quiz #1 – patients in Coma

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quiz #1 – patients in Coma
2011-02-20 22:04:53
clinical neurology

patients in coma
Show Answers:

  1. how can a physical therapist help a patient in a coma?
    • helping nursing staff establish a position schedule
    • transfers
  2. what does oriented X 3 mean
    that the patient knows who they are, where they are, and what time it is

    Person, place, time
  3. in reference to consciousness confused means?
    the patient has no clue of where they are, who they are, or the time and they might mumble. Must be very careful with this term.
  4. Obtuned / stupor
    "the patient is out of it". It's like the patient is in a deep sleep and know something is going on but they are pretty much unresponsive
  5. persistent vegetative state?
    means that the patient has no awareness and that the cerebral cortex is not working at all
  6. locked in state?
    the patient can see and hear but can't react. This is often associated with stroke to the brainstem. Usually the patient will die from pneumonia or some form of respiratory illness
  7. Glascow coma scale assesses what three major components
    • eyes open
    • verbal response
    • motor response
  8. Describe the eye open scale of the Glascow coma scale
    • 4– spontaneous – they notice you walking into a room
    • 3– to speech– they respond to you when you call their name
    • 2– to pain– they respond to moderate pain
    • 1– absent– no response at all
  9. describe the verbal scale of the glascow coma scale
    • 5– converses/oriented
    • 4 – converses/disoriented
    • 3 – inappropriate–
    • 2 – incomprehensible
    • 1 – absent
  10. describe the motor scale for the Glasgow coma scale
    • 6– obeys
    • 5 – localizes pain– Pinch the patient and they go to protect area
    • 4 – withdraws– pull away from painful stimulus
    • 3 – decorticate rigidity– tend to have a flexed posture
    • 2 – decerebrate rigidity–tend to have an extended posture
    • 1 – absent
  11. describe the scoring for the Glasgow Coma Scale
    • normal: 15
    • mild change: 13 – 14
    • moderate: 9 – 12
    • severe: 3 – 8
  12. if the patient in a recent head injury has a score of less than eight for more than six hours, what is there prognosis
  13. what are some metabolic causes of a coma?
    • hypoglycemia/ketoacidosis – typically found in somebody with diabetes but don't know they have it, type I
    • hepatic coma – liver failure
    • uremic coma
    • hypoxia
    • severe electrolyte disturbances
  14. what are some toxic causes of comas
    barbiturates, narcotics, mercury, lead, CO
  15. true or false – barbiturates and narcotics are often use to bring patients out of comas
    false – there used to induce a coma
  16. what are some other causes of comas
    • trauma
    • stroke
    • heat
    • infection
  17. how high does the core body temperature have to be in order to cause a heat stroke
  18. abrupt comas are usually caused by what conditions
    • hemorrhage
    • hypoglycemia
    • trauma
    • occlusive stroke
    • heatstroke
  19. gradual comas are usually caused by what conditions
    • metabolic
    • toxic
    • space occupying lesions
    • subdural hematomas – venous bleed
  20. what are some of the neurological changes that can occur in posture
    decerebrate/decorticate postures
  21. what is the basic care of the patient in a coma
    • prevent pressure sores
    • care of mouth and eyes
    • prevent contractures
    • prevent deep vein thrombosis
    • prevent stress ulcers of stomach
    • maintain nutrition and fluid balance
    • urinary catheter
    • heart and blood pressure monitor
    • infection control
    • maintain adequate ventilation
  22. a patient in a coma will typically have a: high or low temperature?
    • high temperature
    • may increase due to damage of hypothalamus
  23. how will the pupils react in a metabolic coma
    they will be symmetrical reactive
  24. how will the pupils react to anoxia
    they will be bilaterally fixed, dilated
  25. how will the pupils react in a narcotic overdose
  26. how will the pupils react to a physical lesion in the brain
    the pupils will be asymmetrical
  27. for patients in a coma, as blood pressure goes up so does
    intracranial pressure