10: Assessment of Neurocognitive Disorders Flashcards
What are 6 potential settings?
1) acute care
2) inpatient rehab
3) skilled nursing facility (SNF)
4) long term acute care (LTAC)
5) home health care
6) outpatient clinics
What are 13 initial parts of assessment regardless of setting?
1) vision
2) hearing
3) prior level of function (driving, cooking, cleaning, managing finances, etc.)
4) education
5) work history/vocation
6) support system
7) GOALS
8) specific nature of the brain injury (acute vs subacute vs chronic)
9) current social demands
10) pre-morbid personality factors
11) emotional response to injury
12) adaptive and coping skills
13) beliefs and expectations (patient and family)
What are 5 pieces of case history medical information to collect?
1) chief complaint
2) circumstances leading to hospitalization
3) testing results
4) medications
5) pre-injury medical history (mental health, substance abuse)
What are 6 testing results you might collect information on for a patient?
1) Glasgow Coma Scale (GCS)
2) neuroimaging
3) length of posttraumatic amnesia
4) surgical procedures
5) complications
6) motor deficits
What are 13 areas to assess during a cognitive assessment?
1) arousal
2) alertness
3) orientation
4) memory
5) language/communication
6) object recognition
7) reading
8) writing
9) math
10) visuoperceptual and visuospatial abilities
11) reasoning
12) problem solving
13) new learning
What are 8 areas of executive function to assess?1
1) initiation
2) inhibition
3) planning
4) organization
5) maintenance
6) mental flexibility
7) behavioral flexibility
8) self awareness
What are 4 areas of behavior to assess?
1) ability to initiate appropriate behaviors
2) inhibit inappropriate behaviors
3) effective interpersonal communication
4) self regulation of mood and emotion
What are 2 ways that we can assess lower level patients?
1) Glasgow Coma Scale (GCS)
2) Galveston Orientation and Amnesia Test (GOAT)
Which Rancho level?
Confused-Appropriate: person is confused, responds accurately to commands
Level 6
Which Rancho level?
No response: person appears to be in deep sleep
Level 1
Which Rancho level?
Purposeful-Appropriate: goes through daily routine aware of need for stand-by assistance, depression may continue
Level 9
Which Rancho level?
Localized Response: reacts inconsistently, directly to stimuli
Level 3
Which Rancho level?
Automatic-Appropriate: person goes through daily routine with minimal confusion
Level 7
Which Rancho level?
Purposeful-Appropriate: person has functioning memory, responsive to environment, may display depression
Level 8
Which Rancho level?
Generalized Response: person reacts inconsistently, not directly in response to stimuli
Level 2
Which Rancho level?
Confused-Inappropriate/Non-Agitated: person is confused and responds inaccurately to commands
Level 5
Which Rancho level?
Purposeful-Appropriate/Modified Independent: goes through daily routine but may require more time or compensatory strategies, periodic depression may occur
Level 10
Which Rancho level?
Confused/Agitated, person is extremely confused, agitated
Level 4
Rancho Level 1
- ___ ________
- complete absence of observable change in ___________ when:
no response
behavior
presented with visual, auditory, tactile, proprioceptive, vestibular, or pain stimuli
Rancho Level 2
- generalized ________ _________ to _________ stimuli
- responds to repeated _____________ stimuli with _________ or __________ activity
- responds to _________ stimuli with ________________ changes
- no purposeful _____________
- reflex response, painful
- auditory, increased or decreased
- external, physiological
- vocalizations
Rancho level 1 and 2 assessment would be done by who?
nursing/medical team
What are 5 informal observations you would make for Ranchos Level 3?
1) response to environment when alert and awake (look at tv, people entering room)
2) responsiveness to speech (eye contact, facial expression, attempt to speak)
3) visual stimulation (lights, bright colors in patients line of vision)
4) olfactory stimuli (pleasant/unpleasant, taste)
5) tactile stimuli (pressure, hot/cold, rough/smooth)
When would you assess orientation?
When client begins responding to environmental stimuli
typically rancho levels 4 and 5, with rt CVA
How do you obtain baseline for orientation and memory?
person, place, and time
also assesses sense of passage of time
What is not appropriate for assessing orientation in rancho levels 4 and 5? What are 2 alternatives?
a long assessment
1) informal measures (sustained attention, yes/no, command following)
2) GOAT
For pts at rancho levels 5 + 6, what are
