Physical Assessment Assignment

Overview of the Glasgow Coma Scale

The Glasgow Coma Scale (GCS) is a normalized neurological scale of a patient’s head injury that was introduced in 1974 by Teasdale and Jennett of the University of Glasgow. It was also used to measure the quantitative level of consciousness of TBI patients and other neurological patients. It consists of three subtests, each evaluating eye, verbal, and motor response, thus offering a structured way to determine the cerebral functioning as well as the severity of the head injury. Since the development of GCS, this has realized its application in emergency medicine, neurology, and intensiveness care units in various parts of the globe: Physical Assessment Assignment.

Though in its early years, the GCS has also undergone some changes to increase the accuracy and interobserver reliability for uniformity in grading clinically. The Glasgow Coma Scale on its own was derived from the practice of assessment and MRI research on comatose patients. This has also been backed by other research and integrated as an aspect in managing trauma in numerous guidelines worldwide.

At present, this scale is employed in North America, Europe, Asia, and Africa and is integrated into the scale of neurological pathologies. It is also included in the guidelines of the World Health Organization (WHO). It is also a point in the American College of Surgeons Advanced Trauma Life Support (ATLS) criteria to apply it in practice.

Literature Review and Summary

According to Bodien et al. (2021), although the GCS is an effective tool for identifying the severity of the injury, the score of the total estimated sum may not capture the actual consciousness level of the patient. Likewise, the study on 2455 adults, out of which 75 were included in the present study, emphasized that different GCS from 4 to 14 indicate various planes of consciousness, which also reveals the weaknesses of GCS in characterizing the extent of brain damage. Instead of analyzing the total scale scores, information of such nature may be helpful if one focuses on a broader scale, which includes its eye, verbal, and motor response subscores.

Another study by Mkubwa et al. (2022) investigated the relationship between GCS and mortality rates among TBI patients in Botswana. This finding further underscores the idea that the severity of TBI, as measured by GCS scores below 9, is directly proportional to mortality rates and re-emphasizes the importance of using a GCS score of ≤ 8 as a benchmark for admission to the ICU and intensification of interventions. However, it also highlighted that monitoring pupillary reactivity, temperature, and ICP could offer additional benefits for prognostic evaluation, which means that GCS may be insufficient in critical care contexts.

Nallaluthan et al. (2023) also made a noteworthy contribution to the GCS understanding by analyzing the importance of the pain stimulus in its evaluation. The study supports the consideration of pain response in the assessment of non-responsive patients since patients could still respond to pain among those who are comatose patients. Pain stimuli such as sternal rub and supraorbital pressure counter are also a measure of central and peripheral, and therefore, GCS should always be included in neurological assessments.

Scoring of the Tool

The Glasgow Coma Scale (GCS) has three parts: eye-opening responsive level (E), verbal response (V), and motor response (M); the total points are from 3 to 15. This is done by varying the weight of each component based on the response it has provided on the health status of a particular patient. Eyes open (1–4) checks whether the patient can open their eyes on their own (4), in response to verbal command (3), in response to painful stimulus (2), or no response (1).

The interaction is rated with verbal response from 1 to 5, where 5 is oriented speech, 4 is confusion, three is vague but responds to speech, 2 is minimally understandable noises, and 1 is no verbal response. The motor response (1–6) scale evaluates motor activity, where 6 is obedience to command, and 1 is no motor activity (Jain & Iverson, 2023). Based on the total points, there are three levels of brain damage: minimal (13-15 points), moderate (9-12 points), and significant (8 points and less), with a score of less than eight points indicating coma and high mortality.

Population

It is commonly used when patients have TBI, stroke, seizures, tumors, and other diseases that are related to the nervous system. Assessing neurological status and extent of injury is critical for emergency crews, ICU personnel, neurosurgeons, and neurologists. The GCS is valid for this group of patients as early assessment and documentation of consciousness status may inform key procedures such as intubation, neuro-imaging, and surgical timings, leading to improved outcomes.

Despite the fact that GCS is a valuable test on its own, it is often used in combination with other tests to ensure the best possible results (Jain & Iverson, 2023). The others are pupillary reactivity tests, computerized tomography scans or magnetic resonance imaging, a full outline of the unresponsiveness score in intubated patients, and the National Institute of Health stroke scale for assessing strokes. When the GCS is used with these, the clinicians are in a position to conduct complete neurological assessments with the aim of offering adequate medical care at the right time.

Metrics

GCS has been incorporated in clinical studies and numerous databases such as NTDB or the TRACK-TBI to monitor trauma patients and evaluate alterations in the clinical approach to trauma care. GCS can be described as a reliable and valid tool that has been confirmed in several studies to correspond with outcomes and mortality rates of patients. However, there is substantially valuable variability between raters, which has been observed to be worse among new evaluators, possibly due to variation in scoring.

