1. Week 4 Intracranial Regulation and Level of Consciousness (L.O.C.)

2. Learning Objectives 1. Identify awake/asleep, alert, orientation to person, place and time as norms, vs. abnormal findings. 2. Explain how intracranial regulation controls level of consciousness and vital signs. 3. Identify key normal neurologic assessment techniques and findings with consideration for variations across the lifespan.

3. What is consciousness?

4. Consciousness is a condition in which the person is aware of self and environment and is able to respond appropriately to stimuli.

6. Constricted Pupil

7. Constricted pupil occurs when bright light enters the eye, and when it is used for near vision.

8. In response to intense light, the pupil constricts rapidly in the pupillary light reflex.

9. We use a penlight or flashlight to assess the reactions of the pupil of the eye during an assessment.

10. PERRLA: Acronym/abbreviation for: Pupils Equal, Round, Reactive to Light Accommodation

11. Dilated Pupil

12. The pupil dilates when light conditions are dim, and is used for far vision.

13. Unequal Pupils

14. What should pupils look like?

15. Equal and reactive to light…

16. We are also looking for symmetry, which is lacking in the presence of facial drooping.

17. This deviated tongue lacks symmetry.

18. Weakness in an extremity, as in arm drift, lacks symmetry.

19. A hand grasp can determine equal strength in the upper extremities.

20. Q. What if the pupils are unequal, but reactive to light? A. This is an abnormal sign, especially with a head injury.

21. (An assessment tool to be aware of.)

22. Observe for clear and appropriate patient verbal response

23. Subjective Assessment Findings: What might you observe or hear? A specific complaint, history of precipitating event from patient or family…

24. Objective Assessment Findings: What might you observe that is measureable? Vital Signs, slurred speech, unable to speak, bruising, wounds, blood in ears or nose, poor balance, weakness in an extremity, facial asymmetry, pupillary response, pupillary size…

25. A few words about perfusion…

26. What is perfusion? The continuous supply of oxygenated blood to every cell in the body. (Changes in perfusion affect all human functions!)

27. Remembering soft brain, hard skull…

28. Q. As a nurse, what are you observing for when…

29. …a bleeding brain creates pressure on the brain tissues and prevents adequate tissue perfusion?

30. A. Decreased tissue perfusion

31. Observe if the patient is the responsive or unresponsive… Are there any changes in L.O.C? (Level of consciousness)

32. If your once responsive patient is suddenly unresponsive, what part of the assessment becomes your first priority? We want to be sure the patient has a patent airway!

33. End of Week 4