PEDS- week 3- Neurological Disorders

Assessing Motor Function- SCALE

+0-5 levels 0: no movement +1: slight movement +2: can raise extremity; not lift if +3: can raise extremity; not against resistance +4: full ROM, less strength than normal +5 full ROM, full strength

Hydrocephalus is suspected in a 4-month-old infant. Which of the following would the nurse expect to assess? A) Sunken fontanels B) Diminished reflexes C) Lower extremity spasticity D) Skull symmetry

C) Lower extremity spasticity

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which of the following? Select all answers that apply. A Complaints of stiff neck B Photophobia C Absent headache D Negative Brudzinski sign E Vomiting

A Complaints of stiff neck B Photophobia E Vomiting

A 10-month-old is brought to the emergency department by her parents after they found her face down in the bathtub. The mother said, "I just left the bathroom to answer the phone. When I came back, I found her." Which of the following assessments would be the priority? A) Airway, breathing, and circulation B) Level of consciousness C) Vital signs D) Pupillary response

A) Airway, breathing, and circulation

A group of students are reviewing information about head injuries in children. The students demonstrate understanding of this information when they identify which of the following as the most common type of skull fracture in children? A)Linear B)Depressed C)Diastatic D)Basilar

A) Linear

A nurse is preparing a presentation for a local health fair about meningitis and has developed a display that lists the following causes: Streptococcus group B Haemophilus influenzae type B Streptococcus pneumoniae Neisseria meningitidis Which of these would the nurse highlight as the most common cause of meningitis in newborns? A) Streptococcus group B B) Haemophilus influenzae type B C) Streptococcus pneumoniae D) Neisseria meningitides

A) Streptococcus group B

A 4-year-old boy has a history of seizures and has been started on a ketogenic diet. Which of the following food selections would be most appropriate for his lunch? A Fried eggs, bacon, and iced tea B A hamburger on a bun, French fries, and milk C Spaghetti with meatballs, garlic bread, and a cola drink D A grilled cheese sandwich, potato chips, and a milkshake

A) Fried eggs, bacon, and iced tea

The physician has ordered rectal diazepam (Valium) for a 2-year-old boy with status epilepticus. Which of the following instructions is essential for the nurse to teach the parents? A) Monitor their child's level of sedation. B)Watch for fever indicating infection. C)Gradually reduce the dosage as seizures stop. D)Monitor for an allergic reaction to the medication.

A) Monitor their child's level of sedation.

A child with increased intracranial pressure is being treated with hyperventilation. The nurse understands the need for this treatment is based on which of the following? A PaCO2 levels decrease, causing vasoconstriction. B Drainage of cerebrospinal fluid occurs. C Activity is controlled via a stimulator. D Hyperexcitability of the nerves is reduced.

A) PaCO2 levels decrease, causing vasoconstriction.

A nurse is preparing a school-aged child for a lumbar puncture. The nurse would expect to position the child in which manner? A)On her side with the head flexed forward and knees flexed to the abdomen B)Sitting upright with the head flexed forward to the chest C)Supine with arms and legs pronated and extended D)Prone with the arms flexed under the chest

A)On her side with the head flexed forward and knees flexed to the abdomen

Absence seizures

Abrupt on/off-set Sudden cessation of motor activity/speech

Appropriate questions related to the seizure event:

Asking parent or family Where did the event occur? When? While sleeping, eating, playing? Description of the child's behavior during the event. What types of movements, progression, length, respiratory status, apnea occurred? How did the child act after the event? Have the episodes been recurrent? If so, how frequent? Any precipitating factors such as a fever, fall, activity, anxiety, infection, or exposure to strong stimuli (lights?) Postictal state: how long to return to baseline?

Head Injury causes:

Automobile accidents Abusive head trauma Bicycle Skiing Hockey Football

A child is brought to the emergency department after sustaining a concussion. The child is to be discharged home with his parents. Which of the following would the nurse include in the child's discharge instructions? A) "Expect his headache to get worse initially and then disappear." B) "Wake him every 2 hours to check his movement and responses." C) "Call your medical provider if he vomits more than five times." D) "Any watery fluid draining from his ears is normal.

B "Wake him every 2 hours to check his movement and responses."

