arousal (A&O) mental status

Question 1

if a person is A&O x4 what does that mean?

Answer 1

they are alert and oriented to person, place, time & situation

Question 2

how do you quickly screen for memory/cognition?

Answer 2

give the patient 3 words to remember
–> retention & recall: ask patient to repeat those words back to you right away & then ask them later on to recall those 3 words

Question 3

what are 4 things you should be sure to include in your subjective exam note?

Answer 3

behavior
language
attention
affect

Question 4

what is level of consciousness (LOC)?

Answer 4

measurement of a person’s alertness
arousal and responsiveness to stimuli from the environment

Question 5

alertness = _____ and _______

Answer 5

arousal and attention

Question 6

stimulation to action or physiologic readiness for activity
level of excitability - state of responsiveness to sensory stimulation

Answer 6

arousal

Question 7

directing of consciousness to person, thing, or environment
direction of awareness
necessary to perform conscious task

Answer 7

attention

Question 8

state of arousal accompanied by awareness to one’s environment

Answer 8

consciousness

Question 9

the ability to comprehend and to adjust oneself with regard to time, location, and identify of self

Answer 9

orientation

Question 10

which level of hypoarousal is this describing?

mildly depressed level of consciousness or alertness

Answer 10

lethargic

Question 11

which level of hypoarousal is this describing?

significantly diminished level of consciousness and cannot be fully aroused. responds to noxious stimuli and appears confused.

Answer 11

obtund

Question 12

which level of hypoarousal is this describing?

not able to be aroused from a sleep-like state, requires vigorous unpleasant stimuli for minimal arousal

Answer 12

stupor

Question 13

which level of hypoarousal is this describing?

unconscious, inability to make any purposeful response and no arousal

Answer 13

coma “unconscious”

Question 14

if your patient is aroused but remains unaware of their environment and no purposeful attention or cognitive response is given but has normal respiration, digestion and BP control, what state are they in?

Answer 14

minimally conscious (vegetative) state

Question 15

if a person is in a vegetative state for 1 year or longer after TBI or 3 months or longer after ABI, what state are they considered then?

Answer 15

persistent vegetative state

Question 16

pt appears agitated, irritable, unable to self console, has hyperactive movement and increased intensity of voice. they are:

Answer 16

hyperaroused

Question 17

patient is unable to attain alert state, lethargic, poor response to verbal communication and has poor processing. they are:

Answer 17

hypoaroused

Question 18

what are some factors that affect level of arousal?

Answer 18

disease/pathology
acute change in behavior
acute change in brain chemistry

Question 19

what three areas of function are examined to determine arousal?

Answer 19

eye opening
motor response
verbal response

Question 20

what is the Glasgow Coma scale used for?
Low score = _______

Answer 20

outcome measure for arousal - used to document level of consciousness in acute brain injury
low score = less aroused

Question 21

what is an example of noxious stimulation in which a response would be a facial grimace?

Answer 21

sternal rub

Question 22

what is an example of noxious stimulation in which a response would be withdrawing, slight flexion or extension?

Answer 22

nailbed pressure

Question 23

what are examples of environment modifications that can be performed if a patient is hypoaroused?

Answer 23

turn on lights
decrease ambient sounds
open vs closed environment

Question 24

making environment or scheduling modifications to improve arousal

Answer 24

coping

Question 25

5 categories of attention: 1. _______ attention - process and respond to specific info. 2. _____ attention - perform an activity continuously over a period of time 3. _______ attention - focuses on one thing, perform activity with distracting stimuli 4. _______ attention - shifts focus of attention between multiple stimuli 5. ______ attention - respond to multiple stimuli simultaneously

Answer 25

1. focused 2. sustained 3. selective 4. alternating 5. divided

Question 26

how do you test selective attention with your patient?

Answer 26

digit span task - repeat short list of numbers fwd/bkwd

Question 27

how do you test divided attention with your patient?

Answer 27

walk while counting or naming objects

Question 28

______ can play a role in attention. why?

Answer 28

behavior intentionally distracted, obstinate behavior

Question 29

what is an outcome measure assessment for attention?

Answer 29

Moss Attention Rating Scale (MARS) characterizes behavioral responses after brain injury

Question 30

what type of behavior matches the following definitions? - unable to fixate - unable to disengage - unable to share attention between multiple tasks - unable to manipulate new info or attend to previous info - ability to sustain attention over time (positive sign)

Answer 30

- distractable - perseverative - limited capacity/flexibility - poor recall - vigilance

Question 31

a patient's "affect" is ? mood is?

Answer 31

a collection of behaviors that describe their emotional state or mood mood is a more sustained emotional state

Question 32

what is apathy? what is it often mistaken as?

Answer 32

shallow affect and blunted emotional responses misconstrued as depression or poor motivation

Question 33

what is euphoria?

Answer 33

exaggerated feelings of well being

Question 34

what is social inappropriateness?

Answer 34

missed social cues or makes inappropriate comments

Question 35

what is depression?

Answer 35

poor perception of one's self and environment may lead to increasing isolation and social withdrawal

Question 36

what is irritability?

Answer 36

changes in ability to sense, move, communicate, think or act as before are frustrating by themselves and create high stress levels for stroke patients

Question 37

what is pseudobulbar affect?

Answer 37

emotional dysregulation syndrome characterized by emotional outbursts of uncontrolled or exaggerated laughing or crying that are inconsistent with mood

Question 38

the behavior of selecting vocabulary and sentence structures before communicating a message

Answer 38

language

Question 39

communication disorders

Answer 39

aphasia

Question 40

slurred speech

Answer 40

verbal apraxia (motor control issue)

Question 41

sound production and tone of voice

Answer 41

phonation

Question 42

taking turns talking and tangenital speech

Answer 42

pragmatic language behaviors

Question 43

sequence of words acceptable in the formation of sentence

Answer 43

syntax

Question 44

what are the 3Ds?

Answer 44

dementia (pathological condition of the mind) delirium (impaired sensorium) depression (low vital sense and poor attitude)

Question 45

age-associated cognitive decline is similar to _______ but NOT loss of cognition

Answer 45

dementia

Question 46

what is encephaloppathies primarily seen in?

Answer 46

alcoholism

Question 47

when chart reviewing, you notice a note in the chart to see the patient in the morning because they often exhibit increased agitation in the late afternoon/early evening. what is the reason for this & what causes it?

Answer 47

sundowning - part of dementia causes - unknown, pharmacy, patient affect

Question 48

alcohol withdrawal delirium: - what is it? - when does withdrawal set in? - symptoms peak ______ days after they begin & decrease _____ days after they begin - appropriate for PT?

Answer 48

- severe delirium and delusion associated with fever and other metabolic symptoms - 48-72 hours after last drink - 5 days; 5-7 days - no