
Results from multiple pathophysiologic phenomena
Name three categories of cause

What is the primary assessment tool?

Altered LOC and Associated Presumptions
D.G., 52-years-old, is comatose. Pupils are increasingly sluggish and motor responses are delayed or absent.
What would you presume is the cause?
J.S., 65-years-old, is comatose. Pupils react normally to light. When the chest is pinched, J.S. grimaces and withdraws from the stimulus.
What would you presume is the cause?

Diagnostics
CT
MRI
PET
SPECT

Glucose
Electrolytes
LFTs
BUN
PT, PTT
Calcium
Serum
Ammonia
Osmolality
Calcium
Ketones
Alcohol
Drug concentrations

ABGs

Complications
Discuss why the following complications could occur
Respiratory Failure
Pneumonia
Pressure ulcers
Aspiration
Deep Vein Thrombosis
Contractures

Medical Management
What is the first priority?

What treatment modality must be anticipated?

How will circulatory status be monitored and supported?

What is the focus of neurologic care?

Nursing Care
Discuss nursing care associated with the following areas
Maintaining the airway
Protecting the patient
Maintaining fluid balance and managing nutritional needs
Providing mouth care
Maintaining skin and joint integrity