In the legal and ethical sense, the GCS has the essential duty of providing evidence of a patient’s neurological condition, which is vital when differentiating between malpractice and disability or when deciding on the patient’s competency to make life-ending decisions (Omar et al., 2024). It assists in ethical dilemmas, especially on prognosis and treatment options when the patient is in a state of severe brain damage or a coma, promoting decision that respects the rights of the patient.

Conclusion

The Glasgow Coma Scale (GCS) is useful in assessing neurological impairment in TBI and other disease states that involve alteration in consciousness. Because the responses are given with a high degree of accuracy, this tool can be applied when there is an emergency, in an acute care facility, or for research purposes.

Thus, this grading system still plays an essential role in assessment and tracking, as well as in prognosis and mapping in any situation where patients may require intubation, despite these differences and limitations. It is, therefore, less influenced by potential confounds than when taken with pupil reactivity tests and neuroimaging; as part of the indicators for neurological diagnosis and treatment in the global healthcare system, it can only stand to develop further.

References

Bodien, Y. G., Barra, A., Temkin, N. R., Barber, J., Foreman, B., Vassar, M., Robertson, C., Taylor, S. R., Markowitz, A. J., Manley, G. T., Giacino, J. T., Edlow, B. L., Badjatia, N., Duhaime, A.-C., Ferguson, A. R., Gaudette PhD, E., Gopinath, S., Keene, C. D., McCrea, M., & Merchant, R. (2021). Diagnosing Level of Consciousness: The Limits of the Glasgow Coma Scale Total Score. Journal of Neurotrauma, 38(23), 3295–3305. https://doi.org/10.1089/neu.2021.0199

Jain, S., & Iverson, L. M. (2023, June 12). Glasgow Coma Scale. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513298/

Mkubwa, J. J., Bedada, A. G., & M, T. (2022). Traumatic brain injury: Association between the Glasgow Coma Scale score and intensive care unit mortality. Southern African Journal of Critical Care, 60–63. https://doi.org/10.7196/sajcc.2022.v38i2.525

Omar, W. M., Rasheed, I., Hani, S. B., & ALBashtawy, M. (2024). The Glasgow Coma Scale and Full Outline of Unresponsiveness score evaluation to predict patient outcomes with neurological illnesses in intensive care units in West Bank: a prospective cross-sectional study. Acute and Critical Care, 39(3), 408–419. https://doi.org/10.4266/acc.2024.00570

Vasu Nallaluthan, Tan Guan Yan, Murni Mohamed Fuad, Saleh, U., Sanihah Abdul Halim, Idris, Z., Rahman, A., & Jafri Malin Abdullah. (2023). Pain as a Guide in Glasgow Coma Scale Status for Neurological Assessment. The Malaysian Journal of Medical Science, 30(5), 221–235. https://doi.org/10.21315/mjms2023.30.5.18

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

NUR2180 APA Writing Assignment (100 points)

Write a 3–5-page paper using a minimum of 5 peer reviewed resources from the past 5 years.

Guidelines

• Select an assessment tool from the list provided.
• Overview of Tool (10 points): Provide an overview of the assessment tool including the history and what it was developed to assess for.
• How was the assessment tool developed?
• What countries use the assessment tool?
• Literature Review & Summary[LN1] (20 points): Perform a literature review related to the use of the tool.
• Scoring of the Tool (20 points): Describe the scoring. How are points assigned? What does the score indicate?
• Population (20 points): Describe the population that the assessment tool would be used for. Explain why it is important to use the tool with this specific population. Is the tool used in conjunction with other specific assessments?
• Metrics (10 points): Are there data banks that use the results from the assessment tool? What is the reliability and validity of the assessment tool? Are there legal or ethical reasons to use the assessment tool?
• Conclusion (10 points): Overall summary and conclusion of the paper.
• APA formatting (10 points): Must follow APA guidelines and include an APA title page and reference page. Abstract not required.
  

  Physical Assessment Assignment

Assessment Tools (other tools may be used with approval from the faculty)

• Assessment of a Hospital-Wide CIWA-Ar Protocol for Management of Alcohol Withdrawal Syndrome
• Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar)
• CAGE Questionnaire
• APGAR Scoring
• Acute Concussion Evaluation form (Physician/Clinician Office Version)
• Glasgow Coma Scale
• Universal Mini Cog © Instrument.
• The Geriatric Depression Scale (GDS)
• Mini-Mental State Exam
• Domestic violence screening quiz