No Coma,No Glasgow - page 2

The Glasgow Coma Scale was designed to measure the depth of Coma. This means that a person must already be in a Coma prior to the test administration. When we have a new admit, The Glasgow is on our... Read More

  1. by   ohbet
    Hey Guys, its fine if you folks want to keep administering a test unnecessarily to any one admitted to your facility but this what the Saunders,Encyclopedia and Dictionary of Medicine , Nursing and Allied Health has to say about the purpose of the test ,Glasgow Coma Scale: "a standardized system for assessing response to stimuli in a neurologically impaired patient."
    Now please correct me if Im wrong, but a person alert and oriented x 3 is not neurologically impaired.
    I was listening to an audio tape,produced by MED ED and designed to assist nurses in preparation for taking the Med-Sug Certification exam from ANCC. The instructor was telling this story about when she was teaching nursing school and the student nurse said to her "Its to bad I have to wake Mr. Smith up to give him his neuro exam" the instructor replied "honey,waking Mr. Smith up is the neuro exam" She also stated the glasgow coma scale is for measurement for depth of coma.


    Ill keep administering the test when appropriate.
    Thank you and God Bless
    Last edit by ohbet on Aug 25, '02
  2. by   cbs3143
    Hey, you asked our opinions. Don't get upset if they don't agree with yours.

    Chuck
    Last edit by cbs3143 on Aug 25, '02
  3. by   ohbet
    Sorry,but since Im Right,will someone please agree with me.
    Thank you.
  4. by   rncountry
    We do not routinely have the GCS on our admit forms. We do have an assessment for LOC. The GCS is used if the patient has had a neurological assault. That said I would fully expect the GCS would routinely be used in the ED and a Neuro unit. Having once upon a time been a Neuro trauma nurse every patient had a GCS done every two hours. Sometimes hourly depending on the injury and ongoing assessment. I do believe that the cardiac ICU also used the scale routinely. Not all coma's are neurologically induced.
    I do think that if it is on the assessment form it should be filled out. Even if policy is stupid it should be followed simply because if that one time it is not and there is a problem with a patient it is awful hard to defend not using the policy and procedures for your unit. If you have a nurse practice committee perhaps this is an issue they should look at.
  5. by   DelGR
    ohbet,
    I guess I'd agree with you in a way. I've only done it when there are signs of impairment. And, I've usually done it after a patient has had a seizure or other signs of alteration in mentation.
    Our ICU director always wanted it on everybody when he was doing some reasearch.
    I just never thought much about it one way or the other.
  6. by   LPN & EMT-CT
    I do one on every one of my pt's and when I'm on the squad I do one routinely on every transport pt. to the hospital, Trauma related or not and the nurses at the receiving ER truely appreciate it, it's helps them with a baseline if they head down hill after they get admitted to the ER or while enroute up there.
    It should be dome on any pt. just like doing a primary and secondary assesment on your pt.'s.
    David-LPN & EMT-CT -VA
  7. by   ohbet
    DelGR-God Bless you. Thats what I mean. You only administer the GCS when there are signs of impairment.
    But no,at our facility,everone gets it.Someone comes in for rehab,maybe he broke his leg 2 weeks ago,got treated at another hospital for initial injury and comes to ours for rehab. He is alert,smiling ,pleasant,knows his name, place and time,he can even walk in on his crutches.But he is a new admit. So what does the nurse do?She administers the god d--- GCS!
    And you wont believe the looks Id get if I said "Excuse me,that new admit,he is alert and oriented and can walk,why are you giving the GCS?
    Last edit by ohbet on Aug 26, '02
  8. by   fedupnurse
    Let me play devils advocate here. If it is only a coma scale as you say why does it have a awake and oriented as a part of the scale? Why does it have obey commands? The eye thing, well I've seen plenty of dead people with their eyes open as well as live humans asleep with their eyes open (freaky!!), so the eye deal doesn't tell you as much as verbal and motor. I use it on all patients. It is so much faster and easier to write in those numbers than to write a long narrative about how they aren't in a coma!!!!
    A TRUE coma scale would end at (leaving the eyes out here for now) motor: localizes pain (not obeys commands) and verbal would have to end at or even below confused conversation.
    Just a thought!
    Last edit by fedupnurse on Aug 26, '02
  9. by   OrthoNutter
    I would question the purpose of using GCS at all if we waited until the person was in a coma before doing it. Sorry...but I'm thinking...how stupid!
  10. by   hapeewendy
    I use it
    although we do not formally chart it upon a patients admission I agree that it is quick and simple and a good way to gauge your patients neurological status.
    It shouldnt bother you at all that your fellow nurses are doing the GCS , if you dont find the need to do it thats your nursing judgement at work
    It doesnt however make your judgement correct and theirs incorrect.
    in one of your posts you mentioned that a patient who is alert and oriented x3 does not have a neuro deficit and therefore doesnt need a GCS assessment, however there are many other "neuro'isms" that you can pick up from GCS and neurovital type routines that you might miss otherwise.
    I dont really see how this is any big chore , if you patient is alert and oriented and following your instruction (hold out your arm while I take your blood pressure, put this oximeter on your finger etc) it all just becomes part of your assesement in general.
    I do many things in my nursing practice that other nurses dont tend to do , I do this for my own knowledge and to complete what I feel is the best nursing care/assessment I can.
    you believe you are right ohbet and thats cool, other nurses believe that using the GCS is correct and thats cool too
    different nurses different beliefs different ways of delivering care/doing the "job"
    being disoriented and confused is not the only neurological red flag to be concerned about , so saying that someone is a+o x 3 does not safely draw a conclusion to someones neurological status in all cases. I would be more concerned that some nurses waste time on truly non nursing type tasks as opposed to doing an assessment that although may not be warranted by textbook description or direct doctors order is completed to assist everyone in obtaining a fuller picture of the patients condition, needs and overall health status.
    thats the neat thing about a persons 2 cents worth, nobody asks you for it but you give it anyway! so theres mine......

