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Responsiveness: The patient would immediately respond to sound, tone of voice and to touch and pain.
Sensory Exam: The patient was tested to light touch, pressure, and sharp touch and pain in all four extremities and on her face. The pain portion in the extremities was conducted by pinching the nail beds of her hands and feet. She clearly feels pain as the videotapes show.
On the face, noxious stimulation including cotton swab up the nose and gag sensation and papillary touch with cotton evidenced a pain response. These were more than just reflexes, as she appeared to be annoyed by these painful responses long after they had stopped, and would not smile at me again for the rest of the day. She certainly feels pressure, as was discussed earlier, and opposes pressure with voluntary motor activity. When using a sharp piece of wood, which she found uncomfortable, and going over her entire body (except diapered areas and breast areas), we found that sensation is present everywhere. Sensation on the right side as evidenced by moaning or tightening up muscles or withdrawal and was more prevalent than on the left.
On the face, noxious stimulation including cotton swab up the nose and gag sensation and papillary touch with cotton evidenced a pain response. These were more than just reflexes, as she appeared to be annoyed by these painful responses long after they had stopped, and would not smile at me again for the rest of the day. She certainly feels pressure, as was discussed earlier, and opposes pressure with voluntary motor activity. When using a sharp piece of wood, which she found uncomfortable, and going over her entire body (except diapered areas and breast areas), we found that sensation is present everywhere. Sensation on the right side as evidenced by moaning or tightening up muscles or withdrawal and was more prevalent than on the left.
Impression:
The patient is not in coma.
She is alert and responsive to her environment. She responds to specific people best. She tries to please others by doing activities for which she gets verbal praise. She responds negatively to poor tone of voice. She responds to music.
She differentiates sounds from voices.
She differentiates specific people's voices from others.
She differentiates music from stray sounds.
She attempts to verbalize.
She has voluntary control over multiple extremities
She can swallow.
She is partially blind
She is probably aphasic and has a degree of receptive aphasia.
She can feel pain.
On this last point, it is interesting to observe that the records from Hospice show frequent medication administered for pain by staff.
The patient is not in coma.
She is alert and responsive to her environment. She responds to specific people best. She tries to please others by doing activities for which she gets verbal praise. She responds negatively to poor tone of voice. She responds to music.
She differentiates sounds from voices.
She differentiates specific people's voices from others.
She differentiates music from stray sounds.
She attempts to verbalize.
She has voluntary control over multiple extremities
She can swallow.
She is partially blind
She is probably aphasic and has a degree of receptive aphasia.
She can feel pain.
On this last point, it is interesting to observe that the records from Hospice show frequent medication administered for pain by staff.
Not a court-appointed neurologist though...
great source!
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