Neurological
• Clinical Manifestationsfor alterationsin arousal
o Changes in LOC is the most critical piece on information we have
o LOC: are early changes, first thing you will see when something goes wrong
neurolog
...
Neurological
• Clinical Manifestationsfor alterationsin arousal
o Changes in LOC is the most critical piece on information we have
o LOC: are early changes, first thing you will see when something goes wrong
neurologically
o Pattern of breathing: assess the rate, rhythm and pattern; can have changesin any
of those. Respiratory rate can be low or labored. Could have Cheyne stroke
respirations
o Pupillary Changes: biggest thing to look for fixed and dilated pupils. (Pupils are wide
and don’t move). This is not good, its sign of brain hypoxia or ischemia.
o Oculomotor Responses: just looking for changes and or things your not supposed to
have.
▪ Resting,spontaneous, reflexive eye movements
o Motor Responses: Can help evaluate level of dysfunction and damaged side ( just
looking for changes or things that shouldn’t be there)
▪ Purposeful, inappropriate, or not present
o Consciousness: state of awareness of oneself and the environment
▪ Arousal: state of being awake and being able to respond
▪ Awareness: state of being aware
▪ These are all mediated by the RAS, in brainstem
▪ If you get damage to cerebrum then the RAS will maintain you in a vegetative
state- will keep you alive if something happens severely to your brain tissue.
o Structural: could be due to a tumor, bleeding in the brain
o Metabolic: anything that effectsthe metabolism like hypoxia, electrolyte changes,
medications or drugs
o Psychogenic: patients with psychiatric diseaseslike schizophrenia
o Outcomes: Long-term disabilities, or patients could die.
• Brain Death: body can no longer maintain internal homeostasis
o Occurs when the brain has been damaged so severely that it can never recover.
Death or damage to the brain stem. These patients are considered legally dead
• Cerebral death : irreversible damage to the cerebrum but the cerebellum and brain stem
maintain intact- because the cerebellum and brainstem are intact, all vitals can be
maintained, your still alive, just not where you want to be
o 4 types:
o Remain in coma for life: they will have vital signs, but will not move, talk or open
their eyes etc.
o Emerge into a persistent vegetative state: the only thing they can do is open their
eyes and have normal sleep patterns. Will have vital signs
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