Lecture 2 - Exam 1 Flashcards
Why do we perform a neuro screen
Screen for red flags
Screen for referral
Differential diagnosis
Establish baseline
Observe for changes
What is the first step in a neuro screen?
How is this assessed?
Mental status
Pt history
Assessing A & O
Behavior signs
Assessing cognitive status
Assess memory
What does A&O x 4 mean
Pt is oriented to person, place, time, situation
During your subjective exam, you should note…
Behavior
Language
Attention
Affect
What is level of consciousness (LOC)
Measurement of a person’s alertness
Arousal and responsiveness (attention) to stimuli from the environment
What is arousal
Stimulation to action/physiologic readiness for activity
Level of excitability - state of responsiveness to sensory stimulation
What is attention
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
What is consciousness
State of arousal accompanied by awareness (attention) to one’s environment
What is orientation
Ability to comprehend and to adjust oneself with regard to time, location, and identification of self
What is A&O x 3
Alert and oriented to time, person, place
What is A&O x 4
Alert and oriented to time, person, place, circumstance/situation
Define lethargic
Mildly depressed level of consciousness/alertness
Define o tune
Significantly diminished level of consciousness and cannot be fully aroused responds to noxious stimuli and appears confused
Define stupor
Not able to be aroused from a sleep-like state, requires vigorous unpleasant stimuli for minimal arousal
Define coma/unconscious
Unconsciousness, inability to make any purposeful response and no arousal
May/may not be ventilator dependent
What does it mean if the patient is minimally consciousness or in a vegetative state
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)
What if the patient is in a persistent vegetative state
Pt remains in vegetative state for 1+ years after TBI or longer for ABI
Describe the characteristics of hyperarousal
Unable to attain/maintain an alert state
Restless, agitated
Irritable
Unable to self console
Hyperactive movements
Increased intensity of voice
Describe the characteristics of hypoarousal
Unable to attain/maintain an alert state
Lethargic/ontunded
Labeled
Poor response to verbal communication
Poor processing
What factors affect levels of arousal
Disease/pathology
Acute change in behavior
Acute change in Bain chemistry
What 3 areas of function are examined to assess arousal for hypoaroused patients
Eye opening
Motor response
Verbal response
What is the Glasgow Coma Scale
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
What is the range for the Glasgow Coma Scale
Rate the severities
3-15
Mild: 12-15
Moderate: 9-11
Severe: 3-8
What is the NIHSS and what is it used for
NIH stroke scale
Examines pt’s level of consciousness, arousal, cognition following a stroke to determine severity
Define coping
Process of making adaptation to meet the personal needs and respond to the demands of the environment
What are the 5 categories of attention
Focus attention
Sustained attention
Selective attention
Alternating attention
Divided attention
Define focused attention
Ability to process and respond to specific info or input
Define sustained attention
Ability to perform an activity continuously over a period of time
define selective attention
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
Define alternating attention
Ability to shift the focus of attention between multiple stimuli
Define divided attention
Ability to respond to multiple stimuli simultaneously
E) walk while counting or naming objects
T/f
Can behavior play a role in attention
True
Behavior can be intentionally distracted or obstinate
What is Moss Attention Rating Scale (MARS)
Items are grouped in to what 3 major factors
Outcome measure for attention
Standardized objective measure of attention to characterize behavioral responses after brain injury
Restlessness/distractibility, Initiation, Sustained/consistent attention
Define distractable
Unable to fixate or sustain attention
Define perseverative
Unable to disengage or switch attention
Define limited capacity/flexibility
Unable to perform multiple tasks concurrently or share attention between multiple tasks
Define poor recall
Unable to manipulate new information and attend to previous information
Define vigilance
Positive sign
Ability to sustain attention over time
What is affective status
A patient’s affect is a collection of behaviors that describe their emotional state or mood
What is apathy
Shallow affect and blunted emotional responses
Occurs in ~22% of pts
Frequently misconstructed as depression or poor motivation
What is euphoria
Exaggerated feelings of well being
What is social inappropriateness
Decreased pragmatism
Missed social cues or makes inappropriate comments
Poor safety awareness or judgement
What is depression/withdrawal
Poor perception of one’s self and environment may lead to increasing isolation and social withdrawal
What is irritability/frustration
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
What is pseudobulbar affect/emotional lability
Emotional dysregulation syndrome
18% of stroke patients
Characterized by emotional outbursts of uncontrolled/exaggerated laughing/crying that are inconsistent with mood
What are the 3Ds
Dementia
Delirium
Depression
Define dementia
Pathological condition of the mind
Global decline can be caused by persistent delirium
Degine delirium
Impaired sensorium/reduced level of consciousness
Define depression
Disturbance in mood
Low vital sense and poor attitude
Describe alcohol withdrawal delirium (AWD)
Severe delirium and delusion association with fever and other metabolic symptoms
Most serious symptoms; 48-72 hours - 5 days
Not appropriate for physical therapy
