Chapter 61
Management of Patients with Neurologic Dysfunction
Altered Level of Consciousness (LOC)
- LOC: is apparent in the patient who is not oriented, does not follow commands, or
needs persistent stimuli to achieve a state of alertness.
- Level of responsiveness and consciousness is the most important indicator of the
patient's condition
- LOC is a continuum from normal alertness and full cognition (consciousness) to coma
- Altered LOC is not the disorder but the result of a pathology
- Coma: unconsciousness, unarousable unresponsiveness
- Akinetic mutism: unresponsiveness to the environment, makes no movement or sound
but sometimes opens eyes
- Persistent vegetative state: devoid of cognitive function but has sleep-wake cycles
- Locked-in syndrome: inability to move or respond except for eye movements due to a
lesion affecting the pons
Coma is a clinical state of unarousable unresponsiveness in which there are no
purposeful responses to internal or external stimuli, although nonpurposeful
responses to painful stimuli and brain stem reflexes may be present (Hickey, 2003).
The duration of coma is usually limited to 2 to 4 weeks. Altered LOC is not a disorder itself; rather, it is a result of multiple pathophysiologic
phenomena. The cause may be neurologic (head injury, stroke), toxicologic (drug
overdose, alcohol intoxication), or metabolic (hepatic or renal failure, diabetic
ketoacidosis).Nursing Process: The Care of the Patient with Altered Level of Consciousness—
Assessment
- Assess verbal response and orientation
- Alertness
- Motor responses
- Respiratory status
- Eye signs
- Reflexes