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Neuromuscular > Lecture 2 - Exam 1 > Flashcards

Lecture 2 - Exam 1 Flashcards

1
Q

Why do we perform a neuro screen

A

Screen for red flags
Screen for referral
Differential diagnosis
Establish baseline
Observe for changes

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2
Q

What is the first step in a neuro screen?

How is this assessed?

A

Mental status

Pt history
Assessing A & O
Behavior signs
Assessing cognitive status
Assess memory

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3
Q

What does A&O x 4 mean

A

Pt is oriented to person, place, time, situation

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4
Q

During your subjective exam, you should note…

A

Behavior
Language
Attention
Affect

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5
Q

What is level of consciousness (LOC)

A

Measurement of a person’s alertness

Arousal and responsiveness (attention) to stimuli from the environment

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6
Q

What is arousal

A

Stimulation to action/physiologic readiness for activity

Level of excitability - state of responsiveness to sensory stimulation

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7
Q

What is attention

A

Directing of consciousness to a person, thing, of a part/aspect of the environment

Direction of awareness

Selective responsiveness to one class of stimuli

Necessary to perform a conscious task

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8
Q

What is consciousness

A

State of arousal accompanied by awareness (attention) to one’s environment

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9
Q

What is orientation

A

Ability to comprehend and to adjust oneself with regard to time, location, and identification of self

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10
Q

What is A&O x 3

A

Alert and oriented to time, person, place

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11
Q

What is A&O x 4

A

Alert and oriented to time, person, place, circumstance/situation

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12
Q

Define lethargic

A

Mildly depressed level of consciousness/alertness

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13
Q

Define o tune

A

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

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14
Q

Define stupor

A

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

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15
Q

Define coma/unconscious

A

Unconsciousness, inability to make any purposeful response and no arousal

May/may not be ventilator dependent

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16
Q

What does it mean if the patient is minimally consciousness or in a vegetative state

A

Pt is aroused/conscious but remains unaware of their environment and no purposeful attention of cognitive response

Return of irregular sleep-wake cycles and normalization of the vegetative functions (respiration, digestion etc)

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17
Q

What if the patient is in a persistent vegetative state

A

Pt remains in vegetative state for 1+ years after TBI or longer for ABI

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18
Q

Describe the characteristics of hyperarousal

A

Unable to attain/maintain an alert state
Restless, agitated
Irritable
Unable to self console
Hyperactive movements
Increased intensity of voice

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19
Q

Describe the characteristics of hypoarousal

A

Unable to attain/maintain an alert state
Lethargic/ontunded
Labeled
Poor response to verbal communication
Poor processing

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20
Q

What factors affect levels of arousal

A

Disease/pathology
Acute change in behavior
Acute change in Bain chemistry

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21
Q

What 3 areas of function are examined to assess arousal for hypoaroused patients

A

Eye opening
Motor response
Verbal response

22
Q

What is the Glasgow Coma Scale

A

Outcome measure for arousal

Gold standard instrument used to document level of consciousness in acute brain injury

Used immediately following a head injury to assess arousal and neurological function

23
Q

What is the range for the Glasgow Coma Scale

Rate the severities

A

3-15

Mild: 12-15
Moderate: 9-11
Severe: 3-8

24
Q

What is the NIHSS and what is it used for

A

NIH stroke scale

Examines pt’s level of consciousness, arousal, cognition following a stroke to determine severity

25
Q

Define coping

A

Process of making adaptation to meet the personal needs and respond to the demands of the environment

26
Q

What are the 5 categories of attention

A

Focus attention
Sustained attention
Selective attention
Alternating attention
Divided attention

27
Q

Define focused attention

A

Ability to process and respond to specific info or input

28
Q

Define sustained attention

A

Ability to perform an activity continuously over a period of time

29
Q

define selective attention

A

Ability to perform an activities in the presence of distracting stimuli, inclining ignoring irrelevant information

Ex) digit span task: repeat a short list of numbers fwd/bkwd

30
Q

Define alternating attention

A

Ability to shift the focus of attention between multiple stimuli

31
Q

Define divided attention

A

Ability to respond to multiple stimuli simultaneously

E) walk while counting or naming objects

32
Q

T/f
Can behavior play a role in attention

A

True

Behavior can be intentionally distracted or obstinate

33
Q

What is Moss Attention Rating Scale (MARS)

Items are grouped in to what 3 major factors

A

Outcome measure for attention

Standardized objective measure of attention to characterize behavioral responses after brain injury

Restlessness/distractibility, Initiation, Sustained/consistent attention

34
Q

Define distractable

A

Unable to fixate or sustain attention

35
Q

Define perseverative

A

Unable to disengage or switch attention

36
Q

Define limited capacity/flexibility

A

Unable to perform multiple tasks concurrently or share attention between multiple tasks

37
Q

Define poor recall

A

Unable to manipulate new information and attend to previous information

38
Q

Define vigilance

A

Positive sign
Ability to sustain attention over time

39
Q

What is affective status

A

A patient’s affect is a collection of behaviors that describe their emotional state or mood

40
Q

What is apathy

A

Shallow affect and blunted emotional responses
Occurs in ~22% of pts
Frequently misconstructed as depression or poor motivation

41
Q

What is euphoria

A

Exaggerated feelings of well being

42
Q

What is social inappropriateness

A

Decreased pragmatism
Missed social cues or makes inappropriate comments
Poor safety awareness or judgement

43
Q

What is depression/withdrawal

A

Poor perception of one’s self and environment may lead to increasing isolation and social withdrawal

44
Q

What is irritability/frustration

A

Changes in the ability to sense, move, communicate, think, act as before are enormously frustrating by themselves and create high stress levels fro the patient with stroke

45
Q

What is pseudobulbar affect/emotional lability

A

Emotional dysregulation syndrome

18% of stroke patients

Characterized by emotional outbursts of uncontrolled/exaggerated laughing/crying that are inconsistent with mood

46
Q

What are the 3Ds

A

Dementia
Delirium
Depression

47
Q

Define dementia

A

Pathological condition of the mind

Global decline can be caused by persistent delirium

48
Q

Degine delirium

A

Impaired sensorium/reduced level of consciousness

49
Q

Define depression

A

Disturbance in mood

Low vital sense and poor attitude

50
Q

Describe alcohol withdrawal delirium (AWD)

A

Severe delirium and delusion association with fever and other metabolic symptoms

Most serious symptoms; 48-72 hours - 5 days

Not appropriate for physical therapy

Neuromuscular (4 decks)

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