Clinical Care- Altered Mental Status Flashcards
Coma is a major complication of serious CNS disorders. What can it result from?
(a) Seizures,
(b) Hypothermia,
(c) Metabolic disturbances,
(d) Structural lesions causing bilateral cerebral hemispheric dysfunction or
(e) A disturbance of the brainstem reticular activating system.
(f) A mass lesion involving one cerebral hemisphere may cause coma by compression of the brainstem.
Patient management in patients who are comatose must be concomitantly done with what else?
diagnostic workup
What type of comatose patient might have all vital signs absent?
hypothermic
What is proper positioning of a comatose patient?
on one side with the neck partly extended, dentures removed, and secretions cleared by suction. if necessary, the patency of the airways is maintained with an oropharyngeal airway
what are some common labs to be drawn for comatose patients?
serum glucose, electrolyte, calcium levels, arterial blood gases, liver biochemical and kidney function test and toxicology studies as indicated
abrupt onset of a coma could be associated with what three conditions?
(a) Subarachnoid hemorrhage
(b) Brainstem stroke,
(c) Intracerebral hemorrhage
if a patient has a slower onset and progression what are some associated conditions?
structural or mass lesions
what cause could be assumed likely in a comatose patient who had a preceding intoxicated state or agitated delirium?
metabolic cause
in regards to painful stimuli, unilateral absence of responses despite application of stimuli is indicative of what type of lesion?
Unilateral absence of responses despite application of stimuli to both sides of the body in implies a corticospinal lesion
what does purposeful limb withdrawal from painful stimuli imply?
that sensory pathways from and motor pathways to the stimulated limb are functionally intact.
Bilateral absence of responsiveness from painful stimuli could be suggestive of what type of involvement?
suggests brainstem involvement, bilateral
pyramidal tract lesions, or psychogenic unresponsiveness.
how do the pupils present with metabolic encephalopathies?
the pupils are slightly smaller than normal but responsive to light.
how to pupils present with brainstem compression, drug overdose on MDMA, cocaine, and amphetamines?
dilated (mydriasis)
overdose with opioids will have the pupils doing what?
constricting (miosis)
what is a fancy word for unequal pupil size
anisicoria
