Ranchos levels Flashcards
At what Ranchos level do you typically see localized responses? Give an example of a localized response.
Level III-Total Assist.
- Demonstrates withdrawal or vocalization to painful stimuli
- turns toward or away from auditory stimuli
- blinks when strong light passes visual field
- follows moving object passed within visual field.
- responds to discomfort by pulling tubes or restraints
- responds inconsistently to simple commands
- responds directly related to type of stimulus
- may respond to some persons, but not others.
be awake on and off during the day;
• make more movements than before;
• react more specifically to what he sees, hears, or
feels. For example, he may turn towards a sound,
withdraw from pain, and attempt to watch a
person move around the room;
• react slowly and inconsistently;
• begin to recognize family and friends;
• follow some simple directions such as “Look at
me” or “squeeze my hand”;
• begin to respond inconsistently to simple
questions with “yes” and “no” head nods.
At what Ranchos level do you typically see generalized responses? Give an example of a generalized response
Level II- Total Assist.
- demonstrates generalized reflex response to painful stimuli
- responds to repeated auditory stimuli with increased or decreased stimuli
- responds to external stimuli with physiological changes generalized, gross body movements and/or not purposeful vocalization.
- responses above may be the same regardless of type and of stimuli
- response may be significantly delayed.
begin to respond to sounds, sights, touch or
movement;
• respond slowly, inconsistently, or after a delay;
• responds in the same way to what he hears, sees
or feels. Responses may include chewing,
sweating, breathing faster, moaning, moving,
and/or increasing blood pressure.
What are some characteristics of a level IV confused-agitated phase? What would be some factors to consider in tx given the behaviors at this level?
level IV (4) max assist
- alert and in heighted state of activity
- purposeful attempts to remove restraints or crawl out of bed
- may perform motor activities such as reaching, sitting, walking, but without any apparent purpose or another’s request.
- absent STM
- may cry out or scream out of proportion even after removal of stimulus.
- may exhibit aggressive or flight behavior
- mood may swing from euphoric to hostile with no apparent relationship to environmental events.
- unable to cooperate with treatment efforts
- verbalizations frequently incoherent and/or inappropriate to environment/activity.
• be very confused and frightened;
• not understand what he feels or what is
happening around him;
• overreact to what he sees, hears, or feels by
hitting, screaming, using abusive language, or
thrashing about. This is because of the
confusion;
• be restrained so he doesn’t hurt himself;
• be highly focused on his basic needs; ie.,
eating, relieving pain, going back to bed, going
to the bathroom, or going home;
• may not understand that people are trying to
help him;
• not pay attention or be able to concentrate for
a few seconds;
• have difficulty following directions;
• recognize family/friends some of the time;
• with help, be able to do simple routine
activities such as feeding himself, dressing or
talking.
What are some characteristics of a level VI confused-appropriate phase? What are some behaviors or skills now that the client has that they may have lacked earlier?
What might be some treatment solutions at this level?
- inconsistently oriented to person and place
- attend to highly familiar tasks in non-distracting environment for 30 min with mod redirection
- remote memory has depth and detail than recent memory
- vague recognition of some staff
- able to use assistive memory aid with max assist.
- emerging awareness to appropriate response to self family and basic needs
- supervised for old learning
- max assist for new learning with little or no carryover
- unaware of impairments
- consistently follows simple directions
be somewhat confused because of memory
and thinking problems, he will remember the
main points from a conversation, but forget
and confuse the details. For example, he may
remember he had visitors in the morning, but
forget what they talked about;
• follow a schedule with some assistance, but
becomes confused by changes in the routine;
• know the month and year, unless there is a
severe memory problem;
• pay attention for about 30 minutes, but has
trouble concentrating when it is noisy or
when the activity involves many steps. For
example, at an intersection, he may be unable
to step off the curb, watch for cars, watch the
traffic light, walk, and talk at the same time;
-Differentiate between a level VIII Purposeful and appropriate on the Ranchos scale and a level V Confused-Inappropriate Non-agitated.
VIII
A person at this level may:
• realize that he has a problem in his thinking
and memory;
• begin to compensate for his problems;
• be more flexible and less rigid in his thinking.
For example, he may be able to come up with
several solutions to a problem;
• be ready for driving or job training evaluation;
• be able to learn new things at a slower rate;
• still become overloaded with difficult,
stressful or emergency situations;
• show poor judgment in new situations and
may require assistance;
• need some guidance to make decisions;
• have thinking problems that may not be
noticeable to people who did not know the
person before the injury.
consistently orientated to person place time
attend and complete familiar task for 1 hour in distracted environment.
-recall and implement past and present events
-initiates and carries out steps to complete familiar tasks like household, leisure and community routines with standby assistance
-no assistance once new task is learned
-over/under estimates abilities
-acknowledges others needs an feelings and responds appropriately with min assist.
-depressed
-irritable
-easily angered
-argumentative
-self centered
V
CONFUSED AND INAPPROPRIATE
A person at this level may:
• be able to pay attention for only a few minutes;
• be confused and have difficulty making sense of
things outside himself;
• not know the date, where he is or why he is in
the hospital;
• not be able to start or complete everyday
activities, such as brushing his teeth, even when
physically able. He may need step-by-step
instructions;
• become overloaded and restless when tired or
when there are too many people around; have a
very poor memory, he will remember past events
from before the accident better than his daily
routine or information he has been told since the
injury;
• try to fill in gaps in memory by making things up;
(confabulation)
-may wander randomly or with a vague intention of going home.
-inappropriate use of objects without external direction
-may be able to perform previous learned tasks with cues and external structure
-unable to learn new info
-can respond to simple commands
-can converse for brief amount of time with cues and external support.
