HYPHO AMS Flashcards
. Identify indications for the. Glasgow Coma Scale (GCS), how to score each and generally what a high versus a low score for each indicates
measure level of conscious
score between 3-15,
use 3 parameters: eye-opening, verbal response, motor response
>13 mild brain injury
9-12 mod. injury
<8 severe
. Identify indications for the Richmond Agitation Sedation Scale (RASS) how to score each and generally what a high versus a low score for each indicates
indication: level of agitation or sedation in mechanically ventilated patients to avoid under or over sedation
-5 (unarousable) to +4 (combative)
Identify indications for Confusion Assessment Method (CAM), how to score each and generally what a high versus a low score for each indicates
indications: Allows nonpsychiatric clinicians to detect delirium in high risk environments
must have features 1 and 2 with either 3 or 4. Feature 1 – Acute onset and fluctuating course, feature 2– inattention, feature 3 – disorganized thinking, feature 4 – altered level of consciousness (anything other than alert)
what is the strongest risk factor for dementia?
old age
you must rule out what in dementia?
depression
what is the I in I WATCH DEATH, for DDx of delirium
infection
what is the watch in I WATCH DEATH
WITHDRAWAL
ACUTE METABOLIC
TRAUMA
CNS PATHOLOGY
HYPOXIA
What is the DEATH in I WATCH DEATH
Deficiencies
ENDOCRINE
ACUTE VASCULAR
TOXINS/DRUGS
HEAVY METALS
What are the … for biomechanical in AMS?
- considerations
- assessement
- OMT treatment
- Loss of muscle mass/bone density, osteoarthritis
- Gait, posture, ROM UEs/Les, feet for ulcers nail care, OSE
- FPR, BLT, soft tisse, MET
what are the …. for neurological model for AMS?
- consideration
- assessment
- OMT tx
- ↓brain weight, memory, sleep, alteration in CNS neurotransmitters, gait
- Muscle tone, motor strength, attention/orientation, gait, OA/AA (vagus n) T10-L2 (VSR bladder/bowel)
- S/CS, paraspinal inhibition
Repiratory, Circulatory model for AMS
- CV: Calcification, stenosis, baroreceptor reflex & elasticity of vasculature
Resp: resp muscle strength
- Vital signs, respiratory effort, edema
- Rib raising, lymphatics, soft tissue to C and T-spine
how do you assess for metabolic, energetic, immune in AMS?
Skin for any signs of breakdown, abdomen for signs of constipation
assessment for behavioral model of AMS?
Gait, muscle tone, motor strength, mental status exam
what are the 4 dementia screens?
- mini-Cog,
- MoCA* (Copyright) Montreal Cognitive Assessment
- MMSE* (Copyright) Mini-Mental State Exam
- SLUMS (free to download and use) Saint Louis University Mental Status Examination
mini- Cog compared to MMSE
- better at detecting MCI(mild cognitive impairment)
- less affected by education level
which of the 4 screens for dementia test have score range of 0-30 and “normal is 25+
MoCa
MMSE
SLUMS
what is all the other 3 screenign test have in common compare to MMSE
considered superior, although MMSE is more standard
which dementia screening test is most affected by education?
SLUMS
screening for dementia, high level of education lead to ___, and low level of education can lead to____.
false negative
false positives
Sundowning:
Exacerbation of agitation and cognitive issues seen during evening and night hours in patients with delirium and/or dementia.
