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Neuro 1 > Ranchos Los Amigos Revised Scale > Flashcards

Ranchos Los Amigos Revised Scale Flashcards

1
Q

Ranchos Los Amigos assumption

A

observation of type, nature, and quality of patient’s behavior is representative of cognitive level

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2
Q

cutoff for Agitated Behavior Scale

A

< 21 - within normal limits
22-28 - mild agitation
29-35 - moderate agitation
> 35 - severe agitation

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3
Q

What is the hallmark transition between RLAS-R 4 and 5?

A

agitation goes away in level 5

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4
Q

What will a RLAS-R 5 score on agitated behavior scale?

A

21 or below

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5
Q

At what RLAS-R level does orientation start to come in?

A

6

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6
Q

What are hallmarks of RLAS-R 6?

A

become inconsistently oriented and begin to demo carryover for relearned familiar task

  • can sit down and do something structured with patient with max assist and max external cues
  • poor insight (safety risk)
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7
Q

At what stage is the patient no longer confused?

A

RLAS-R 7

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8
Q

At what stage does the patient start to have awareness of what their condition but think they are fine?

A

RLAS-R 7

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9
Q

RLAS-R 7 orientation

A

consistently oriented to person and place

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10
Q

How would you describe a RLAS-R 7 cognitive responses?

A

robot/automatic like cognitive responses

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11
Q

What is the difference between RLAS-R 7 and 8 in terms of orientation?

A

8 is consistently orientated to person, place, and time

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12
Q

What is behavior of RLAS-8?

A
  • depression common - reality is setting in
  • similar to a toddler
  • defiant and underestimate abilities
  • able to recognize inappropriate social behavior and correct w/ min assist
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13
Q

What is a defining factor of RLAS-R 9?

A

able to realize and ask for help when needed

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14
Q

What is the GOAT? What cutoff scores exist for it?

A

Galveston Orientation and Amnesia test - determines if person is in state of post-traumatic amnesia (state of disorientation)

normal - 76-100
borderline - 66-75
impaired - < 66

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15
Q

What is the O-Log? What cutoff scores exist for it?

A

basic A + O exam - determines if person is in state of post-traumatic amnesia (state of disorientation)
- scoring out of 30 and want > 25

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16
Q

How do we determine if someone is no longer in a post-traumatic amnesia state?

A

> 75/100 on GOAT and > 25/30 on O-log

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17
Q

Post-traumatic amnesia determined by _______ demonstrated even better prediction of rehabilitation outcomes than ______

A

O-log better predictor than GOAT

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18
Q

What is the MARS?

A

Moss Attention Rating Scale

- observational scale that measures behavioral responses that affect attention

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19
Q

MARS scoring

A
  • negative items need to be flipped before scoring

- 22-110 scale w/ higher scores = better attention

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20
Q

What are the 3 major factors that the MARS rates?

A
  • irritability
  • initiation
  • sustained attention
21
Q

What are the options available to deal with an agitated patient?

A

talk calmly, quietly, slowly, and short sentences

  • turn off lights, close shades, turn off TV, have less people in room, close/crack door
  • lessen stimulus
22
Q

Why are restraints a last-ditch option?

A

increase risk for delirium, worsening agitation, skin breakdown, and length of stay

23
Q

At what stage does the patient become consistently oriented?

A

7 - consistently oriented to person and place in familiar environments; ModA for time

8-10 - consistently oriented to person, place, and time

24
Q

At what stage does the patient begin to see confusion between STM and LTM?

A

5

25
Q

At what stage can the patient distinguish between STM and LTM?

A

6

26
Q

At what stage does the patient need maxA with memory device? ModA? SBA?

A

maxA - 6

modA - 7

SBA - 8

27
Q

What is the difference between RLAS 9 and 10 in terms of memory?

A

9 independent w/ memory aide but may need help procuring and maintaining

10 - independent w/ memory aide

28
Q

At what stage can the patient recall and integrate past/recent events?

A

8

29
Q

At what stage of problem solving will the patient be able to demo previous learned tasks, no carryover? What will they need to complete this task?

A

5 - need max structure and cues

30
Q

At what stage does the patient start to show improvements in problem solving even though it remains difficult (maxA)? What else can they do at this stage?

A

6 - maxA w/ learning new tasks but no carryover

31
Q

At what stage will the patient be able to problem solve through ADLs and other familiar tasks with MinA?

A

7

32
Q

What is the difference between RLAS 9 and 10 with problem solving?

A

9 - initiate and carry out familiar tasks but may need some assistance w/ unfamiliar tasks

10 - independent initiates and carries out steps to familiar and unfamiliar tasks but may need more time or compensatory strategies

33
Q

At what stage does the patient begin to initiate and carry out familiar tasks independently?

A

8

34
Q

What is the difference between RLAS 4 and 5 when it comes to attention?

A

4 - very brief and non-purposeful movements of sustained and divided attention

5 - highly distractable, tangential

35
Q

At what stage can you perform a structured activity for the patient? What is the environment like and for how long?

A

6 - highly familiar tasks in non-distracting environment for short time (< 30 min) w/ assist

36
Q

At what stage can the patient perform tasks in a distracting environment?

A

8

37
Q

What is the difference between RLAS 9 and 10 when it comes to attention?

A

9 - independently shift back and forth between tasks and complete accurately for 2 hours

10 - independently handle multiple tasks simultaneously in all environments but may require breaks

38
Q

What type of directions should be used with an RLAS 6?

A

simple directions

39
Q

At what level will the patient respond appropriately to simple and multistep directions?

A

7

40
Q

behavior of RLAS 4

A

agitated

  • inappropriate crying out, mood swings, uncooperative
  • alert and in heightened state of activity
41
Q

What type of activities will a RLAS 4 perform? Will they be purposeful?

A

motor activities such as sitting, reaching, walking but w/o purpose or upon another’s request

42
Q

behavior of RLAS 5

A

alert, not agitated but may have infrequent outbursts

  • lack self monitoring or goal directed behavior
  • wander/elope risk
43
Q

behavior of RLAS 6

A

emerging awareness of appropriate response to self, family, and basic needs
- unaware of impairments, disabilities and safety risk

44
Q

behavior of RLAS 7

A
  • superficial awareness of condition but cannot link impairment to disability - unrealistic planning, overestimates abilities
  • unaware of other’s needs and feelings and has inappropriate social interactions
  • oppositional, uncooperative
45
Q

At what level does a patient become aware and acknowledge their impairments?

A

8

46
Q

behavior of RLAS 8

A
  • aware and acknowledge impairments - need help w/ appropriate action and able to consider consequences w/ min cues
  • depression, irritability, low frustration tolerance
  • acknowledges other’s needs and feelings and responds w/ Min cues
  • can correct inappropriate social interactions
47
Q

At what level can a patient recognize inappropriate social interactions and correct them?

A

8

48
Q

At what level can a patient anticipate with assistance?

A

9

49
Q

behavior of RLAS 9

A
  • aware and acknowledges impairments but needs help taking appropriate action independently
  • requires assistance to anticipate but able to consider consequences
  • acknowledges others feelings w/ SBA
  • depression, irritability, low frustration improving
  • self-monitors social interactions w/ SBA

Neuro 1 (11 decks)

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