The nurse knows that children have larger heads in relation to the body and a higher center of gravity. When developing a teaching plan for parents, the nurse includes information about an increased risk for which of the following problems? A Febrile seizures B Head trauma C Caput succedaneum D)Posterior plagiocephaly

B Head trauma

The nurse assesses a child's level of consciousness, noting that the child falls asleep unless he is stimulated. The nurse documents this finding as: A Confusion B Obtunded C Stupor D Coma

B Obtunded

During a well-child visit, the nurse assesses an infant's ability to suck on a pacifier. The nurse is assessing which cranial nerve? A Olfactory B Trigeminal C Facial D Accessory

B Trigeminal

Reflexes assesment (2) Babinksi is? protective reflexes are where?

Babinski- extension of big toe and fanning of others outward Protective reflexes- brain stem

As a result of seizure activity, a computed tomography (CT) scan was performed and showed that an 18-month-old child has intracranial arteriovenous malformation. When developing the child's plan of care, the nurse would expect to implement actions to prevent which of the following? A Drug interactions B Developmental disabilities C Hemorrhagic stroke D Respiratory paralysis

C Hemorrhagic stroke

When providing care to a newborn infant who was born at 29 weeks' gestation, the nurse integrates knowledge of potential complications, being alert for signs and symptoms of which of the following? A Neonatal conjunctivitis B Facial deformities C Intracranial hemorrhage D Incomplete myelinization

C Intracranial hemorrhage

The nurse is caring for an 8-year-old boy who has chronic epilepsy. Which of the following would be most important to address when teaching the child and parents about living with this condition? A Multiple corrective surgeries to slowly remove diseased parts of his brain B Physical, occupational, and speech therapy to maximize his potential C Support for maintaining self-esteem because of his altered lifestyle D Hyperventilation therapy to counteract the periods of decreased oxygenation

C Support for maintaining self-esteem because of his altered lifestyle

A nurse is providing teaching to the parents of a child who has had a shunt inserted as treatment for hydrocephalus. The parents demonstrate understanding of the teaching when they state which of the following? A) "Having the shunt put in decreases his risk for developmental problems." B) "If he doesn't get an infection in the first week, the risk is greatly reduced." C) "He will need more surgeries to replace the shunt as he grows." D) "The shunt will help to prevent any further complications from his disease."

C) "He will need more surgeries to replace the shunt as he grows."

Focal Seizure

One one side of the brain Affects the opposite side (right affects left)

Epilepsy

Chronic illness with recurrent, unprovoked seizures due to an abnormality in the brain.

Nursing interventions- Head Injury what scale? prep for?? Monitor for signs of?? Teaching of parents for? what should child do??

Concussion scale Prep for CT vs. MRI Parents almost always as for CT, we don't want to do this bc a lot of radiation. MRI kid needs to stay still. Emergency management Monitor for signs of increased ICP Concussion teaching and follow-up- give parents orders on how to let it get better, its like a bruise on the brain. REST! No TV, no reading. Simple board games are okay. Educate about head safety

A nurse is talking with the parents of a child who has had a febrile seizure. The nurse would integrate an understanding of which of the following into the discussion? A The child's risk for cognitive problems is greatly increased. B Structural damage occurs with febrile seizure. C The child's risk for epilepsy is now increased. D Febrile seizures are benign in nature.

D Febrile seizures are benign in nature.

A nurse is preparing a presentation for an expectant parent group about neural tube defects and prevention. Which of the following would the nurse emphasize? A Smoking cessation B Aerobic exercise C Increased calcium intake D Folic acid supplementation

D Folic acid supplementation

A group of nursing students are reviewing information related to seizures that occur in infants and children. The students demonstrate a need for additional review when they identify which type as common in neonates? A Tonic B Focal clonic C Multifocal clonic D Myoclonic

D Myoclonic

A 16-year-old boy complains to the school nurse of headaches and a stiff neck. Which of the following signs and symptoms would alert the nurse that the child may have bacterial meningitis? A Fixed and dilated pupils B Frequent urination C Sunset eyes D Sunlight is "too bright"

D Sunlight is "too bright"