    cheers
    Last edit by hapeewendy on Aug 26, '02
  11. by   JMP
    GCS is USED to evaulate LOC.

    In ICU we do not use it, since people are intubated and can not verbalize. We however do get report from ER and EMS who tell us that their GCS was 8 at the scene....... then the pt could not protect their airway............then they where intubated.......then they came to ICU.

    GCS is a tool, it is a universal system that is used, so when I read the chart and see that the pts GCS was 8 or below, they required intubation.

    The Glascow Coma Scale score ranges from 3 to 15 and is a measurement of LOC. IT IS NOT a measure of total neurologic function. The proper place to us the scale is on the scene, in emerg, and ALWAYS by someone who knows what they are doing, hopefully someone who has taken TNCC, or simular course. I would say, it should not be used on regular floors, rehab etc.........there they should chart and say " pt is alert and orientated to time, place and person". If not say "pt is confused....... disorientated......etc. If someone truly needs a GSC scale done, say in Emerg....it should be done by appropriate trained people. On the floors, if someone who was talking is not now, or you can not wake up, get the appropriate person there, they may require intubation. To run around doing GCS on all your pts is kind of dumb. ( my opinion) BUT NOT FOR THE REASONS STATED IN EARLIER RESPONSES. REMEMBER YOUR ABC's........airway is first.

    Everyone needs to maintain an airway, if you drop below 8, you can NOT maintain your airway and require intubation.

    Then you come to ICU. Then we do something called "neuro vitals".
    Last edit by JMP on Aug 26, '02
  12. by   cathy949
    P_RN. Thanks for the site, medal.org.
  13. by   hapeewendy
    JMP while I agree with many of your post
    I disagree wholeheartedly 100% about your comment about not using the GCS scale on "regular floors"
    the floor I work on is far from regular, and far from routine and emergency situations happen daily
    (where do you think many of your ICU patients come from? - from a med/surg floor d/t complications)
    I wasnt suggesting for a moment that we as nurses devote a crazy amount of time GCS'ing the heck out of every patient, that is absurd and of course our priorities are ABC's but when you are assessing your patient , it really is not simple enough to chart or only assess alert and oriented...
    total neurlogical fucntion assessment as you mentioned is not the GCS , we use a comprehensive neurovital form for that (much like the one you use on your unit I'm sure), I think what people were trying to say in response to the original post is that , ohbet suggested that the GCS is to monitor the status and progression of a person in a coma , when in fact it is as bestblond I believe it was a tool used to gauge peoples responses to various neuro stimuli etc...
    I dont think that the nurses ohbet works with are "running around doing GCS on everyone " , if they are they probably are only doing so because it is ,as ohbet mentioned part of the admission package and they feel obligated to complete all that is expected of them on an admission note.
    the med/surg floor I work on has a huge percent of neuro patients , many of whom have needed ICU beds that were not available, so in many cases we have had to institute the neurovitals you mentioned in your post - if the nurses on my med/surg floor had not picked up signs and symptoms and charted accordigly and used the GCS as they felt appropriate then all that would be found in the patients chart would be , pt confused or pt disoriented, which is of course not acceptable.
    the thing you mentioned that hit the nail on the head JMP was that it is a universal system, which means that information is instantly available to all of us to interpret on the patient, this better enables everyone to monitor changes and intervene appropriately.
    in the ICU how frequently do you normally find yourself doing neurovitals? and do you complete it on a separate graphic record? just trying to get some info on this from the ICU standpoint if you dont mind
    thanks JMP
    cheers

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