ALTERED LEVELS OF

CONSCIOUSNESS
LEVELS OF CONSCIOUSNESS – BRAIN DYSFUNCTION
Conscious Unconscious

TWO COMPONENTS OF CONSCIOUSNESS

1- Alertness – Ability to respond to stimuli, alter
2- Cognitive Power – Ability to process information, reason

TERMS RELATED TO VARIOUS LEVELS OF CONSCIOUSNESS

Describe to decrease confusion between health care professions: Be specific
1- Full Consciousness
• Alert, oriented, behavior appropriate
2- Confusion
• Impaired decision making
3- Disorientation
• Time, Person, Place
4- Lethargic/Drowsy
• Limited Spontaneous movement, sluggish speech
5- Obtunded
• Arousable with stimulation, sleepy
6- Stuporous
• Deep sleep, hard to arouse
7- Semi-comatose
• Responds to painful stimuli only with purposeful response
8- Comatose
• Unresponsive to even painful stimuli
9- Persistent Vegetative state (PVS)
• Permanent cerebral cortex loss, eye follows may be able to swallow
10-Akinetic Mutism
• Unresponsive to environment, opens eyes

GLASGOW COMA SCALE Brunner P. 1682

The lower the score the worse the coma
1- Eye Opening
2- Best Motor Response
 3- Verbal Response
ASSESSMENT OF LOC
NEURO CHECKS
• Compare to baseline
• Arouse them to their highest level of stimulation or functioning before performing a
neuro check
• Never elicit painful stimuli on an alert client
• Explain to family what you are doing

POSTURING
• Check Flaccidity (worst - no function)

REFLEXES
• Not responsive to anything – last thing to go

1- Corneal
• Check abrasion – Cleanse with drops, tape eyes with shield
• Blinking Reflex: Protects the eye
• Alternate patches – Tape eyes

2- Gag
• Aspiration problems
• Could develop aspiration pneumonia

SPECIAL TESTS

1- Doll’s Eye Movement – Eyes move in opposite direction Do NOT Perform

ER determines brain
stem intact
2- Caloric Test or Oculovesribular Response – Move toward stimuli

CAUSES OF ALTERED LOC

NEUROLOGIC

TOXICOLOGIC
• Drug overdose, alcohol

METABOLIC
• Liver, kidney, diabetes
CARE OF THE CLIENT WITH ALTERED LOC
AIRWAY MAINTENANCE
• Ensures ventilation, Increase HOB: On side Handwritten notes begin
here and this info is also in
MAINTAINING SAFETY the packet
• Side rails up, bed low, physical restraints avoided
MAINTAINING FLUID AND NUTRITIONAL BALANCE
• Mucus membrane, turgor, daily weights, I’s and O’s – Feeding tube
MAINTAINING HEALTHY ORAL MUCOUS MEMBRANES
• Oral Care – Q4o – mouth breathers: Do not pull the stuff out of the mouth be careful
not to damage tissue in mouth
MAINTAINING SKIN INTEGRITY
• Turn Q2H
MAINTAINING JOINT MOBILITY
• Correct alignment, passive ROM
MAINTAINING CORNEAL INTEGRITY
• Artificial tears
ATTAINING THERMOREGULATION
• Normothermic
PREVENTING URINARY RETENTION
• Palpate bladder, cath care, I’s & O’s
PROMOTING BOWEL FUNCTION
• Abdominal distention, check for impaction, if NO Increased ICP may have an enema
PROMOTING SENSORY STIMULATION
• Touch and talk – ROCK a baby if stable
SUPPORT THE FAMILY
• Promote involvement, teaching
ATTAINING SELF CARE
• Daily Grooming

MONITORING AND MANAGING POTENTIAL COMPLICATIONS

• PNEUMONIA – Turn
• ASPIRATION – Elevate HOB
• RESPIRATORY FAILURE – Aspiration
• PRESSURE ULCERS – Turn Q2H
• THROMBUS FORMATION – Homans Sign
• INCREASED ICP – Monitor
• SEIZURES – Monitor

ADMINISTERING MEDICATIONS
• ANTIBIOTICS – Meningitis
• OSMOTIC DIURETICS – For Increases in ICP
• ANTICONVULSANTS – To control seizures
• SEDATIVES – Restlessness – Not narcotic
• DECADRON – Cerebral edema