Which of the following would lead the nurse to suspect that a child is beginning to develop increased intracranial pressure? A Bradycardia B Cheyne-Stokes respirations C Fixed, dilated pupils D Projectile vomiting

D) Projectile vomiting

A 4-year-old boy has a febrile seizure during a well-child visit. Which of the following would be a priority? A) Hyperextending the child's head while placing him on his side B) Using a tongue blade to pry open the child's jaw C) Loosening the child's clothing to ensure a patent airway D) Protecting the child from harm during the seizure

D) Protecting the child from harm during the seizure

The nurse has developed a teaching plan for the family of a 2-year-old boy who holds his breath when he gets frustrated. Which of the following will be most important to include in this plan? A Provide cuddle time whenever the child begins to act out. B Explain the child's behavior to the parents. C Encourage the parents to interact more with the child. D Stay close to prevent injury when he gets frustrated.

D) Stay close to prevent injury when he gets frustrated.

Nursing interventions: Increased Cranial Pressure (4)

Elevating the head of the bed 15-30 degrees- to allow fluid to return Keep child's head straight Minimize environmental stimuli Medicate as ordered- we don't want to wait, they are in pain

Seizure precautions:

Padding of side rails and other hard objects Side rails raised on bed at all times when child is in bed Oxygen and suction at bedside Supervision, especially during bathing, ambulation, or other potentially hazardous activities Use of a protective helmet during activity Child should wear a medical alert bracelet (Esp epilepsy)

Increased Intracranial Pressure is due to

Pressure due to a growth, inflammation, or increased CSF in the central nervous system

Hydrocephalus-

Enlargement of the ventricles due to increase in CSF

Simple Febrile Seizure generalized or focal? normal ages? lasts how long? how many per 24 hour period?

Febrile- generalized seizure, not focal, happens at same time as a fever 6 months to 6 years "6 to 6" No more than 15 minutes Only one per 24 hours period Fever does not cause seizure When your sick w/ virus, body mounts a fever to kill virus, as body is changing to fight- cellular changes cause misfiring of brains Does not have any increased risk of developing epilepsy in future

Tonic-clonic

Generalized Alternating tonic contractions and rhythmic clonic contractions Cant stop it

Generalized Seizure (3)

Generalized misfiring of electrical activity Causes bilateral and symmetric abnormalities +Loss Of Consciousness

Clonic seizures

Generalized repeated jerking movements Cannot be stopped by restraining/repositioning

Tonic seizures

Generalized stiffening of muscles

Simple Febrile

Generalized tonic-clonic With postictal period- confused or sleepy after, should be about same time to seizure or up to double (10 min seizure, 10 min postictal period)

Pathophysiology of Seizure: can be due to (5) things

Genetic link (if siblings/parents have) Injuries (mostly severe injuries traumatic brain injury or brain bleeding) Infection (can be meningitis) Idiopathic (we don't know cause) Fever (Febrile seizures)

Status epilepticus how long?

Greater than 5 minutes Multiple seizures without return to consciousness

Increased Intracranial Pressure: Signs and Symptoms whats usually 1st? whats a later sign (2)

Headache (usually 1st) Vomiting (later sign) Visual changes Dizziness Decreased pulse and respirations (later) Increased systolic blood pressure Widened pulse pressure (systolic goes up, diastolic normal or low) Increased head circumference (infants/toddlers bc head not fused) Separated sutures (widened) Bulging fontanels Enlarged fontanels Frontal bossing- fluid in forehead bc fluid has nowhere to go Shrill, high-pitched cry- "cat cry" Seizures (later sign- can be caused by other causes not just ICP) Fontanels is supposed to be flat, bulging when crying not worried

Head Injury: Signs and Symptoms

History Vomiting (more than 2x) Bruises Headache Dizziness Abnormal pupils Lacerations Confusion Clear liquid from nose/ear-check for sugar.

Increased Intracranial Pressure results from: (4)

Injury CNS Infection Tumor (benign/cancerous) Excess CSF

Signs and symptoms of Hydrocephalus

Irritability WEAK CRY Lethargy Poor feeding Vomiting Headache Bulging eyes- bc pressure is pushing out any way it can go Wide/bulging fontanels Increased head circumference Dilated scalp veins

Nursing interventions- meningitis- what do you want to do immediately?

