An unconscious patient moves his extremity spontaneously, opens eyes with pain, and speaks inappropriate words. Then what is the GCS?

Appeared in: AIIMS Delhi NO - 2017

Explanation

The Glasgow Coma Scale (GCS) is a neurological tool used to assess a patient's level of consciousness.
The patient's score is calculated by adding the points from three categories: Eye Opening, Verbal Response, and Motor Response.
Eye Opening to pain scores 2 points.
Speaking inappropriate words scores 3 points.
The motor response 'moves his extremity spontaneously' is best interpreted as 'Localizes pain' in an unconscious patient responding to painful stimuli, which scores 5 points. An unconscious patient cannot obey commands (a score of 6).
The total GCS score is 2 (Eye) + 3 (Verbal) + 5 (Motor) = 10.

Option B: A score of 12 would require a higher level of function, for example, opening eyes to speech (3), speaking confused words (4), and localizing pain (5), totaling 12.
Option C: This score is often reached by incorrectly assigning 6 points for the motor response ('Obeys commands'). An unconscious patient cannot follow commands, making this interpretation clinically inaccurate.
Option D: A score of 8 would indicate a more severe impairment, such as abnormal flexion (decorticate posturing) in response to pain for the motor component (E2 + V3 + M3 = 8).

Clinical Relevance

Nursing practice connection: Use the key finding related to Calculation of Glasgow Coma Scale (GCS) score based on clinical findings to guide bedside assessment, documentation, and the next nursing action.
The GCS is a critical tool for nurses to quickly assess and communicate a patient's neurological status, especially after a head injury or in intensive care.
A GCS score of 8 or less is generally considered to indicate a coma and often necessitates advanced airway management, such as intubation, to protect the airway.
Serial GCS assessments are vital. A drop in the GCS score is a significant finding that must be reported to the physician immediately as it can indicate worsening neurological function, such as increasing intracranial pressure.

How to Approach the Question

First, identify that the question asks for the Glasgow Coma Scale (GCS) score.
Break down the patient's responses into the three GCS categories: Eye Opening, Verbal Response, and Motor Response.
Score each category individually based on the provided description: 'opens eyes with pain' (E=2), 'speaks inappropriate words' (V=3).
Carefully analyze the motor response. 'Moves his extremity spontaneously' is ambiguous. Since the patient is unconscious and responding to pain, interpret the motor response in that context. The most appropriate score is 5 for 'Localizes pain', as 'Obeys commands' (6) is impossible for an unconscious patient.
Sum the scores from the three categories: E(2) + V(3) + M(5) = 10.
Select the option that matches your calculated total score.

Concept Tested & Keywords

Concept Tested: Calculation of Glasgow Coma Scale (GCS) score based on clinical findings.
Stem keywords: unconscious patient, GCS, opens eyes with pain, speaks inappropriate words, moves his extremity
Lead-in keywords: what is the GCS
Clinical cues: The patient is described as unconscious, which is a key factor in interpreting the motor response.

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E6 Nursing Fundamentals Taylor p. 412-414

E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 2 (pp 290-564 of 579) p. 196-198

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