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Foundations 4 SG > AMS 1 > Flashcards

AMS 1 Flashcards

1
Q

Glasgow Coma Scale (GCS)

  • 15
A

Best score

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2
Q

GCS

8 or lower

A

Comatose

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3
Q

GCS

3

A

Unresponsive

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4
Q

AMS is present in up to ___% of elderly hospitalized patients

  • (elderly >__ years of age)
A

50%

  • 65 yrs
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5
Q

3 origins of AMS

A
  • Medical
  • Neurologic
  • Psychiatric
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6
Q

Other names of AMS

A
  • ALOC
  • Encephalopathy
  • Confusion
  • Delirium
  • Acute confusional impairment
  • Neurocognitive disorder (dementia)
  • Organic brain syndrome
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7
Q

7 levels of consciousness

A
  • Alert
  • Clouding of consciousness
  • Confusional state
  • Lethargic / Somnolent
  • Obtunded
  • Stuporous / Semicomatose
  • Comatose
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8
Q

Which level of AMS/LOC?

  • Awake & fully aware of surroundings
  • Responds appropriately to normal stimuli
  • Does not imply capacity to focus attention
A

Alert

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9
Q

Which level of AMS/LOC?

  • Very mild form of altered mental status
  • Inattention and reduced wakefulness
A

Clouding of consciousness

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10
Q

Which level of AMS/LOC?

  • More profound deficit
  • Disorientation, bewilderment, difficulty following commands
A

Confusional State

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11
Q

Which level of AMS/LOC?

  • Not fully alert / drifts off to sleep when not stimulated
  • Spontaneous movements decreased
  • Awareness limited
  • Unable to pay close attention, loses train of thought
  • “confabulating”
A

Lethargic / Somnolent

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12
Q

Which AMS / LOC?

  • Difficult to arouse & when aroused is confused
  • Constant stimulation required to elicit minimal cooperation
A

Obtunded

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13
Q

Which AMS / LOC?

  • Does not arouse spontaneously
  • Requires persistent & vigorous stimulation
  • When aroused, will moan/mumble
A

Stuporous / Semicomatose

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14
Q

Which AMS / LOC?

  • Unarousable, unresponsive to stimuli (reflexes)
  • GCS usually less than 8
A

Comatose

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15
Q

____ is common & associated w/ substantial morbidity for older people & often unrecognized

A

Delirium

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16
Q

Incidence of delirium is highest in which patients?

(up to 70%)

A

ICU patients

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17
Q
  • Disturbance in attention / awareness
  • Disturbance develops over a short period of time (hrs to days) and fluctuates during course of day
  • Additional disturbance in cognition
A

DSM V for Delirium

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18
Q

7 Risk Factors for Delirium

A
  • Age (over 65)
  • Male
  • Dementia
  • Functional impairment in activities of daily living
  • Medical comorbidities
  • Hx of excessive ETOH use (associated w/ withdrawal)
  • Sensory impairment (vision/hearing) so, have pt’s hearing aids/glasses available immediately after procedures/surgeries

“65 yr old male w/ dementia having a bad day bc of his comorbidities, so he drinks ETOH and has withdrawals, and he can’t hear or see anything”

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19
Q
A
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20
Q
  • Which infections lead to Delirium?
  • Which medications lead to Delirium?
A
  • Urinary Respiratory (PNA)
  • Meds: Opioids, Benzos, anticholinergics
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21
Q

When taking a hx for pt w/ Delirium, be sure to do a medication review (especially which 3 things?)

A
  • Rx
  • OTC
  • ETOH
22
Q

W/ delirium, ETOH withdrawal usually occurs ___ hours after their last drink. Can be as soon as ___ hours if the patient is a heavy drinker and their withdrawal sxs would include: ____.

A
  • Usually 48 hours
  • Soon as 24 hours
  • Hallucinations
23
Q

Do people w/ delirium from ETOH withdrawal usually experience hypothermia or hyperthermia?

A

Either

24
Q
  • When ordering labs for pt w/ delirium, what 3 things are you looking for?
  • Which one thing does not cause delirium?
A
  • Hypernatremia
  • Hypoglycemia
  • Hypercalcemia
  • NOT: Hyperkalemia
25
Q

When checking an ABG on a pt w/ delirium, what would you be looking for?

A

Hypercapnia

26
Q

4 labs for Delirium

A
  • CBC
  • Electrolytes
  • Renal function tests
  • Liver function tests
27
Q

Consider ordering what 3 things for delirium?

A
  • Brain imaging
  • EEG
  • CSF
28
Q
  • When maintaining behavioral control in pts w/ Delirium, what should be avoided?
  • Which 2 meds should only be used if they are absolutely necessary?
A
  • Avoid restraints
  • Small doses of Haloperidol or Quetiapine
29
Q

Which drugs should be reduced/eliminated in pts w/ delirium?

A
  • Alcohol
  • Anticholinergics
  • Some antidepressants
  • Antihistamines
  • Anticonvulsants
  • Antiparkinsonian agents
  • Antipsychotics
  • Barbiturates
  • Benzos
  • H2 blockers
  • Opioid analgesics
30
Q

Delirium or Dementia?