Isolation immediatley!!! With suspicion Droplet ASAP & stay this way until ruled out or treated

BIGGEST THING IS TAKING PARENTS ASIDE during febrile seizure

JUST A CHILD SEIZURE, NOTHINGS WRONG WITH THE BRAIN, its because kid is sick. Febrile seizure is NOT caused by fever itself its caused by the change itself in fighting infection

Nursing interventions- meningitis how do we test for meningitis***

Minimize environmental stimuli Bloods WBC you'll see increase! Prep for Lumbar Puncture Throat culture (where bacteria hides) Antibiotics- STAT Antipyretics/analgesics- PRN Vaccinations If negative:Bed rest

Nursing interventions for Hydrocephalus (4 things!) Monitor.. Monitor for .. Careful.. Keep baby..

Monitor head circumference Monitor for seizure activity- educating what to look out for Careful position changes- don't want to kink shunt Keep baby calm

Bacterial Meningitis

Most common central nervous system infection

Pathophysiology of Meningitis

Multiple types of bacteria Viral forms are less serious, but may have seizures Pathogen invades the meninges, lining of the brain, and spinal cord

Status epilepticus what is it? risk for (3) things?

Prolonged, continuous seizure of more than 5 minutes Intermittent without return to consciousness between Risks increased for hypoxia, neurological damage, and death

Nursing interventions during seizure what is the med that stops the seizure for happening??

Self-limiting Safety first Oxygen Monitoring symptoms and vital signs Bloods IV placed Medications as ordered *Rectal diastat- stops the seizure from happening/continuing- only as oredred *Want to make sure not to restrain them Protect their head- put padding, TAKE AWAY ALL BAD THINGS Have airway tray ready! If not returning to baseline Blood work- IV to give meds!

Nursing interventions for simple febrile seizure:

Self-limiting Safety intervention Monitor Describe and document Antipyretics Only to make them more comfortable

Best place to hit head

Sides of the head is worse to hit than the front because of temporal Best place to hit is the front of the head

Sensation assessment

Soft vs. sharp Soft- superficial Sharp- deeper

What is the most important thing to do while child is having a seizure?

TIME THE SEIZURE

Seizure definition:

Times of abnormal electrical discharged in the brain Involuntary movements

Pathophysiology of Hydrocephalus-

Too much production, or too little absorption of CSF

Treatment for Hydrocephalus

Ventriculoperitoneal shunt Monitor for malfunction (kinking) or infection Fluid goes own ventricles down the neck and into abdomen *Leave enough of shunt in abdomen- ideally we only do this 1 time ever bc decreased risk of infection- as kid grows it unravels. Could kink.

A parent reports that her child has begun to do poorly at school and experiences episodes where he appears to be staring into space. Of which type of seizure is this behavior a characteristic? a. Absence b. Akinetic c. Myoclonic d. Complex partial

a. Absence

Which of the following types of seizures may be difficult to detect? a. Absence b. Generalized c. Simple partial d. Complex partial

a. Absence

Which is the priority nursing intervention for an unconscious child after a fall? a. Establish adequate airway. b. Perform neurologic assessment. c. Monitor intracranial pressure. d. Determine whether a neck injury is present.

a. Establish adequate airway.

Which assessment finding in a child with meningitis should be reported immediately? a. Irregular respirations b. Tachycardia c. Slight drop in blood pressure d. Elevated temperature

a. Irregular respirations Irregular respirations in conjunction with slowing heart rate and increasing blood pressure are reported immediately because they could indicate increased intracranial pressure.

What intervention(s) would the nurse caring for a child with infectious meningitis include? (Select all that apply.) a. Isolation precautions b. Provision of brightly lit room c. Observation for increasing intracranial pressure d. Preparation for spinal tap e. Seizure precautions

a. Isolation precautions c. Observation for increasing intracranial pressure d. Preparation for spinal tap e. Seizure precautions

Which drug should the nurse expect to administer to a preschool child who has increased intracranial pressure (ICP) resulting from cerebral edema? a. Mannitol (Osmitrol) b. Epinephrine hydrochloride (Adrenalin) c. Atropine sulfate (Atropine) d. Sodium bicarbonate (Sodium bicarbonate)

a. Mannitol (Osmitrol)

