Being in a country where there is a nurse-patient ratio of 1:15-26 per shift, it is not easy to be able to perform a thorough assessment to all of the patients. In most cases, especially in a government setting, some assessments are skipped and only a few things are endorsed. In my experience among some institutions, the Glasgow Coma Scale or GCS is often missed because the assessment takes a while to finish, and only a few have actually memorized this scale by heart--some nurses also tend to focus more on the vital signs.

I was on ambulance duty when we responded to an 18-year old girl who lost consciousness at home. We assessed her vitals signs and gathered her medical history along with a brief physical assessment. She was diagnosed with chickenpox and is currently on her third day from when the symptoms started to appear. Although her vital signs are stable and within the normal range, I still assessed her GCS and had a score of 5 (E-3, V-1, M-1). We loaded her into the ambulance and I reassessed her during transport. I got a GCS of 4 (E-2, V-1, M-1) by the time that we arrived at the Emergency Room.

Baked Tuna in Eggs and Cream Cheese, Topped with Tomatoes, Parmesan Cheese, and Basil