an alteration in the perception of stimuli. disorientation to time, then place, and eventually to person. Attention span is shortened
Still has orientation to person, place and time, but has slow vocalization, decreased motor skills and oculomotor activity are present.
awakening in response to stimulation. Continuous stimulation is needed for arousal, and the eyes are usually closed.
Vocalization only in response to painful stimuli, decrease spontaneous movement, eyes closed
No vocalization, no spontaneous eye movement, not arousal to any stimulus, however the brainstem reflexes are intact.
alertness with orientation to person, place, and time. Normal speech, movement and oculormotor activity
altered level of arousal
may be structural, metabolic, and psychogenic.
structural causes of altered arousal, 5 locations of the pathology
1.supratentorial (above the tentorium cerebella). 2. Infrantentorial (below the tentorium cerebella). 3. subdural, 4. extracerebral, 5. intracerebral.
(above the tentorium cerebella) decreased level of consciousness because of encephalitis, brainstem trauma, cerebral vascular accident or impared function of the thalamic or hypothalamic activating systems.
(below the tentorium cerebella) produce a reduction in arousal by cerebrovascular disease, demyelinating disease, neoplasms, granulomas, abscesses, and head injuries that destroy the brain stem. Also compression of the reticular activating system (hematomas, hemorrhages, aneurysms, cerebellar hemorrhage, infarcts, abscesses neoplasms and demyelinating disorders
include neoplasms, closed-head trauma w/bleeding, subdural accumulation of pus
manifest as masses, include bleeding, infarcts, emboli and tumors
metabolic induced altered arousal
A wide spectrum of diseases may produce theses. widespread direct or indirect interference with neuronal metabolism throughout much of the brain.
Psychogenic unresponsiveness (altered arousal)
may develop in general sychiatric disorders. Despite apparent unconsciousness, the person is actually physiologically awake.
occurs when brain damage is so extensive that the brain has no potential for recovery and can no longer maintain the body's internal respiratory and cardiac vascular functions. Destruction of the brainstem and cerebellum.
Irreversible coma. Death of the cerebral hemispheres exclusive of the brainstem adn cerebellum. The individual is permanently unable to respond to the environment. The brain can contunue to maintain normal resspiratory and cardivascular functions, normal temperature, and normal gastrointestinal function.