What will the nurse include then documenting a grand mal seizure? (Select all that apply.) a. Presence of incontinence b. Current dose of antispasmodic medication c. Activity level prior to and following seizure d. Level of consciousness following seizure e. Length of seizure

a. Presence of incontinence c. Activity level prior to and following seizure d. Level of consciousness following seizure e. Length of seizure

An adolescent has just had a generalized seizure and collapsed in the school nurse's office. When should the nurse should call 911? a. The seizure lasts more than 5 minutes. b. The child is sleepy and lethargic after the seizure. c. The child fell at the onset of the seizure. d. The child is confused and has slurred speech after the seizure.

a. The seizure lasts more than 5 minutes. If there are multiple seizures or if seizures last more than 5 minutes, call 911 because these are indicators of possible status epilepticus, a medical emergency.

A toddler fell out of a second-story window. She had a brief loss of consciousness and vomited four times. Since admission, she has been alert and oriented. Her mother asks why a computed tomography (CT) scan is required when she "seems fine." Which explanation should the nurse give? a. Your child may have a brain injury and the CT can rule one out. b. The CT needs to be done because of your child's age. c. Your child may start to have seizures and a baseline CT should be done. d. Your child probably has a skull fracture and the CT can confirm this diagnosis.

a. Your child may have a brain injury and the CT can rule one out.

An important nursing intervention when caring for a child who is experiencing a seizure would be to: a. describe and record the seizure activity observed. b. restrain the child when seizure occurs to prevent bodily harm. c. place a tongue blade between the teeth if they become clenched. d. suction the child during a seizure to prevent aspiration.

a. describe and record the seizure activity observed.

A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school. Breathing is not impaired, but some postictal confusion occurs. The most appropriate initial action by the school nurse is to: a. stay with child and have someone call emergency medical service (EMS). b. notify parent and regular practitioner. c. notify parent that child should go home. d. stay with child, offering calm reassurance.

a. stay with child and have someone call emergency medical service (EMS).

The nurse has received report on four children. Which child should the nurse assess first? a. A school-age child in a coma with stable vital signs b. A preschool child with a head injury and decreasing level of consciousness c. An adolescent admitted after a motor vehicle accident is oriented to person and place d. A toddler in a persistent vegetative state with a low-grade fever

b. A preschool child with a head injury and decreasing level of consciousness

The nurse is caring for a 3-year-old with a head injury. Which assessment would lead the nurse to report the probability of increasing intracranial pressure (ICP)? a. Temperature increase from 37.2° C (99° F) to 37.7° C (100° F) b. Increase in blood pressure with an attendant decrease in pulse c. Increase in respirations d. Equilateral pupils

b. Increase in blood pressure with an attendant decrease in pulse

What is an appropriate nursing action when a child is experiencing a generalized tonic-clonic seizure? a. Guide the child to the floor if the child is standing, and then go for help. b. Move objects out of the child's immediate area. c. Stick a padded tongue blade between the child's teeth. d. Manually restrain the child.

b. Move objects out of the child's immediate area.

A child diagnosed with epilepsy had a generalized tonic-clonic seizure that lasted 90 seconds. What would the nurse expect to assess after a generalized tonic-clonic seizure? a. Restlessness b. Sleepiness c. Nausea d. Anxiety

b. Sleepiness

The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. The nurse should interpret this as: a. eye trauma. b. neurosurgical emergency. c. severe brainstem damage. d. indication of brain death.

b. neurosurgical emergency.

A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is: a. "Epilepsy is easily treated." b. "Very few children have actual epilepsy." c. "The seizure may or may not mean that your child has epilepsy." d. "Your child has had only one convulsion; it probably won't happen again."

c. "The seizure may or may not mean that your child has epilepsy."

