Question

11:50 A. Patient:Kurt, a 58 year old white male who works as a carpenter, is admitted to the ER after having a tonic-clonic seizure while at a construction site. At this time, Kurt is unconscious, but breathing on his own. No seizure activity is noted. His coworker shares that he had fallen off a ladder a year ago and sustained a severe concussion and a sprained ankle. However, he has no further complications since recovering from that injury. An emergency computerized axial tomography scan (CAT) reveals an area of scar tissue overgrowth in the frontal lobe of the brain. He is transferred to the ICU for observation. After he is stabilized, you perform the Glasgow Coma Scale (p. 672). Findings are as follows: Eyes: (1); Motor (4); Verbal (2) a) What is the total score and what do the findings indicate? b) The next morning, Kurt begins to wake up and responds to his name, but drifts off to sleep when the nurse stops talking. He asks the nurse to repeat the questions asked, as "What time is it?" How would you assess his level of consciousness? c) As you continue to assess Kurt performing next the deep tendon reflexes, you notice his response to the biceps and triceps test is 1+ What maneuvers could you perform to increase the reflex response? Kurt's response continues to be diminished, what do you suspect? d) Kurt is lethargic after his concussion, but can see to dial a telephone or write and remembers common telephone numbers. At home, he can bath in the tub, but not shower. However, he needs help climbing out of the bathtub.He can sit on a chair in front of the sink as well to wash. He has no difficulties toileting, eating, or dressing but he gets tired if he walks to the kitchen in the next room to eat. His wife goes to the store to shop. She also does the coking and laundry

Answer 1

A) The total GCS score is 7 . It is defined as moderate score . 4-7 comes under the moderate score and requires resuscitative care .

B) According , to the assessment done the next day the GCS score is 13 .

Eye - to speech - 3

Verbal - confused - 4

Motor - obeys command - 6

C) When reflex responses are absent this could be a clue that the spinal cord, nerve root, peripheral nerve, or muscle has been damaged. When reflex response is abnormal, it may be due to the disruption of the sensory (feeling) or motor (movement) nerves or both.