98年专科护理师训练神经系统常见问题之一.ppt

98年專科護理師訓練神經系統常見問題之評估 (二) 意識不清 Confuse 情緒和行為的改變 Mood behavior change Consciousness Level The state of arousal Content The quality and coherence of thought and behavior (awareness) Attention Attention in both right and left aspects of extrapersonal space is governed by the nondominant parietal and frontal lobes. Insight and judgment are dependent on intact higher order integrated cortical function, especially regarding frontal lobe involvement in scrutinizing incoming sensory information Terms to describe consciousness Normal (Clear) consciousness Confusion Drowsiness Stupor Coma Confusion A problem with coherent thinking The p’t doesn’t take into account all elements of his immediate environment Deficit in working memory (reduced attention) “clouding of sensorium” “sun-downing phenomenon” Missed day/night light cues Deterioration of suprachiasmatic nucleus of the hypothalamus Disruption of REM sleep Delirium acute confusional state Drowsiness The p’t is inability to sustain a wakeful state without the application of external stimuli Coma The p’t who appears to be asleep and incapable of being aroused by external stimuli or inner need Degrees of severity : reflexes Semicoma Sleep vs. Coma Dilirium (DSM IV) Disturbance of consciousness with reduced ability to focus, sustain, or shift attention. This loss of mental clarity is often subtle and may precede more flagrant signs of delirium by one day or more ; Distractibility A change in cognition or the development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia. memory loss, disorientation, and difficulty with language and speech The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day. There is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by a medical condition, substance intoxication, or medicatio