The nurse urges the mother of a 6-month-old to get her child inoculated with Haemophilus influenzae type B. What does this immunization protect against? a. Encephalitis b. Influenza c. Bacterial meningitis d. Otitis media

c. Bacterial meningitis

Which neurologic diagnostic test gives a visualized horizontal and vertical cross-section of the brain at any axis? a. Nuclear brain scan b. Echoencephalography c. CT scan d. Magnetic resonance imaging (MRI)

c. CT scan

A child is brought to the emergency department after he fell and hit his head on the ground. Which nursing assessment suggests the child has a concussion? a. Sleepy but easily arousable b. Complaining of a stiff neck c. Cannot remember what happened to him d. Pupils react sluggishly to light

c. Cannot remember what happened to him

The nurse observes a child's position is supine with his arms and legs rigidly extended and the hands pronated. How does the nurse identify this posture? a. Correct anatomical position b. Decorticate c. Decerebrate d. Opisthotonos

c. Decerebrate

Which type of seizure involves both hemispheres of the brain? a. Focal b. Partial c. Generalized d. Acquired

c. Generalized

What would the nurse include when creating a teaching plan that includes the long-term administration of phenytoin (Dilantin)? a. The medication should be given on an empty stomach. b. Insomnia can be a significant side effect. c. Gums should be massaged regularly to prevent hyperplasia. d. Blood pressure should be closely monitored.

c. Gums should be massaged regularly to prevent hyperplasia.

Which is the initial clinical manifestation of generalized seizures? a. Being confused b. Feeling frightened c. Losing consciousness d. Seeing flashing lights

c. Losing consciousness

An appropriate nursing intervention when caring for an unconscious child should be to: a. change the child's position infrequently to minimize the chance of increased ICP. b. avoid using narcotics or sedatives to provide comfort and pain relief. c. monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. d. give tepid sponge baths to reduce fever because antipyretics are contraindicated.

c. monitor fluid intake and output carefully to avoid fluid overload and cerebral edema

A 10-year-old boy on a bicycle has been hit by a car in front of the school. The school nurse immediately assesses airway, breathing, and circulation. The next nursing action: should be to a. place on side. b. take blood pressure. c. stabilize neck and spine. d. check scalp and back for bleeding

c. stabilize neck and spine.

The nurse is performing a Glasgow Coma Scale on a school-age child with a head injury. The child opens eyes spontaneously, obeys commands, and is oriented to person, time, and place. Which is the score the nurse should record? a. 8 b. 11 c. 13 d. 15

d. 15

The nurse is performing a neurological assessment on a 10-month-old infant using a modified Glasgow Coma Scale. What score will the nurse give if the child is babbling? a. 1 b. 2 c. 3 d. 4

d. 4

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. Which is the most essential part of the nursing assessment to detect early signs of a worsening condition? a. Posturing b. Vital signs c. Focal neurologic signs d. Level of consciousness

d. Level of consciousness

What does the nurse explains to parents of a child with febrile seizures? a. They occur when the body temperature exceeds 38.3° C (101° F). b. They can be prevented by anticonvulsant medication. c. They usually lead to the development of epilepsy. d. They occur when the temperature rises quickly.

d. They occur when the temperature rises quickly.

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like her oldest son did when he was an infant. The nurse should base her response on which statement? a. Meningitis rarely occurs during infancy. b. Often a genetic predisposition to meningitis is found. c. Vaccination to prevent all types of meningitis is now available. d. Vaccination to prevent Haemophilus influenzae type B meningitis has decreased the frequency of this disease in children.

d. Vaccination to prevent Haemophilus influenzae type B meningitis has decreased the frequency of this disease in children.

The nurse should recommend medical attention if a child with a slight head injury experiences: a. sleepiness. b. vomiting, even once. c. headache, even if slight. d. confusion or abnormal behavior.

d. confusion or abnormal behavior.

A child is unconscious after a motor vehicle accident. The watery discharge from the nose tests positive for glucose. The nurse should recognize that this suggests: a. diabetic coma. b. brainstem injury. c. upper respiratory tract infection. d. leaking of cerebrospinal fluid (CSF).

d. leaking of cerebrospinal fluid (CSF).

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Meningitis signs and symptoms-

fever refusing feeds/vomiting high pitched cry dislike of being handled NECK RETRACTION w/ ARCHING OF BACK blank & staring expression LETHARGIC*** LIGHT SENSITIVITY joint pain

Neuro Disorders- assess level of consciousness with what is best score?

glasgow coma scale -Eyes opening -Motor response -Verbal response

If someone is LETHARGIC-

they need to be seen ASAP