1. ALTERED LEVEL OF CONSCIOUSNESS

3. COMA > is a clinical state of unconsciousness in which the patient is unaware of self or the environment for prolonged periods. AKINETIC MUTISM > a state of unresponsiveness to the environment which the patient makes no movement or sounds but sometimes opens the eyes. PERSISTENT VEGETATIVE STATE > is a condition which the patient is described as wakeful but devoid of conscious content, without cognitive or affective mental function.

5. LEVEL OF CONSCIOUSNESS : LEVEL I- CONSCIOUS > normal awareness oriented to time, person, and place. LEVEL II- LETHARGY SOMNOLENCE DROWSINESS OR OBSTUNDATION > responds with confusion alone, falls alone to sleep; responds briefly to stimuli. LEVEL III- STUPOR > physical and mental activity is minimal. > Reflexes and sphincter actions are not changed. > Patient awareness by vigorous stimulation. LEVEL IV- SEMI-COMA > no spontaneous movement, withdrawal from painful stimuli and verbal response are limited to groaning. > vomiting. > reflex activities. COMA OR DEEP COMA > no spontaneous movement.

10. GLASGOW COMA SCALE

17. INCREASED INTRACRANIAL PRESSURE (ICP)

24. BLOOD PRESSURE MEDICATION > required to maintain cerebral perfusion at a normal level. > notify the physician if the BP range is below 100 or above 150mm Hg systolic. ANTIPYERETIC AND MUSCLE RELAXANTS > temperature reduction decreases metabolism, cerebral blood flow, and thus ICP. > prevents shivering. ANTICONVULSANTS > may be given prophylactic ally to prevent seizures. > seizures increase metabolic requirements and cerebral blood flow and volume and increase ICP. IV FLUIDS > administration via infusion pump to control the amount of IV fluid treatment. > Hypertonic IV solutions are avoided because of the risk of promoting additional cerebral edema.

26. SEIZURES

28. MYOCLONIC >a seizure that presence as a brief generalized jerking or stiffening of extremities. > the victim may fall to ground as a result of seizure. ATONIC OR AKINETIC ( DROP ATAACKS ) > a sudden momentary loss of muscle tone. > The victim may fall to ground as a result of the seizure. PARTIAL SEIZURE : SIMPLE PARTIAL > produces sensory symptoms accompanied by motor that are localized or confined to a specific area. > client remains conscious and report an aura > with autonomic symptoms > with special sensory and somatosensory symptoms. COMPLEX PARTIAL > with impairment of consciousness only. > a psycho motor seizure. > characterized by periods of altered behavior that the client is not aware of. >the client loses of consciousness for a few seconds.

33. HEADACHE

39. CLINICAL MANIFESTATIONS: I.MIGRAINE PRODOME PHASE : depression, irritability, feeling cold, food cravings, anorexia, change in activity level, increase urination, diarrhea, constipation. AURA PHASE : characterize by focal neurologic symptoms, visual disturbances, numbness and tingling of face and lips, hand, mild confusion, slight weakness of extremity, drowsiness, dizziness. HEADACHE PHASE: a vasodilatation and a decline in serotonin level occur, a throbbing headache over several hours. Severe anticipating; associated with photo phobia, nausea and vomiting. RECOVERY PHASE : pain gradually subsides; muscle in the neck and scalp; muscle ache, localized tenderness, exhaustion and mood changes.

40. II.TENSION PHASE: ·steady, constant feeling of pressure that usually begins in forehead, temple or back of the neck. III. CLUSTER HEADACHE: ·are unilateral and come in clusters of one to 8 daily with excruciating pain localized to eye and orbit radiating to the facial temporal regions. ·Pain accompanied by watering eye and nasal congestion. IV. CRANIAL ARTERITIS ·fatigue, malaise, weight lose and fever ·inflammation usually are present ·sometimes a tender swollen or nodular temporal artery is visible.

43. Anthony Toledo, MD, RN