Glasgow Coma Scale (GCS)

Definition

A Glasgow Coma Scale (GCS) is the most widely used scoring system that determines the level of consciousness of
an individual with a suspected or confirmed brain injury. Use of the GCS scale does not take place an in-depth
neurologic assessment

Purpose

This scale is used to:

1. Address the three areas of neurologic functioning

2. Gives an overview of the patient’s level of consciousness (LOC)
3. Evaluates the neurologic status of patients who have had a head or brain injury

This scale is not only used after a traumatic head or brain injury but is also utilized in first aid, Emergency medical
services (EMS), acute cases and for the monitoring of chronic patients in intensive care units.

What is assessed or measured in GCS?

Use of the Glasgow Coma Scale does not take place an in-depth neurologic assessment rather it provides an
evaluation of the patient’s responses in the following areas:

1. Eye-opening responses
2. Motor responses
3. Verbal responses

The three areas are further divided into different levels where a number is assigned to each of the possible responses
within the categories. A high number means that the response is normal while a low one denotes impairment of
neurologic function. The calculated total figure indicates the severity of the coma a patient is experiencing.

The lowest score is 3 (least responsive) suggests or reflects that a patient is in a deep coma, while the highest score
of 15 (most responsive) means that the patient is fully intact.

The Glasgow Coma Scale

Characteristic Response Score

Eye Opening(E) Spontaneous 4
To verbal command or speech 3
To pain 2
Does not open eyes to painful 1
stimuli or no response
Best Motor Response (M) Obeys commands 6
 Localizes pain; pushes stimuli 5
away
Flexes and withdraws 4
Abnormal flexion (decorticate 3
response)
Abnormal extension response 2
(decerebrate response)
No motor response 1
Best Verbal Response (V) Oriented and converses 5
Disoriented and converses 4
(arouse patient with painful (confused conversation)
stimuli if necessary) Uses inappropriate words 3
Makes incomprehensible 2
sounds
No verbal response 1
Total: E + M + V 3 to 15

Interpretation of Scores

Individual categories or elements as wells as the sum of the score are important. The score is expressed in this form
for a client who is most responsive:

“GCS 15 = E4 V5 M6 at 14:00”

This means that the client’s GCS total score is 15 where the Eye Opening is scored 4, Motor response of 6 and
verbal response of 5 as of 2:00 in the afternoon or 14:00 in a 24-hour time format.

Coma is suspected if the GCS score is equal to or less than 7. A score equal to 8 or less could also suggest a severe
brain injury. GCS 9-12 indicates moderate brain injury and more than 13 denotes minor brain injury. Coma with the
use of GCS is defined as not opening the eyes, not obeying commands and no verbal response.

Related posts:

1. Myxedema coma
2. Traumatic Brain Injury
3. Arteriovenous Malformation (AVM)

Nursing Ethics
Posted: 15 Nov 2010 08:58 PM PST
Definition

Ethics is defined as the standards or principles of moral judgment or actions. It provides a methodical system in
differentiating right from wrong basing on a certain belief.

Significance in profession

Ethics reflects the standards that govern a proper conduct in a particular profession. For instance, the nurse on duty
knows that she is obligated to act for the good of the client and to prevent any incident to harm the patient. This
principle of doing no harm to the client is the intervention of knowing the ethics in nursing.

Values, Morals and Ethics

To formulate an ethical decision, the nurse should gain knowledge on the situation taking a look at all angles to
promote maximal benefit to the client. Aside from scrutinizing every possible aspect of the problem the nurse should
be able to understand the relationship between values, morals and ethics.

The values of the client, nurse and society and so as the morals interact to set the environment for ethical behavior. If
in a given situation the value systems of the nurse, client and society is opposing, an ethical dilemma will most likely
occur. A dilemma is a situation with unsatisfactory alternatives or options. Ethical dilemma requires the medical team
to make challenging and difficult decisions regarding the possible best way to care for the patients.

Values are operational beliefs an individual chooses as the basis for behavior which can change over time. These
beliefs serve as the building blocks of moral and ethical development. Values influence not only the behavior but also
the decision making of a person. It could be based on the following:

 Experience
 Religion
 Education
 Culture
 Professional peer group

Morals are personal opinion or principle that a particular action or behavior is absolutely right or wrong in all
situations. Usually a person is reluctant or unwilling to change his personal opinions on specific issues of a moral
nature. For instance, some people view abortion a totally wrong and there is no justifiable excuse for it. However,
some hold the belief that aborting a fetus is better rather than improperly rearing a child.

Ethics in Nursing

Nursing ethics provides the standards of professional behavior for nurses and the principles of knowing right from a
wrong conduct during implementation of nursing duties and responsibilities. Through this set of standards, nursing
duties and responsibilities of nurses towards their clients, co-workers, profession and community is made known. It
promotes the philosophical and theological study of morality, moral judgments and moral problems. The three types
of ethics are the following:

1. Descriptive ethics – this type of ethics provides an accurate and realistic narration of moral behaviors
without producing a moral judgment.
2. Metaethics – the center of this type is on reasonable and justifiable judgments. It is basically concerned with
theoretical issues of meaning and its justification.
3. Normative ethics – with this classification, a question is raised about what is right or wrong. Something
should be done in a situation that calls for an ethical decision. For instance, a teenager who is maintaining a
scholarship is pregnant. She is to decide whether she will abort the baby to avoid issues and being kicked
out of the school or sustain the pregnancy and deliver the baby.