Level of consciousness: the trend that warns first
8 questions on this concept, from 4 angles.
The idea in full
The level of consciousness is the earliest and most sensitive indicator that the brain is in trouble, so the nurse assesses it by the response to graded stimulation — voice, then touch, then a central painful stimulus only when the lesser ones fail — records it as the separate components of the Glasgow Coma Scale rather than the total alone, examines the pupils for size, equality and reaction to light, and reads every finding as a trend against the patient's own last assessment, because new restlessness, confusion or drowsiness, a fall in any component of the score, or a pupil that has become sluggish, unequal or fixed announces deterioration and is reported at once, while the changes in blood pressure, pulse and breathing are late signs that arrive when the pressure is already compressing the brainstem.
Beliefs this concept corrects
- 1A patient who is hard to rouse is sleeping deeply and should be left to rest rather than woken for the check
- 2New restlessness or confusion is pain, anxiety or a bad night, not the brain
- 3If the blood pressure, pulse and breathing are normal, the neurological state is stable
- 4A total score the same as last time means nothing has changed, whatever the components did
- 5A patient who still withdraws from a painful stimulus is responding purposefully and is therefore fine
- 6A nailbed or peripheral pinch is as good a stimulus as a central one for judging the motor response
- 7A newly unequal pupil is a long-standing quirk or the eye drops and can be checked again on the next round
- 8New confusion in an older patient is dementia or sundowning before it is a neurological change
- 9A rising blood pressure with a slowing pulse is a cardiac problem to be treated as one
Your record
8 questions · 4 anglesYou have not practised this concept yet.