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Cognitive Alteration

Cognitive Alterations

Consciousness State of awareness-”Oriented x3” Person, Place, Time Arousal and wakefulness rely on an intact Reticular Activating System (RAS), a cluster of primitive cells in the central brainstem
Consciousness cont'd Content and cognitive aspects of consciousness dependent on cerebral hemispheres For any deficit in level of consciousness, either the RAS or BOTH cerebral hemispheres concurrently must be injured
Reticular Activating System been around for billions of years, most primitive creature– in Central brain stem– any problem with brain stem, problem with RAS
Altered Mental States Structural: brain tumor, physical pressure Metabolic: glucose levels too low, other electrolytes out of whack Psychogenic: doesn’t mean it’s any less real or treatable
Confused Unable to think clearly or engage in effective problem solving; orientation to time, place, person impaired; easily aroused by verbal stimuli
Delirious Restless and disoriented, may have hallucinations; easily aroused, but may have difficulty with attention
Lethargic Uninterested in surroundings or events; sluggish in thought and motor activities; does not engage spontaneously in activities
Obtunded Falls asleep unless stimulated; arousable with voice or touch, but quickly returns to sleep
Stuporous In a deep state of sleep; vigorous stimulation is required to arouse and a wakeful state is not maintained
Comatose Unable to be aroused, even with vigorous painful stimuli; motor responses, such as withdrawl or posturing, may occur
Altered Breathing Patterns: Cheyne-Stokes and Central Neurogenic Hyperventilation Cheyne-Stokes Respirations: Gradual increase and decrease in rate and depth. Deep cerebral or diencephalic structures Central Neurogenic Hyperventilation: rapid and regular. Midbrain or upper pons Can be reversible if remove the problem, dependin
ALtered Breathing Patterns: Apneusis and Cluster breathing Apneusis: Prolonged pause at full inspiration. Pons Cluster Breathing: irregular clusters. Lower pons and upper medulla Can be reversible if remove the problem, depending
Altered Breathing Patterns: Ataxic and Agonal gasps Ataxic breathing: completely irregular, dysfunction of medullary breathing center Agonal gasps: complete failure of medullary respiratory center
Pupillary Changes Metabolic Imbalance: small, reactive, regular Diencephalic Dysfunction: small and reactive Metabolic: regularly reactive– still be brisk investigate further between metabolic and diencephalic– reaction are the same Met: chemistries Di: phys & hx
Pupillary Changes Pontine Dysfunction: pinpoint Midbrain: midposition and fixed Severe Hypoxia and Ischemia: fixed and dilated
Positioning/Posturing Decorticate: corticospinal tract– coming down from motor cortex. Both arms are flexed and wrists are dorsiflexed and legs extended Decerebrate: arms go from against chest to sides: Cerebral brain stem Usually progressive, Could be one sided
Created by: Marissagostanian