acute change in mental status Flashcards
Lethargic is…
drowsy but easily aroused
Obtunded…
arousable but responds slowly and is somewhat confused
what is the activity to each scale of glasgow coma scale for eye opening?
None
1: even to supraorbital pressure
To pain
2: pain from limb/supraorbital pressure
To speech
3: nonspecific response, not necessarily to command
Spontaneous
4: Eyes open, not necessarily aware
what is the motor response(1-6) in GLASGOW COMA SCALE?
None
1: to any pain, limbs stay flaccid
Extension
Decerebrate Rigidity
2:Shoulder adducted AND shoulder& forearm internally rotated
Flexor response
Decorticate rigidity
3: withdrawal response or assumption of hemiplegic posture
Withdrawal
4: arm withdraws to pain, should abducts
Localized pain
5: arm attempts to remove supraorbital or trapezius pinch
Obeys commands
6: follow simple commands
what is the scale for verbal response of Glasgow scale?(1-15)
None
1:no verbalization of any type
Incomprehensible
2: moans/groans; no speech
Inappropriate
3: intelligible, no sustained sentences
Confused
4: converses but confused, disoriented
Oriented
5: converses and is oriented.
Total
3 - 15
The diagnosis of delirium by CAM (Confusion Assessment Method )requires the presence of features____and___ either___ .
1 & 2
either 3 or 4
- Acute onset or Fluctuating course: Is there evidence of an acute change in mental status from the patient’s baseline?
- Inattention: Does the patient have difficulty focusing attention, for example, being easily distractible or following the conversation?
- Disorganized thinking: Is the patients thinking disorganized or incoherent
- Altered level of consciousness
Nuchal rigidity
Patient is unable to touch chin to chest either actively or passively.
Brudzinki’s Test
Patient lies supine. When the head is elevated the knees involuntary flexing the knees and hips in an attempt to relieve the pain caused by meningeal irritation.
Kernig Test
Patient is supine. The hip and knee begin in the flexed position. When the knee is extended there is pain in the back suggesting meningeal irritation. Returning to knee flexion relieves the pain.
Babinski Response
what CNS lesion does it test for
normally should cause plantar flexions, Dorsiflexion of the big toe is a positive Babinski response
CNS lesion affecting the corticospinal tract.
Pronator drift
what lesion does it test for?
Patient extends arm, palms up and closes their eyes for 20 – 30 seconds. They then close their eyes and try to maintain arm positions. Positive sign is when one arm drifts downward.
test for contralateral CST
Finger-to-nose test
what does it test for ?
Hold your finger in one place so that the patient can touch it with one arm and finger outstretched. Ask the patient to raise the arm overhead and lower it again to touch your finger. After several repeats, ask the patient to close both eyes and try several more times. Repeat on the other side. Normal: patient is able to perform maneuver with eyes open and closed. In cerebellar disease, the movements are clumsy or unsteady and vary in speed.
test for labyrinth of the inner ear and the cerebellum.
Heel to shin (knee), what does it test for?
Have the patient place one heel on the opposite knee, then go up and down the shin of the big toe. Repeat with the patients eyes closed. Observe for smoothness and accuracy. Repeat on the other side.
Tests coordination of multiple systems including motor, basal ganglia, cortical association and cerebellar systems
Rapid alternating movements test for ?
dysdiadochokinesis.
