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PSP > Altered Mental Status > Flashcards

Altered Mental Status Flashcards

1
Q

Arousal

A

Physiologic and psychological state of being awake

. Regulated by: ascending reticular system (ARAS), ANS, endocrine system

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2
Q

Wakefulness regulated by ____

A

. ARAS

. Involves ACh, NE, dopamine, histamine, and serotonin

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3
Q

Locus coeruleus

A

. Fibers to limbic system

. Release of NE causes wakefulness

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4
Q

Pons and basal forebrain

A

. Activate ACh neurons

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5
Q

Midbrain and substantiated Nigra

A

. Release of dopamine coordinating excitement and arousal

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6
Q

Raphe nuclei

A

. Release of serotonin causing cortical arousal

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7
Q

Hypothalamus

A

. Stimulates release of ACh to cerebral cortex

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8
Q

What causes altered mental status (AMS)

A

. Disruption in brain function that causes a change in behavior or responsiveness
. Range from slight confusion to total disorientation and coma

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9
Q

Causes of AMS

A 
. Hypoxia/hypoxemia 
. Trauma (subdural.epidural hematoma, intracranial hemorrhage, sub-arachnoid hemorrhage) 
. Nutrition deficiencies (thiamine) 
. Med interactions/poisons
. Encephalopathy 
 Electrolyte abnormalities (uremia/renal failure) 
. Infection
. Stroke
. Pain
. Seizure (post ictal state) 
. Drug overdose
. Temperature (hypothermia/hyperthermia)
. Insulin issues 
. Space occupying lesions/ Shunt (VP) malfunction (tumors, patients w/ ventricular shunt) 
. Mnemonic: AEIOU TIPS
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10
Q

Causes of fluctuating AMS

A

. Alcohol/hepatic encephalopathy (underlying liver disease/ ammonia build up causing encephalopathy)
. Acidosis/metabolic disorders (inc. anion gap acidosis)
. Cardiac arrhythmia
. Endocrine/electrolyte derangement

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11
Q

Risk factors for hepatic encephalopathy

A 
. TIPs, portal vein thrombosis 
. Infections (spontaneous bacterial pericarditis from ascitis getting infected)
. AKI, electrolyte derangement (dec. K) 
. GI bleed
. Hypoxemia, hypercapnia
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12
Q

Wernicke-Korsakoff’s psychosis

A

. Wernicke’s encephalopathy: confusion, ophthalmoplegia, ataxia, thiamine deficiency
. Korsakoff’s psychosis/stage 2: retrograde amnesia, anterograde amnesia, confabulation, Korsakoff’s psychosis
. Treated w/ thiamine supplements

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13
Q

Glasgow coma scale

A

. Eyes opening: 1 (none), 2(to pain) 3(voice) 4(spontaneously)
. Verbal response 1 (none) 2 (incomprehensible sound) 3. (Inappropriate words) 4 (confused) 5 (oriented)
. Motor: 1(none) 2 (abnormal extension) 3 (abnormal flexion) 4(withdraws from pain) 5(localized to pain) 6(obeys commands)

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14
Q

Dementia

A

. Decline in memory, language, problem solving, and thinking skills
. Usually occurs slowly
. Affect’s a person’s ability to perform tasks
. Causes: Alzheimer’s, Levy body, vascular, frontotemporal, alcohol-related
. Reversible causes: hematoma, hypothyroid, B12 deficiency, syphilis, normal pressure hydrocephalus (gait instability, bladder incontinence)
. Labile/irritated to normal mood

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15
Q

Delirium

A

. Abrupt change in brain that causes mental confusion and emotional disruption
. Causes: metabolic, infection, CNS issues, post-concussive, auto-antibody (tumors, hashimotos)
Symptoms: emotional dysregulation, psychomotor disturbance, circadian rhythm disturbance, impairment of consciousness
. Flat and depressed mood

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16
Q

Psychosis

A

. Severe, disconnection form reality
. Delusions, hallucinations, incoherency, agitation
. Causes: organic and psychotic causes

17
Q

Mental status evaluation

A

. Orientation to person, place, and time
. Affect: labile (unstable) or blunt/depressed
. Appearance and behavior: level of consciousness (GCS), gross motor function, personal hygiene
. Speech
. Thought and perception: obsessions, phobias, anxieties, feelings of unreality, abnormalities of perception (illusions/hallucinations)
. Cognitive function: attention span, learning ability (remembering items, counting)

18
Q

MMSE components and scoring

A 
. Orientation 
. Memory
. Language
. Visual-spatial skills 
. Highest score 30 
. Score 20-24: mild cognitive deficit
. Less than 12: severe cognitive deficit
19
Q

Trauma primary survey

A

. Identifies immediate life-threatening injuries

. Check airway, breathing, circulation, disability, and exposure

20
Q

Airway etiologies and management

A

. Obstruction or injury

. Chin lift, suction, surgical airways/intubation

21
Q

Breathing etiology and management

A

. Tension or open pneumo
. Tracheobronchial injury w/ air leak
. Flail chest
. Manage: listen for breath sounds, inspect for wounds, palpate for crepitus, consider needle thoracotomy

22
Q

Circulation etiology and management

A

. Hemorrhage, pelvic fracture w/ bleeding, extremity blood loss, cardiogenic tamponade
. Manage: 2 large bore IV, start fluids, consider central access, pericardiocentesis or paracentesis

23
Q

Disability etiology and management

A

. Intracranial hemorrhage, cervical spine injury

.manage: pupil size, GCS, strength and grip testing

24
Q

. Exposure etiology and management

A

. Spinal fracture, puncture wounds

. Manage: disrobe and look at skin, logroll patient for spine exam

25
Q

Secondary survey

A

. Brief history and head to toe

. AMPLE (allergies, meds, past med history, last meal, events leading to injury)

26
Q

General categories of AMS

A

. Acute global confusion w/ psychomotor activity
. Delirium
. Dementia
. Psychosis

27
Q

Medical diseases assoc. w/ acute global confusion w/ hypoactivity

A

. Salt (hyper/hypoNA)
. Sugar (glycemic)
. Septic (UTI, infection in elderly, only if they have other health problems too)
. Solid organ stupors (4 S’s)

28
Q

Drugs/meds assoc. w/ acute global confusion w/ hypoactivity

A 
. Opiates
. Anticholinergics
. Sedatives
. Steroids
. Weed
. Psychotropics
. Toxic alcohols
. Dopa/serotonin agents
. Antibiotics or chemotherapy
29
Q

CNS diseases assoc. w/ acute global confusion w/ hypoactivity

A 
. Store, tumor, or abscess in R parietal, L temporal
. Subdural hematoma
. Encephalitis
. Cerebral vasculitis
. Hypertensive encephalopathy 
. Nonconvulsive status epilepticus
30
Q

1st step in hepatic encephalopathy

A

. Reversal of sleep/wake cycle (sleep during day, awake at night)

31
Q

Labs and diagnostic for AMS

A

. CBC/BMP/LFTs for bleeding, uremia, liver failure
. UA, urine, blood culture: infections
. ABG: hypercapnia
. U tox: opiates, PCP, BZDs
. CT/MRI: subdural, strokes, lesions
. LP: encephalitis, meningitis, autoimmune
. B12, RPR(syphilis), HIV, thyroid function: reversible dementia causes

PSP (35 decks)

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