CONSCIOUSNESS
The state of being aware, or perceiving physical facts or mental concepts; a state of general
wakefulness and responsiveness to environment; a functioning sensorium. [L. conscio, to know, to
be aware of]
totally aware of surrounding activities and incoming stimuli
oriented to time, place, and people
person can respond quickly and appropriately to questions, commands, or events.
Various levels of reduced consciousness may present as
o Lethargy
o Confusion
o Disorientation
o memory loss
o unresponsiveness to verbal stimuli
o difficulty in arousal
Glasgow Coma Scale
o Used for assessing LOC
Coma
o Most serious level of loss of consciousness
o Affected person does not respond to stimuli (pain, or verbal)
o Some reflexes may still be present
Deep coma
o Loss of all reflexes
o Fixed and dilated pupils
o Slow and irregular pulse and respirations
AROUSAL
Reticular Activating System
determines the degree of arousal or awareness of the cerebral cortex
The pons and medulla influence the brain's awareness of the incoming pain stimuli
o PONS – composed of bundles of both afferent (incoming) and efferent (outgoing) fibers
o MEDULLA
contains vital control centers that regulate respiratory and cardiovascular function
contains the coordinating centers that govern coughing, swallowing, vomiting
VEGETATIVE STATE
Loss of awareness and mental capabilities
Results from diffuse brain damage
AMNESIA
Loss of memory
,CONVULSION
sudden, involuntary movement with loss of awareness, caused by uncontrolled neuronal discharge in
the brain.
TONIC
In a state of continuous unremitting action; denoting especially a muscular contraction. 2.
Invigorating; increasing physical or mental tone or strength.
CLONIC/CLONIC STATE/CLONIC SPASM
Relating to or characterized by clonus
Movement marked by repetitive muscle contractions and relaxations in rapid succession.
Alternate involuntary contraction and relaxation of a muscle
DYSPHASIA
Difficulty comprehending language or speaking; partial impairment of communicating ability
Less severe form of aphasia
Caused by damage to the brain
APHASIA
Inability to comprehend or express language; total loss of communicating ability
Receptive—damage to Wernicke’s area
Expressive—damage to Broca’s area
Mixed, global—damage to both areas or to the fibers and tracts between them
PARESIS
Muscle weakness
Mild paralysis
OTORRHEA
Leaking of CSF from the ear
Occurs with fractures
Tearing of meninges
o Allows CSF to pass out of the subarachnoid space
SEIZURES
Seizures (look up types of seizures)
● Generalized
o Absence seizures (petit mal)
▪ Lapses of awareness lasting only a few seconds
▪ Appear without warning/end abruptly
▪ More common in children
▪ Are frequently so brief, they go undetected
o Tonic-clonic (grand mal)
▪ Most common
▪ Begin with stiffening of limbs (tonic phase)
, ▪ Followed by jerking of the limbs/face (clonic phase)
o Myoclonic
▪ Rapid, brief contractions of bodily muscles
▪ Occur at the same time on both sides of body
▪ Usually involve one arm or a foot
▪ “sudden jerk” movements or “clumsiness”
o Atonic (akinetic, astatic, or drop attacks)
▪ Abrupt loss of muscle tone
▪ Can produce head drops, loss of posture, or sudden collapse
▪ Appear without warning
▪ Can result in injuries to head and face
▪ Seizures are resistance to Rx therapy
▪ Protective headgear recommended
o Lennox-Gastaut Syndrome (febrile seizures)
▪ Form of severe epilepsy
▪ Begins in childhood
▪ Characterized by multiple types of seizures and intellectual disability
▪ Child experiences frequent seizures (mixed type seizures)
▪ Interrupts neurological development
resulting in learning disabilities
delayed motor development
▪ Difficult to control, even with Rx medication
● Partial
o Simple partial
▪ one area of the body is experiencing spasm/twitch
▪ person does not lose consciousness during seizure
▪ while fully aware, person may not be able to speak/move until seizure is over
▪ person may feel odd or altered sensations (affects all five senses)
▪ nausea may be present
▪ emotions may also be affected
o Complex partial (psychomotor)
, ▪ Affect larger area of brain
▪ Affect consciousness; person may appear to altered state of consciousness
▪ During a seizure, person cannot interact normally
▪ Actions are typically unorganized, confused, and unfocused
▪ Unable to control body movements, speech, and actions
▪ Unaware of actions
▪ Does not remember what happened during seizure
▪ “temporal lobe epilepsy”
● Continuous seizures (status epilepticus)
o in/out of seizures every second – constant/continuous state of seizure
o Increased metabolism of glucose and oxygen
o May be life-threatening
o primary focus = PATIENT SAFETY
▪ cannot stop a seizure
▪ ABCs + safety
o Death or brain damage from status seizures (as opposed to death from the underlying cause) is
most likely to result from:
▪ Direct damage to the brain caused by the injury that causes the seizures
▪ Stress on the system from repeated generalized tonic clonic seizures
▪ Injury from repeated electrical discharge in the brain
ALZHEIMER’S DISEASE (AD) (tends to be more psychosocial)(can be considered primary)
● Progressive cortical atrophy
o Neurofibrillary tangles and plagues
o ACh deficit caused by loss of neurons
● No definite diagnostic tests available
o Exclusion of other disorders
o Careful medical and psychological history
● Specific cause unknown
o Repetitive DNA sequences on different chromosomes have been associated with AD.
● Five stages
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