Question

Sensory-Neurologic System Case Study

You are caring for a 67-year-old female patient who was admitted to the hospital for headache and vertigo. When you enter the patient’s room she is lying in her bed and appears to be sleeping. She does not respond when you address her by name and looks pale, her significant other is at the bedside.

Assessment Findings

Mental Status:                         No verbal response, flexes right arm to pain, no eye opening

Airway:                                        Open and clear

Breathing:                                  RR irregular at 14

Circulation:                                 Skin normal color and dry, Radial pule slightly irregular at 32, BP 160/80

Other Findings:                        Temperature 37 C, pulse oximetry 97%, left pupil unreactive

History

Events:                                        The patient was admitted to hospital after complaining of a headache for the

                                                      last several days. Her husband states that earlier today she vomited several

                                                      times and got so dizzy she just couldn’t walk or even sit up in bed.

Previous Illness:                        Hypertension

Medications:                             hydrochlorothiazide

1. What is the patient’s Glasgow Coma Score? (include the total score and the individual scores for each area)
2. What is the relationship between posturing and a history of headache with hypertension?
3. Is there a relationship between the irregular respirations, bradycardia, and BP?
4. What is the pathophysiologic process that has resulted in the patient’s irregular respirations, bradycardia, and BP?
5. Is there any additional health history information that would be important for you to know?

Answer 1

1. Glassgow coma Scale

Glassgow coma Scale is used to describe the Consciousness level of a person.

The patient' Glassgow coma score is 5.

Individual score :

Eye response : 1 ( no eye opening)

Verbal response: 1 ( no verbal response)

Motor response: 3 ( flexion to pain)

total: 5

2. Posturing and history of headache with Hypertension

Hypertension is the disease or disorder of abnormally high Blood pressure. One of the symptoms of hypertension is headache( when it is above 180/ 100mm of Hg). It may due to excess pressure on the brain resulting from hypertension. Excessive pressure on the brain also leads to edema, swelling within the cranium.

Orthostatic Hypertension is a condition ,where there is an increase in blood pressure, while in standing or upright position. Studies shown that there are reports of throbbing headache in patient with Hypertension, which worsened during standing or sitting position but reduced in lying position.

3. Irregular respirations, bradycardia and BP

There is a relationship between irregular respiration , bradicardia and BP. During Hypertension, as a result of increased intracranial pressure there happens a phenomena called Cushing reflex or Cushing's triad,  Characterised by irregular breathing, bradicardia and increased Blood pressure.

4. Pathophysiologic process of Cushing reaction( irregular respiration, bradicardia and increased bp).

Increased intracranial pressure leads increased pressure in the skull

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Physiological nervous system response,( Cushing response) resulting in changes of respiratory cycles ( rate and regularity)

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slow irregular breathing

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leads to dysfunctions in the regulation of blood pressure and heart rate ( bradicardia: heart rate below 60 and increased bp)

5. Additional health history

* History regarding drug compliance or any skipping of blood pressure medication

* Any other medications or Over the counter( OTC) medication , the patient had taken ( interaction of medications)

* did she complaint about chest pain or shortness of breath

* History of any Diabetics, kidney diseases