arousal (A&O) mental status Flashcards
if a person is A&O x4 what does that mean?
they are alert and oriented to person, place, time & situation
how do you quickly screen for memory/cognition?
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
what are 4 things you should be sure to include in your subjective exam note?
behavior
language
attention
affect
what is level of consciousness (LOC)?
measurement of a person’s alertness
arousal and responsiveness to stimuli from the environment
alertness = _____ and _______
arousal and attention
stimulation to action or physiologic readiness for activity
level of excitability - state of responsiveness to sensory stimulation
arousal
directing of consciousness to person, thing, or environment
direction of awareness
necessary to perform conscious task
attention
state of arousal accompanied by awareness to one’s environment
consciousness
the ability to comprehend and to adjust oneself with regard to time, location, and identify of self
orientation
which level of hypoarousal is this describing?
mildly depressed level of consciousness or alertness
lethargic
which level of hypoarousal is this describing?
significantly diminished level of consciousness and cannot be fully aroused. responds to noxious stimuli and appears confused.
obtund
which level of hypoarousal is this describing?
not able to be aroused from a sleep-like state, requires vigorous unpleasant stimuli for minimal arousal
stupor
which level of hypoarousal is this describing?
unconscious, inability to make any purposeful response and no arousal
coma “unconscious”
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?
minimally conscious (vegetative) state
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?
persistent vegetative state
pt appears agitated, irritable, unable to self console, has hyperactive movement and increased intensity of voice. they are:
hyperaroused
patient is unable to attain alert state, lethargic, poor response to verbal communication and has poor processing. they are:
hypoaroused
what are some factors that affect level of arousal?
disease/pathology
acute change in behavior
acute change in brain chemistry
what three areas of function are examined to determine arousal?
eye opening
motor response
verbal response
what is the Glasgow Coma scale used for?
Low score = _______
outcome measure for arousal - used to document level of consciousness in acute brain injury
low score = less aroused
what is an example of noxious stimulation in which a response would be a facial grimace?
sternal rub
what is an example of noxious stimulation in which a response would be withdrawing, slight flexion or extension?
nailbed pressure
what are examples of environment modifications that can be performed if a patient is hypoaroused?
turn on lights
decrease ambient sounds
open vs closed environment
making environment or scheduling modifications to improve arousal
coping
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
- focused
- sustained
- selective
- alternating
- divided
how do you test selective attention with your patient?
digit span task - repeat short list of numbers fwd/bkwd
how do you test divided attention with your patient?
walk while counting or naming objects
______ can play a role in attention. why?
behavior
intentionally distracted, obstinate behavior
what is an outcome measure assessment for attention?
Moss Attention Rating Scale (MARS)
characterizes behavioral responses after brain injury
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)
- distractable
- perseverative
- limited capacity/flexibility
- poor recall
- vigilance
a patient’s “affect” is ?
mood is?
a collection of behaviors that describe their emotional state or mood
mood is a more sustained emotional state
what is apathy? what is it often mistaken as?
shallow affect and blunted emotional responses
misconstrued as depression or poor motivation
what is euphoria?
exaggerated feelings of well being
what is social inappropriateness?
missed social cues or makes inappropriate comments
what is depression?
poor perception of one’s self and environment may lead to increasing isolation and social withdrawal
what is irritability?
changes in ability to sense, move, communicate, think or act as before are frustrating by themselves and create high stress levels for stroke patients
what is pseudobulbar affect?
emotional dysregulation syndrome
characterized by emotional outbursts of uncontrolled or exaggerated laughing or crying that are inconsistent with mood
the behavior of selecting vocabulary and sentence structures before communicating a message
language
communication disorders
aphasia
slurred speech
verbal apraxia (motor control issue)
sound production and tone of voice
phonation
taking turns talking and tangenital speech
pragmatic language behaviors
sequence of words acceptable in the formation of sentence
syntax
what are the 3Ds?
dementia (pathological condition of the mind)
delirium (impaired sensorium)
depression (low vital sense and poor attitude)
age-associated cognitive decline is similar to _______ but NOT loss of cognition
dementia
what is encephaloppathies primarily seen in?
alcoholism
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?
sundowning - part of dementia
causes - unknown, pharmacy, patient affect
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?
- severe delirium and delusion associated with fever and other metabolic symptoms
- 48-72 hours after last drink
- 5 days; 5-7 days
- no
