Chapter 10- Assess Level of Consciousness

Question 1

Early in your assessment, you will need to evaluate _____

Answer 1

The patient’s level of consciousness (LOC)

Question 2

The patient’s Level of Consciousness (LOC) can tell you a great deal about

Answer 2

The patient’s neurologic and physiologic status

The level of consciousness will help you determine if the patient has a life-threatening injury or if the patient will be capable of providing reliable information about his or her own condition

Question 3

The brain requires a constant supply of ______ and ____ to function properly

Answer 3

oxygen and glucose

Question 4

In the primary assessment, you need to ascertain only the ______ LOC

Answer 4

Gross

Question 5

What is gross LOC ?

Answer 5

refers to a basic assessment of a person’s awareness and responsiveness to their surroundings

Question 6

The _____ scale is used to assess the patient’s LOC

Answer 6

APVU

Question 7

The APVU scale tests a patient’s responsiveness based on the following criteria:

Answer 7

Awake and alert
Responsive to verbal stimuli
Responsive to pain
Unresponsive

Question 8

What does it mean for the patient to be awake and alert ?

Answer 8

The patient’s eyes open spontaneously as you approach, and the patient appears to be aware of you and responsive to the environment
The patient is awake, appears to follow commands, and the eyes visually track people and objects

Question 9

What does it mean for the patient to be responsive to verbal stimuli?

Answer 9

The patient is not alert and awake.
The patient’s eyes do not open spontaneously.
However, the patient’s eyes do open when you speak to him or her, or the patient is able to respond in some meaningful way when spoken to- for example by moaning, speaking, or moving

Question 10

A patient who does not respond to your normal speaking voice, but responds when you speak loudly is considered to be:

Answer 10

responding to loud verbal stimuli Responsive

Question 11

What does it mean for a patient to be responsive to pain?

Answer 11

The patients does not respond to your questions but moves or cries out in response to painful stimulus

Question 13

There are ______ and _______ methods of applying a painful stimuli

Answer 13

appropriate and inappropriate

Question 14

Some methods may not give an accurate result if a _______ is present

Answer 14

spinal cord

Question 15

List the methods of gauging of a patient’s responsiveness to painful stimuli:

Answer 15

Gently or firmly apply pressure on or pinch the patient’s sternum

Gently but firmly apply pressure or pinch the posterior edge of the patient’s mandible (lower jaw)

Gently but firmly pinch the patients trapezius muscle on top of the shoulder/collar bone

Apply upper pressure along the ridge of the orbital rim along the underside of the eyebrow (without applying pressure to the eyeball)

Question 16

What does it mean for a patient to be unresponsive?

Answer 16

The patient does not respond spontaneously or to verbal or painful stimulus.

Question 17

Unresponsive patients usually have no ___ or ______

Answer 17

cough or gag reflex

Question 18

Unresponsive patients lack the ability to ______

Answer 18

protect the airway

Question 19

If you are in doubt about whether a patient is truly unresponsive, you should _____

Answer 19

assume the worst and treat appropriately

Question 20

When using the APVU scale, be sure to note ___

Answer 20

Note how the patient responded

Question 22

If the patient is hard of hearing, how should you try to stimulate them ?

Answer 22

Tap with your fingers repeatedly
If the patient responds, note that the patient is hard of hearing but responds to being tapped

Question 23

A patient who ____ or ______ is responding to the painful stimulus.

Answer 23

Moans and withdraws

Question 24

For the patient who responds to painful stimulus, be sure to note the _______ and _______ of the stimulus

Answer 24

Type & Location of the stimulus

Question 25

The point is not to cause as much pain as possible, but to see if the patient responds or withdraws from the sensation of pain where you caused it.

Answer 25

True

Question 26

Note that a patient who remains _____ and _______ is considered unresponsive

Answer 26

Flaccid (limp, loose, droopy, and wrinkly) does not move or make a sound

Question 27

For a patient who is alert or responsive to verbal stimuli, next evaluate _______

Answer 27

Orientation

Question 28

Define orientation.

Answer 28

Orientation tests a patients mental status by checking his or her memory and thinking ability.

Question 29

The most common test evaluates a patients ability to remember 4 things:

Answer 29

Person (remember his or her name) Place (identifies his or her current location) Time (year, month, and day of the week) Event (what happened: MOI and NOI)

Question 30

Why is paramount to assess all four questions?

Answer 30

The questions were not selected at random, they assess 4 different categories.

Question 31

What do you ask to evaluate long term memory ?

Answer 31

Person (patients name) Place (his or her location)

Question 32

What do you ask to evaluate intermediate memory?

Answer 32

Year or month

Question 33

What do you use to evaluate short-term memory ?

Answer 33

Day of the week and event (what happened)

Question 34

If the patient knows these facts, the patient is said to be:

Answer 34

alert and fully oriented alert and oriented to person, place, time, and event alert and oriented x4

Question 35

It is important to determine, if possible, the patient’s ________ to use as a baseline

Answer 35

normal mental status

Question 36

Any deviation from alert and oriented to person, place, time, and event, or from a patient’s normal baseline is considered __________

Answer 36

Altered mental status

Question 37

What circumstances may cause a patient to have a baseline of not being fully alert and oriented ?

Answer 37

Ongoing illness history of stroke traumatic brain injury developmental delay Alzheimer’s disease

Question 38

If you determine that the patient has any indicators for spinal motion restriction, what should you do ?

Answer 38

Ensure the patient’s cervical spine is manually stabilized by either you or another provider

Question 39

If it is not possible to both manually stabilize the patient’s cervical spine and continue your assessment of identifying life threats, what should you do ?

Answer 39

Do your best to ensure the patients spine remains remains in a stable position while you continue your primary assessment

Question 40

You should complete your primary assessment prior to _________

Answer 40

applying a cervical collar

Question 41

What are the two main indications for spinal immobilization?

Answer 41

Blunt trauma (injury of the body by forceful impact can lead to bleeding under the skin) Penetrating trauma (open wound injury in which an object pierces the skin)

Question 42

More specifically,blunt trauma accompanied by any of the following is an indication for spinal immobilization:

Answer 42

Altered mental status Intoxication (alcohol or drugs) Difficulty or inability to communicate

Question 43

Or, blunt or penetrating trauma with anya of the following could also be indications for spinal immobilization

Answer 43

Pain or tenderness on palpation of the neck or spine Patient report of pain in neck or back Paralysis or neurological complaint (numbness, tingling, partial paralysis of the legs or arms)

Question 44

Define a distracting injury.

Answer 44

Any injury that distracts the patient’s attention from others injuries he or she may have, even severe injuries.

Question 45

Give an example of a distracting injury.

Answer 45

A painful femur or tibia fracture that prevents the patient from noticing neck or back pain