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Year 2: Neuromuscular > Test 1: Mental Status and Alertness > Flashcards

Test 1: Mental Status and Alertness Flashcards

1
Q

what components of your screen/exam help you assess mental status

A

pt history
assessing A&O
behavior signs
cognitive status
memory

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2
Q

A&O x4 means what

A

alert and oriented to person, place, time, and situation

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3
Q

how to test for memory/cognitive screen

A

“retention and recall”

repeat 3 words

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4
Q

define level of consciousness

A

measurement of a person’s alertness

arousal and responsiveness to stimuli from environment

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5
Q

what is arousal

A

stimulation to action/readiness for activity

level of excitability - state of responsiveness to sensory stimuli

is the level appropriate for the situation?

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6
Q

what is attention?

A

directing of consciousness to a person, thing, or part of environment

direction of awareness

necessary to perform conscious task

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7
Q

what is consciousness

A

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

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8
Q

what is orientation

A

ability to comprehend and adjust to oneself with regards to time, location, and identity of self

A&O x 3 = oriented to time, person, and place

A&O x 4 = oriented to situation and circumstances

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9
Q

how would a person who is lethargic act

A

mildly depressed level of consciousness or alertness

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10
Q

how would a person who is obtund act

A

significantly diminisehd level of consciousness and cant be fully aroused

responds to noxious stimuli and appears confused

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11
Q

how would a person in a stupor act

A

not able to be aroused from sleep like state

requires vigorous unpleasant stimuli for minimal arousal

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12
Q

how would a person in a coma act

A

unconscious

inability to make purposeful response

no arousal

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13
Q

what is a minimally conscious or vegetative state

A

pt is aroused (conscious)

unaware of environment

no purposeful attention or cognitive response

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14
Q

what is a persistent vegetative state

A

in vegetative state for 1 year or longer after a TBI OR 3 months or longer for ABI

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15
Q

characteristics of a hyperaroused pt

A

unable to attain/maintain alert state

restless/agitated

irritable

unable to self console

hyperactive movements

increased intensity of voice

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16
Q

characteristics of hypoarousal

A

unable to attain/maintain alert state

lethargic/obtunded

labile

poor response to verbal communication

poor processing

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17
Q

normal arousal is characterized by

A

quite attention

follows commands relative to cognotive abilities

responds to cues

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17
Q

factors that affect arousal level

A

diseases or pathologies (i.e. dementia, TBI, brain ischemia)

acute changes in behavior (i.e. fatigue, sundowning, insomnia)

acute changes in brain chemistry (i.e. infection, meds, glucose levels, vitals)

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17
Q

when assessing arousal for a hypoaroused patient, what 3 areas of function do you examine? what outcome measures might you use?

A

eye motor
motor response
verbal response

glasgow coma scale
NIHSS (stroke specific)
MARS

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17
Q

what is the glasgoq coma scale used for

A

outcome measure for arousal

gold standard used to document level of consciousness in acute brain injury

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18
Q

what 3 areas of function are examined with the glasgow coma scale q

A

eye opening
motor response
verbal response

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19
Q

describe the numeric scale for the glasgow coma scale

A

ranges from 3-15

mild head injury = 12-15
moderate = 9-11
severe = 3-8

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20
Q

what is the NIHSS

A

NIH stroke scale

outcome measure for stroke severity

stroke specific

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21
Q

interventions to improve arousal

A

physical touch/stimulaiton
noxious stimuli
sensory stimulation
vestibular stimulation
environment modification
edu of family/staff
decrease duration of task

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22
Q

examples of noxious stimuli

A

sternal rub
nail bed pressure

23
Q

definition of coping

A

making adaptations to meet personal needs and responing to environment demands

24
Q

what is focused attention

A

ability to process and respond to specific info or input

25
Q

what is sustained attention

A

ability to perfrom an activity continuously over a period of time

26
Q

what is selective attention

A

ability to perform an activity in the presence of distracting stimulu, including ignoring irrelevant infow

27
Q

what is alternating attention

A

ability to shift focus of attention between multiple stimuli

28
Q

what is divided attention

A

ability to repsond to multiple stimuli simultaneously

29
Q

how to test selective attention

A

digit span task

repeat a short list of numbers forward and backward

30
Q

how to test divided attention

A

walk while counting or naming objects

31
Q

factors that play a role in attention

A

selective attention
divided attention
behavior
complexity/familiarity of a task determine amount of attention required

32
Q

What is the MARS

A

moss attention rating scale

attention outcome measire

characterizes behavioral response after brain injury

22 items

5-pt rating scale

items grouped to rate:
-restlessness/distractability
-initiation
-sustained/consistent attention

33
Q

what does it mean if a pt is ditractable

A

inable to fixate or sustain attention

34
Q

what does it mean if a pt is perseverative

A

unable to disengage or switch attention

35
Q

what does it mean if a pt has limited capacity/flexibility for behavior

A

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

36
Q

what does it mean if a pt has poor recall

A

unable to manipulate new info and attend to previous info

37
Q

what does vigilance mean

A

ability to sustain attention over time

38
Q

what does affective status mean

A

a patients affect is a collection of behaviors that describe their emotional state or mood

mood = mroe sustained emotional state

39
Q

what is apathy

A

shallow affect and blunted emotional response

often misconstrued as depression or poor motivation

40
Q

what is euphoria

A

exaggerated feelings of well being

41
Q

what is social inappropriateness

A

missed social cues or inappropriate comments

poor safety awareness/judgement

42
Q

how might depression/withdrawal present in a patient

A

poor perception of ones self and environment may lead to increasing isolation

43
Q

how might irritability present in a patient

A

changes in ability to sense, move, communicate, think, or act as before become frustrating

create high levels of stress for patients with strokes

44
Q

what is the pseudobulbar affect

A

emotional lability

emotion dysregulation syndrome

18% stroke cases

emotional outbursts of uncontrolled or exaggerated laughing or crying that are inconsistent with mood

45
Q

what is aphasia

A

communucation disorders

46
Q

what is verbal apraxia

A

slurred speech

47
Q

what is phonation

A

sound production

tone of voice

48
Q

what are pragmatic language behaviors

A

tangential speech

taking turns talking

49
Q

what areas are you observing when checking mental status

A

appearance
behavior
mood
thought processing
perception
attention/concentration
memory
judgement
intelligence
insight

50
Q

what is dementia

A

pathological condition of mind

global decline can be caused by persistent delirium

51
Q

what is delirium

A

impaired sensorium (reduced level of consciousness)

52
Q

what is depression

A

disturbance in mood

low vital sense and poor attitude

53
Q

what is age associated cognitive decline

A

not quite dementia

loss of cognition

54
Q

what is wernicke/Korsakoff’s

A

an encephalopathy (brain disease disorder)

thaiamine deficiency

primarily seen with alcoholism

55
Q

what might you see with alcohol withdrawal

A

neurologic features resemble those of hypocalcemia

irritability, agitation, seizures, tremors, and hyperreflexia

56
Q

what is sundowning

A

increased agitation in late agfternoon/early evening

part of dementia

unknown cause

could be pharmacy, patient affect, etc

57
Q

what is alcohol withdrawal delirium

A

associated with fever and other metabolic symptoms

most serious 48-72 hours after last drink

symptoms peak at 5 days; decrease around 5-7 days

not appropriate for PT

Year 2: Neuromuscular (20 decks)

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