Cognitive Alterations
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| 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
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| 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
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| Reticular Activating System | been around for billions of years, most primitive creature– in Central brain stem– any problem with brain stem, problem with RAS
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| 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
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| Confused | Unable to think clearly or engage in effective problem solving; orientation to time, place, person impaired; easily aroused by verbal stimuli
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| Delirious | Restless and disoriented, may have hallucinations; easily aroused, but may have difficulty with attention
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| Lethargic | Uninterested in surroundings or events; sluggish in thought and motor activities; does not engage spontaneously in activities
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| Obtunded | Falls asleep unless stimulated; arousable with voice or touch, but quickly returns to sleep
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| Stuporous | In a deep state of sleep; vigorous stimulation is required to arouse and a wakeful state is not maintained
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| Comatose | Unable to be aroused, even with vigorous painful stimuli; motor responses, such as withdrawl or posturing, may occur
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| 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
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| 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
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| Altered Breathing Patterns: Ataxic and Agonal gasps | Ataxic breathing: completely irregular, dysfunction of medullary breathing center
Agonal gasps: complete failure of medullary respiratory center
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| 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
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| Pupillary Changes | Pontine Dysfunction: pinpoint
Midbrain: midposition and fixed
Severe Hypoxia and Ischemia: fixed and dilated
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| 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
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Created by:
Marissagostanian
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