how can a physical therapist help a patient in a coma?
helping nursing staff establish a position schedule
transfers
what does oriented X 3 mean
that the patient knows who they are, where they are, and what time it is
Person, place, time
in reference to consciousness confused means?
the patient has no clue of where they are, who they are, or the time and they might mumble. Must be very careful with this term.
Obtuned / stupor
"the patient is out of it". It's like the patient is in a deep sleep and know something is going on but they are pretty much unresponsive
persistent vegetative state?
means that the patient has no awareness and that the cerebral cortex is not working at all
locked in state?
the patient can see and hear but can't react. This is often associated with stroke to the brainstem. Usually the patient will die from pneumonia or some form of respiratory illness
Glascow coma scale assesses what three major components
eyes open
verbal response
motor response
Describe the eye open scale of the Glascow coma scale
4– spontaneous – they notice you walking into a room
3– to speech– they respond to you when you call their name
2– to pain– they respond to moderate pain
1– absent– no response at all
describe the verbal scale of the glascow coma scale
5– converses/oriented
4 – converses/disoriented
3 – inappropriate–
2 – incomprehensible
1 – absent
describe the motor scale for the Glasgow coma scale
6– obeys
5 – localizes pain– Pinch the patient and they go to protect area
4 – withdraws– pull away from painful stimulus
3 – decorticate rigidity– tend to have a flexed posture
2 – decerebrate rigidity–tend to have an extended posture
1 – absent
describe the scoring for the Glasgow Coma Scale
normal: 15
mild change: 13 – 14
moderate: 9 – 12
severe: 3 – 8
if the patient in a recent head injury has a score of less than eight for more than six hours, what is there prognosis
poor
what are some metabolic causes of a coma?
hypoglycemia/ketoacidosis – typically found in somebody with diabetes but don't know they have it, type I
hepatic coma – liver failure
uremic coma
hypoxia
severe electrolyte disturbances
what are some toxic causes of comas
barbiturates, narcotics, mercury, lead, CO
true or false – barbiturates and narcotics are often use to bring patients out of comas
false – there used to induce a coma
what are some other causes of comas
trauma
stroke
heat
infection
how high does the core body temperature have to be in order to cause a heat stroke
107°F
abrupt comas are usually caused by what conditions
hemorrhage
hypoglycemia
trauma
occlusive stroke
heatstroke
gradual comas are usually caused by what conditions
metabolic
toxic
space occupying lesions
subdural hematomas – venous bleed
what are some of the neurological changes that can occur in posture
decerebrate/decorticate postures
what is the basic care of the patient in a coma
prevent pressure sores
care of mouth and eyes
prevent contractures
prevent deep vein thrombosis
prevent stress ulcers of stomach
maintain nutrition and fluid balance
urinary catheter
heart and blood pressure monitor
infection control
maintain adequate ventilation
a patient in a coma will typically have a: high or low temperature?
high temperature
may increase due to damage of hypothalamus
how will the pupils react in a metabolic coma
they will be symmetrical reactive
how will the pupils react to anoxia
they will be bilaterally fixed, dilated
how will the pupils react in a narcotic overdose
pinpoint
how will the pupils react to a physical lesion in the brain
the pupils will be asymmetrical
for patients in a coma, as blood pressure goes up so does
