NSG 460: Neuro
Glasgow Coma Scale (GCS) - CORRECT ANSWER-- a scale used to assess the
degree of mental status changes
- 14-15 = mild. someone who is confused, awake and alert
- 9-13= moderate
- 8 or less = severe. typically call them comatose (varying degrees of this)
Criteria for GCS - CORRECT ANSWER-EYE OPENING (4)
- spontaneous = 4
- to voice = 3
- to touch = 2
- none = 1
VERBAL RESPONSE (5)
- oriented = 5
- confused = 4
- inappropriate = 3
- incoherent = 2
- none = 1
MOTOR RESPONSE (6)
- follows commands (6)
- localizes pain (5)
- withdraws from pain (4)
- decorticate (3)
- decerebrate (2)
- none (1)
cranial nerves responsible for cardinal signs of gaze - CORRECT ANSWER-- III:
oculomotor
- IV: trochlear
- VI: abducens
cranial nerves - CORRECT ANSWER-- O: olfactory. smell
- O: optic. sight
- O: oculomotor. eye movement
- T: trochlear. eye movement
- T: trigeminal: face sensation and chewing
- A: abducens. eye movement
- F: facial. face sensation
- A: auditory/vestibulocochlear. hearing
- G: glossopharyngeal. throat sensation, taste and swallowing
- V: Vagus. movement, GAG REFLEX!! (protective mechanism)
, - A: accessory. neck movement
- H: hypoglossal. tongue movement
pupils - CORRECT ANSWER-- controlled by cranial nerve 3
- used to assess problems with neuro impacted pt
- REACTIVITY IS MORE IMPORTANT
what is more important with pupils, the size or reactivity - CORRECT ANSWER--
REACTIVITY
- patients who have sluggish or unreactive pupils have elevated intracranial pressure
because cranial nerve 3 is being impacted.
*cushing's response to increased ICP* - CORRECT ANSWER-- increased systolic BP
- widening pulse pressure (difference between the systolic and diastolic BPs)
- bradycardia
- irregular respirations
*what is the most important EARLY sign of increased ICP?* - CORRECT ANSWER--
CHANGE IN LOC (mental status)
how temperature affects ICP - CORRECT ANSWER-- hypothermia: vessels
vasoconstrict which decreased the amount of blood that reaches our brain = less
oxygen. Also causes shivering, and we go into aerobic metabolism. a byproduct of
aerobic metabolism is carbon dioxide which is a POTENT vasodilator.
- hyperthermia: vasodilation increases the diameter of the blood vessels which in turn
brings more blood to the brain that could potentially increase our ICP
Can changes in mental status be minimal? - CORRECT ANSWER-- YES
mental status is a spectrum. Changes in mental status do not go from one extreme to
another, it can be as subtle as restlessness and confusion
acute mental status change - CORRECT ANSWER-- when a patient has a change from
their usual baseline
many causes from many systems
- neuro: infection, tumor, trauma, CVA, psychiatric
- CV/pulm: MI, PE, hypotension
- systemic (changes in fluid and electrolytes): hypoglycemia, hyponatremia, ammonia
AEIOU TIPS for altered mental status - CORRECT ANSWER-- A: ALCOHOL
- E: ELECTROLYTE, ENDOCRINE, EPILEPSY, ECP. hypernatremia is the most
common electrolyte abnormality causing AMS. Hypo or hyperthyroidism. Addisonian
crisis. Hypo/hyperglycemia (DKA and HHS). metabolic or toxic encephalopathy.
Epilepsy
- I: INFECTION. particularly sepsis, severe sepsis, and septic shock situations. CNS
infections (meningitis, encephalitis) are also common
Glasgow Coma Scale (GCS) - CORRECT ANSWER-- a scale used to assess the
degree of mental status changes
- 14-15 = mild. someone who is confused, awake and alert
- 9-13= moderate
- 8 or less = severe. typically call them comatose (varying degrees of this)
Criteria for GCS - CORRECT ANSWER-EYE OPENING (4)
- spontaneous = 4
- to voice = 3
- to touch = 2
- none = 1
VERBAL RESPONSE (5)
- oriented = 5
- confused = 4
- inappropriate = 3
- incoherent = 2
- none = 1
MOTOR RESPONSE (6)
- follows commands (6)
- localizes pain (5)
- withdraws from pain (4)
- decorticate (3)
- decerebrate (2)
- none (1)
cranial nerves responsible for cardinal signs of gaze - CORRECT ANSWER-- III:
oculomotor
- IV: trochlear
- VI: abducens
cranial nerves - CORRECT ANSWER-- O: olfactory. smell
- O: optic. sight
- O: oculomotor. eye movement
- T: trochlear. eye movement
- T: trigeminal: face sensation and chewing
- A: abducens. eye movement
- F: facial. face sensation
- A: auditory/vestibulocochlear. hearing
- G: glossopharyngeal. throat sensation, taste and swallowing
- V: Vagus. movement, GAG REFLEX!! (protective mechanism)
, - A: accessory. neck movement
- H: hypoglossal. tongue movement
pupils - CORRECT ANSWER-- controlled by cranial nerve 3
- used to assess problems with neuro impacted pt
- REACTIVITY IS MORE IMPORTANT
what is more important with pupils, the size or reactivity - CORRECT ANSWER--
REACTIVITY
- patients who have sluggish or unreactive pupils have elevated intracranial pressure
because cranial nerve 3 is being impacted.
*cushing's response to increased ICP* - CORRECT ANSWER-- increased systolic BP
- widening pulse pressure (difference between the systolic and diastolic BPs)
- bradycardia
- irregular respirations
*what is the most important EARLY sign of increased ICP?* - CORRECT ANSWER--
CHANGE IN LOC (mental status)
how temperature affects ICP - CORRECT ANSWER-- hypothermia: vessels
vasoconstrict which decreased the amount of blood that reaches our brain = less
oxygen. Also causes shivering, and we go into aerobic metabolism. a byproduct of
aerobic metabolism is carbon dioxide which is a POTENT vasodilator.
- hyperthermia: vasodilation increases the diameter of the blood vessels which in turn
brings more blood to the brain that could potentially increase our ICP
Can changes in mental status be minimal? - CORRECT ANSWER-- YES
mental status is a spectrum. Changes in mental status do not go from one extreme to
another, it can be as subtle as restlessness and confusion
acute mental status change - CORRECT ANSWER-- when a patient has a change from
their usual baseline
many causes from many systems
- neuro: infection, tumor, trauma, CVA, psychiatric
- CV/pulm: MI, PE, hypotension
- systemic (changes in fluid and electrolytes): hypoglycemia, hyponatremia, ammonia
AEIOU TIPS for altered mental status - CORRECT ANSWER-- A: ALCOHOL
- E: ELECTROLYTE, ENDOCRINE, EPILEPSY, ECP. hypernatremia is the most
common electrolyte abnormality causing AMS. Hypo or hyperthyroidism. Addisonian
crisis. Hypo/hyperglycemia (DKA and HHS). metabolic or toxic encephalopathy.
Epilepsy
- I: INFECTION. particularly sepsis, severe sepsis, and septic shock situations. CNS
infections (meningitis, encephalitis) are also common