  • Memory impairment
  • Progressive / insididious onset
A

Dementia

31
Q

Delirium or Dementia?

  • Memory Impairment
  • Disturbance of consciousness
  • Acute / Rapid onset
  • Fluctuation of sxs during 24 hr period
A

Delirium

(everything except progressive/insidious onset)

32
Q
  • Hypoxemia
  • Hypoglycemia (DM pts w/ insulin overdose)
  • Sepsis
  • Hypertensive encephalopathy
  • Wernicke’s encephalopathy
  • Overdose
  • CNS infections / trauma
  • Intracranial hemorrhage
  • Epilepsy
A

Life threatening etiologies of AMS

33
Q
  • UTI
  • PNA
    Electrolyte abnormalities
  • Meds effect / interaction
  • Medication withdrawal
  • Psych illness
A

Common Conditions as etiologies of AMS

34
Q
  • Endocrine disease (thryoid/adrenal)
  • Stroke w/o focal motor deficit
  • CNS mass
  • Dementia
A

“other” etiologies of AMS

35
Q

AMS Mnemonics

AEIOU-TIPS

A
  • Alcohol, acidosis
  • Epilepsy, endocrine
  • Infection
  • Overdose, oxygen deprivation
  • Uremia
  • Trauma, tumor
  • Insulin (hyper/hypoglycemia)
  • Stroke, space occupying lesion
36
Q

AMS mnemonic

DEMENTIA

A
  • Drugs
  • Electrolytes
  • Metabolic
  • Emotional (psych)
  • Neurologic, nutritional
  • Trauma, tumor, temp
  • Infection
  • Alcohol
37
Q

AMS Mnemonic

MOVE STUPID

A
  • Metabolic
  • Oxygen (hypoxemia)
  • Vascular
  • Electrolyte, endocrine
  • Seizure
  • Tumor, trauma, temp, toxin
  • Uremia
  • Pscyhiatric
  • Infection
  • Drugs (withdrawal)
38
Q
  • What is the most common electrolyte / metabolic abnormality of AMS?
  • What can result if this abnormality is corrected too quickly?
A

Hyponatremia

(profoundly low sodium, if corrected too quickly can result in demyelination of central pontine and can result in death)

39
Q

Besides hyponatremia (MC abnormality of AMS), what else should be considered?

A

Hypercalcemia

40
Q

3 pre-existing systemic diseases of AMS

A
  • DM
  • Thyroid
  • Cirrhosis
41
Q

6 Emotional/Psych disorders associated w/ AMS?

A
  • Neurocognitive disorder
  • Dementia
  • Delirium
  • Wernicke’s encephalopathy
  • Conversion disorder
  • Psychosis
42
Q

Thiamine deficiency from ETOH abuse

A

Wernicke’s encephalopathy

43
Q

What is usually the most helpful diagnostic study for AMS when assessing head trauma?

A

CT (need to assess spinal cord injury)

44
Q

When performing a rectal exam when assessing a patient w/ AMS after head trauma,

  • if the sphincter tone is intact, the injury is likely _____.
  • if little or no tone, there may be ____
A
  • Intracranial
  • Coexisting spinal cord injury
45
Q
A
46
Q
  • W/ hypothermia, skin temp is near __ F
  • What 4 things associated w/ hypothermia from AMS?
  • If temp is 92-86F, results in what 3 things?
A
  • 91 F
  • Peripheral vasoconstriction, shivering, cardiovascular changes, respiratory changes
  • Apathy, lethargy, ataxia
47
Q

Hyperthermia

  • Heat exhaustion: core temp may be normal or < ___F
    • 3 signs of heat exhaustion
  • Heat stroke: core temp above ___F
    • 4 signs of heat strroke
A
  • <106F
    • Orthostatic hypotension
    • Tachycardia
    • Sweating
  • 106F
    • Same as heat exhaustion + CNS dysfunction
48
Q
  • High suspicion of infection in which 2 age groups?
  • Elderly pts get which 2 infections?
  • Infants get which infection?
  • Pts may be _____.
  • Need to identify and tx quickly!
A
  • Very young or very old
  • Elderly: UTI or PNA
  • *Infants:** meningitis
  • Febrile
49
Q
  • Produces a metabolic encephalopathy similar to that produced by ________.
A
  • Acute intoxication of alcohol produces metabolic enc similar to that produced by sedative-hypnotic drugs.
50
Q

Apart from “metabolic encephalopathy,” what are 4 other side effects of Acute Alcohol Intoxication?

A
  • Peripheral vasodilation
  • Tachycardia
  • Hypotension
  • Hypothermia (pt passes out in cold weather)
51
Q
  • Most mild signs / sxs of acute alcohol intoxication?
  • Most severe signs / sxs of acute alcohol intoxication?

(BAL = blood alcohol level)

A
  • Mild (20-50): Diminished fine motor coordination
  • Severe (400): Respiratory depression

Foundations 4 SG (19 decks)

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