Test 1: Mental Status and Alertness Flashcards
what components of your screen/exam help you assess mental status
pt history
assessing A&O
behavior signs
cognitive status
memory
A&O x4 means what
alert and oriented to person, place, time, and situation
how to test for memory/cognitive screen
“retention and recall”
repeat 3 words
define level of consciousness
measurement of a person’s alertness
arousal and responsiveness to stimuli from environment
what is arousal
stimulation to action/readiness for activity
level of excitability - state of responsiveness to sensory stimuli
is the level appropriate for the situation?
what is attention?
directing of consciousness to a person, thing, or part of environment
direction of awareness
necessary to perform conscious task
what is consciousness
state of arousal accompanied by awareness (attention) to one’s environment
what is orientation
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
how would a person who is lethargic act
mildly depressed level of consciousness or alertness
how would a person who is obtund act
significantly diminisehd level of consciousness and cant be fully aroused
responds to noxious stimuli and appears confused
how would a person in a stupor act
not able to be aroused from sleep like state
requires vigorous unpleasant stimuli for minimal arousal
how would a person in a coma act
unconscious
inability to make purposeful response
no arousal
what is a minimally conscious or vegetative state
pt is aroused (conscious)
unaware of environment
no purposeful attention or cognitive response
what is a persistent vegetative state
in vegetative state for 1 year or longer after a TBI OR 3 months or longer for ABI
characteristics of a hyperaroused pt
unable to attain/maintain alert state
restless/agitated
irritable
unable to self console
hyperactive movements
increased intensity of voice
characteristics of hypoarousal
unable to attain/maintain alert state
lethargic/obtunded
labile
poor response to verbal communication
poor processing
normal arousal is characterized by
quite attention
follows commands relative to cognotive abilities
responds to cues
factors that affect arousal level
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)
when assessing arousal for a hypoaroused patient, what 3 areas of function do you examine? what outcome measures might you use?
eye motor
motor response
verbal response
glasgow coma scale
NIHSS (stroke specific)
MARS
what is the glasgoq coma scale used for
outcome measure for arousal
gold standard used to document level of consciousness in acute brain injury
what 3 areas of function are examined with the glasgow coma scale q
eye opening
motor response
verbal response
describe the numeric scale for the glasgow coma scale
ranges from 3-15
mild head injury = 12-15
moderate = 9-11
severe = 3-8
what is the NIHSS
NIH stroke scale
outcome measure for stroke severity
stroke specific
interventions to improve arousal
physical touch/stimulaiton
noxious stimuli
sensory stimulation
vestibular stimulation
environment modification
edu of family/staff
decrease duration of task
examples of noxious stimuli
sternal rub
nail bed pressure
definition of coping
making adaptations to meet personal needs and responing to environment demands
what is focused attention
ability to process and respond to specific info or input
what is sustained attention
ability to perfrom an activity continuously over a period of time
what is selective attention
ability to perform an activity in the presence of distracting stimulu, including ignoring irrelevant infow
what is alternating attention
ability to shift focus of attention between multiple stimuli
what is divided attention
ability to repsond to multiple stimuli simultaneously
how to test selective attention
digit span task
repeat a short list of numbers forward and backward
how to test divided attention
walk while counting or naming objects
factors that play a role in attention
selective attention
divided attention
behavior
complexity/familiarity of a task determine amount of attention required
What is the MARS
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
what does it mean if a pt is ditractable
inable to fixate or sustain attention
what does it mean if a pt is perseverative
unable to disengage or switch attention
what does it mean if a pt has limited capacity/flexibility for behavior
unable to perform multiple tasks concurrently or share attention between multiple tasks
what does it mean if a pt has poor recall
unable to manipulate new info and attend to previous info
what does vigilance mean
ability to sustain attention over time
what does affective status mean
a patients affect is a collection of behaviors that describe their emotional state or mood
mood = mroe sustained emotional state
what is apathy
shallow affect and blunted emotional response
often misconstrued as depression or poor motivation
what is euphoria
exaggerated feelings of well being
what is social inappropriateness
missed social cues or inappropriate comments
poor safety awareness/judgement
how might depression/withdrawal present in a patient
poor perception of ones self and environment may lead to increasing isolation
how might irritability present in a patient
changes in ability to sense, move, communicate, think, or act as before become frustrating
create high levels of stress for patients with strokes
what is the pseudobulbar affect
emotional lability
emotion dysregulation syndrome
18% stroke cases
emotional outbursts of uncontrolled or exaggerated laughing or crying that are inconsistent with mood
what is aphasia
communucation disorders
what is verbal apraxia
slurred speech
what is phonation
sound production
tone of voice
what are pragmatic language behaviors
tangential speech
taking turns talking
what areas are you observing when checking mental status
appearance
behavior
mood
thought processing
perception
attention/concentration
memory
judgement
intelligence
insight
what is dementia
pathological condition of mind
global decline can be caused by persistent delirium
what is delirium
impaired sensorium (reduced level of consciousness)
what is depression
disturbance in mood
low vital sense and poor attitude
what is age associated cognitive decline
not quite dementia
loss of cognition
what is wernicke/Korsakoff’s
an encephalopathy (brain disease disorder)
thaiamine deficiency
primarily seen with alcoholism
what might you see with alcohol withdrawal
neurologic features resemble those of hypocalcemia
irritability, agitation, seizures, tremors, and hyperreflexia
what is sundowning
increased agitation in late agfternoon/early evening
part of dementia
unknown cause
could be pharmacy, patient affect, etc
what is alcohol withdrawal delirium
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
