Is Apparent in patient who is not oriented, does not follow commands, or needs persistent stimuli to achieve state of alertness.
Level of consciousness is gauged as a continuum with a normal state of alertness and full cognition( consciousness) on one end or coma on the other end.
COMA > is a clinical state of unconsciousness in which the patient is unaware of self or the environment for prolonged periods. AKINETIC MUTISM > a state of unresponsiveness to the environment which the patient makes no movement or sounds but sometimes opens the eyes. PERSISTENT VEGETATIVE STATE > is a condition which the patient is described as wakeful but devoid of conscious content, without cognitive or affective mental function.
Altered LOC is not a disorder itself: but it is a function and a symptom of multiple of physiologic phenomena.
The underlying cause of neurologic dysfunction in cells of nervous system, neurotransmitters, or brain anatomy.
A disruption in the basic functional units or neurotransmitters results in a faulty impulse transmission impending communication within the brain or from the brain to the other parts of the body.
The brain stems contains areas that control the heart, respiration and blood pressure.
Disruptions of the anatomic structures are caused by trauma, edema, pressure from tumors as well as other mechanisms such as increased or decreased in blood in CSF circulation.
LEVEL OF CONSCIOUSNESS : LEVEL I- CONSCIOUS > normal awareness oriented to time, person, and place. LEVEL II- LETHARGY SOMNOLENCE DROWSINESS OR OBSTUNDATION > responds with confusion alone, falls alone to sleep; responds briefly to stimuli. LEVEL III- STUPOR > physical and mental activity is minimal. > Reflexes and sphincter actions are not changed. > Patient awareness by vigorous stimulation. LEVEL IV- SEMI-COMA > no spontaneous movement, withdrawal from painful stimuli and verbal response are limited to groaning. > vomiting. > reflex activities. COMA OR DEEP COMA > no spontaneous movement.
MONITORING ICP > to quantify the degree of evaluation, to initiate appropriate treatment- VENTRICULOSTOMY, SUBARACHNOID BOLT, EPIDURAL or SUBDURAL CATHETER.
MANNITOL (OSMITROL ) > Hyperosmotic agent; increased intravascular pressure by drawing fluid from the interstitial spaces and from the brain cells.
CORTICOSTEROIDS > stabilizes the cell membrane and reduce the leakiness in the blood-brain barrier.
> A histamine blocker may be administered to counteract the excess gastric secretion that occurs with corticosteroid.
> client must be withdrawn slowly from corticosteroid therapy to reduce the risk of adrenal crisis.
BLOOD PRESSURE MEDICATION > required to maintain cerebral perfusion at a normal level. > notify the physician if the BP range is below 100 or above 150mm Hg systolic. ANTIPYERETIC AND MUSCLE RELAXANTS > temperature reduction decreases metabolism, cerebral blood flow, and thus ICP. > prevents shivering. ANTICONVULSANTS > may be given prophylactic ally to prevent seizures. > seizures increase metabolic requirements and cerebral blood flow and volume and increase ICP. IV FLUIDS > administration via infusion pump to control the amount of IV fluid treatment. > Hypertonic IV solutions are avoided because of the risk of promoting additional cerebral edema.
> this phase may be involves the stiffening or rigidity of the muscles of the arms and legs usually lasts 10 to 20 seconds followed by loss of consciousness.
> this phase consists of hyperventilation and jerking of the extremities and usually lasts about 30 seconds.
> full recovery from seizures may take several hours.
> brief seizures lasts seconds and the individual may or may not lose of consciousness.
> no loss or change in muscle tone occurs.
> seizure may occur several times a day.
>Victim appears to daydreaming.
> this type of seizure is more common in children.
MYOCLONIC >a seizure that presence as a brief generalized jerking or stiffening of extremities. > the victim may fall to ground as a result of seizure. ATONIC OR AKINETIC ( DROP ATAACKS ) > a sudden momentary loss of muscle tone. > The victim may fall to ground as a result of the seizure. PARTIAL SEIZURE : SIMPLE PARTIAL > produces sensory symptoms accompanied by motor that are localized or confined to a specific area. > client remains conscious and report an aura > with autonomic symptoms > with special sensory and somatosensory symptoms. COMPLEX PARTIAL > with impairment of consciousness only. > a psycho motor seizure. > characterized by periods of altered behavior that the client is not aware of. >the client loses of consciousness for a few seconds.
the cerebral signs and symptoms of migraine may result from dysfunction of the brain stem pathways that normally modulate sensory input.
Headache is preceded by risk in plasma serotonin, which dilates the cerebral vessels, but migraines are more than just vascular headaches.
Migraines can be triggered by menstrual cycles, bright lights, stress, depression, sleep deprivation, fatigue, overuse of certain glutamate, nitrates or milk products.
Emotional or physical stress may cause contraction of the muscles in the neck and scalp, resulting in tension headache.
Cranial arteritis is thought to represent an immune vasculitis in which immune complexes are deposited within the walls of the affected blood vessels.
CLINICAL MANIFESTATIONS: I.MIGRAINE PRODOME PHASE : depression, irritability, feeling cold, food cravings, anorexia, change in activity level, increase urination, diarrhea, constipation. AURA PHASE : characterize by focal neurologic symptoms, visual disturbances, numbness and tingling of face and lips, hand, mild confusion, slight weakness of extremity, drowsiness, dizziness. HEADACHE PHASE: a vasodilatation and a decline in serotonin level occur, a throbbing headache over several hours. Severe anticipating; associated with photo phobia, nausea and vomiting. RECOVERY PHASE : pain gradually subsides; muscle in the neck and scalp; muscle ache, localized tenderness, exhaustion and mood changes.
II.TENSION PHASE: ·steady, constant feeling of pressure that usually begins in forehead, temple or back of the neck. III. CLUSTER HEADACHE: ·are unilateral and come in clusters of one to 8 daily with excruciating pain localized to eye and orbit radiating to the facial temporal regions. ·Pain accompanied by watering eye and nasal congestion. IV. CRANIAL ARTERITIS ·fatigue, malaise, weight lose and fever ·inflammation usually are present ·sometimes a tender swollen or nodular temporal artery is visible.