Which of the following score indicates coma in an adult patient as per GCS

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2024

Explanation

A Glasgow Coma Scale (GCS) score of 8 or less is the universally accepted clinical threshold for a severe head injury, which is defined as a coma.
The score of 5 falls squarely within this severe range (3-8), signifying a deep level of unconsciousness.
This low score indicates that the patient's higher brain functions are severely impaired, and they are unresponsive to most stimuli.

Option A: A score of 0 is impossible on the GCS. The scale's minimum score is 3, which is assigned when a patient shows no response in any of the three categories (1 point for each of Eye, Verbal, and Motor responses).
Option B: A score of 12 falls within the 9-12 range, which indicates a moderate head injury. The patient has a depressed level of consciousness but is not in a coma.
Option C: A score of 9 is the lowest score in the moderate head injury category (9-12). While it represents a significant injury, it is above the clinical threshold for coma.

Clinical Relevance

Nursing practice connection: Use the key finding related to Interpretation of the Glasgow Coma Scale (GCS) to determine coma to guide bedside assessment, documentation, and the next nursing action.
The GCS is a fundamental, standardized tool used by nurses for rapid neurological assessment, especially in emergency, trauma, and intensive care settings, to track changes in a patient's condition.
A common clinical guideline is 'GCS of 8, intubate.' This highlights the critical patient-safety implication: a patient in a coma cannot protect their airway, and intubation is necessary to prevent aspiration and ensure adequate ventilation.
What if? If the patient was intubated, the verbal response cannot be assessed. The score is then documented with a 'T' suffix (e.g., GCS 5T), and the assessment relies on the eye and motor scores to trend the patient's neurological status.

How to Approach the Question

First, identify the key terms in the question: 'GCS' and 'coma'.
This is a factual recall question. You need to remember the standard clinical classifications based on the GCS score.
Recall the three levels of head injury severity: Mild (13-15), Moderate (9-12), and Severe/Coma (3-8).
Also, recall that the lowest possible score is 3, not 0.
Evaluate each option against these ranges: '0' is impossible. '12' and '9' are moderate. '5' falls into the severe/coma range.
Select the option that matches the definition of coma.

Concept Tested & Keywords

Concept Tested: Interpretation of the Glasgow Coma Scale (GCS) to determine coma.
Stem keywords: GCS, coma, adult patient, score
Lead-in keywords: Which

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E6 Nursing Fundamentals Taylor p. 412-414

E6 Medicine Harrison 22e Part 2 p. 1475-1477

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