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Based on the case of Atty. Isko. What is the GCS score? (5 pts each parameter a total of 15
points).
Upon admission (15 pts) In the Intensive Care Unit (15 pts)
Eye opening: 3 Eye opening: 3
Verbal response: 2 Verbal response: 2
Motor response: 5 Motor response: 3
What is your interpretation of the above GCS score result you obtained? And what is the
implication to the patient? (10 pts for the GCS interpretation of result and another 10 pts for the
implication)
Upon admission (20 pts) In the Intensive Care Unit (20 pts)
8/15 EO: 3 VR: 2 MR: 5 = Severe 8/15 – (EO-3, VR-2, MR-3 ) = Severe
Brain Injury Brain Injury
A GCS score of 8 or less defines a A GCS score of 8 or less defines a severe
severe head injury. In the situation of Atty. head injury. In the situation of Atty. Isko Upon
Isko Upon admission he has the GCS scoring admission and going to ICU his condition didn't
of Eye response with a score of 3 (being change in terms of GCS scoring of Eye response
responsive to speech) and Verbal Response with a score of 3 (being responsive to speech) and
with a score of 2 (being inaudible when Verbal Response with a score of 2 (being inaudible
speaking) and a score of 3 in motor means when speaking) the only thing that changed in the
there is an abnormal response to the situation of Atty. Isko from admission to ICU is
movement of Atty. Isko, with this condition that his motor response, from 5 to 3, a score of 3
he needs medical attention badly because he means there is an abnormal response to the motor
is at a high risk of getting a stroke. of Atty. Isko, it is said that weakness is noted but
when stimulus is applied for example at the left side
the opposite side will trigger the response. In
general, Atty. Isko having a GCS score of 8 means
that he needs intensive monitoring and more
diagnostics to identify more about the disease
process and to be able to apply proper care to Atty.
Isko.
Assessment Nursing Dx Planning Intervention Rationale Evaluation