Kurt, a 48-year-old white male who works as a carpenter, was admitted to the emergency department after having a tonic-clonic seizure while at a construction site. At this time, Kurt is unconscious but is breathing on his own. No seizure activity is noted. His co-worker said that Kurt had fallen off a ladder about a year and a half ago and sustained a severe concussion. However, he has had no further complications since recovering from that injury. An emergency computerized axial tomography (CAT) scan reveals an area of scar tissue overgrowth in the frontal lobe. He is transferred to the intensive care unit for observation.
After he is stabilized, you perform the Glasgow Coma Scale assessment. Findings are as follows:
- Best Eye-Opening Response: No Response (1)
- Best Motor Response: Flexion—Withdrawal (4)
- Best Verbal Response: Sounds—Incomprehensible (2)
Question 1
What is his Glasgow Coma Score and what does it indicate?
Question 2
The next morning, Kurt begins to wake up. How would you assess his level of consciousness?
Question 3
When you check his level of consciousness, Kurt answers as follows: He has his eyes closed when you walk into the room but opens them when you touch his arm lightly. He seems drowsy.
- Person: He is able to state his name and that he is a carpenter.
- Place: He does not know where he is, but he knows that he is in a hospital somewhere in town. He names the town correctly.
- Time: He states that it is Monday morning (it is Tuesday morning). He correctly states the month and year.
He is able to follow verbal commands appropriately—he raises his hand when asked to do so and turns his head from right to left as requested.
How would you assess his level of consciousness?
Question 4
Later that afternoon, Kurt is more alert and anxious about his condition. While completing his admission history, you ask if he has ever had any seizures before this one. He looks down and reluctantly says, “Yes.” He tells you that he had one other seizure a week ago. He was afraid to mention it at work.
What health history questions should you ask about seizure activity?
Question 5
How would you test for the motor function of the facial nerve (cranial nerve VII)?
Question 6
During your assessment, you ask Kurt to perform several activities. You have him pat his knees with both hands, palm side down, then palm side up, and then repeat this sequence quickly with rapid alternating movements. You have him touch the thumb to each finger on the same hand, starting with the index finger, and then reverse the direction. You also have him use his index finger to touch your finger (which is held out in front of him) and then to touch his nose. As you perform these tests, Kurt laughs and asks, “What in the world are you doing?”
How do you explain these tests?
Question 7
What further assessments should be done to check for deep vein thrombophlebitis?
**Please be sure to include 2 references in APA format within the last 5 years and respond to at least 2 participating classmates, with a substantial descriptive answer.**
