Consiousness, Memory, Communcation Flashcards
What are the 7 levels of consciousness?
Alertness Lethargy Obtundation Stupor Coma Unresponsive vigilance (vegetative) state Minimally conscious state
What is the difference between alertness and lethargy?
Alertness = patient responds appropriately, can open eyes, look at examiner, respond fully and appropriately to stimuli
Lethargy = patient appears drowsy; can open eyes and look at examiner, respond to questions, but falls asleep easily.
What is the difference between obtundation and stupor?
Obtundation = patient can open eyes, look at examiner but responds slowly and is confused, demonstrates decreased alertness and interest in environment
Stupor = patient can be aroused from sleep with only painful stimuli; verbal responses are slow or absent; patient returns to unresponsive state when stimuli are removed; demonstrates minimal awareness of self and environment
What is the difference between coma and unresponsive vigilance (vegetative state)?
Coma = a state of unconsciousness from which a patient cannot be aroused, eyes remain closed; no response to external stimuli or environment
Unresponsive vigilance = a state characterized by the return to sleep/wake cycles, normalization of vegetative functions respiration, heart rate, BP, digestion) and lack of cognitive responsiveness can be aroused but is unaware).
When is a patient considered to be in a persistent vegetative state?
A state lasting > 1 year for TBI and > 3 months for anoxic brain injury
What is a minimally conscious state?
A state characterized by severely altered consciousness with minimal but definite evidence of self or environmental awareness
What elements of consciousness are assessed by the Glasgow Coma scale?
Relates consciousness to 3 elements of response:
Eye opening
Motor response
Verbal response
Explain the scoring categories for the Glasgow Coma Scale.
Score ranges from 3 to 15.
1-8 = severe brain injury 9-12= moderate brain injury 13-15 = minor brain injury
What test can be used to assess a patient’s attention span?
Digit span retention test (i.e. ability to recall 7 numbers in order presented)
What is the difference between sustained, divided, and focused attention?
Sustained = ability to attend to a task without redirection
Divided attention = ability to shift attention from one task to another
Focused attention = ability to stay on task in presence of detractors
What is perseveration?
Getting stuck on a task
Repeated performing the same task or repeating the same word/phrase without purpose
What is the purpose of the Mini Mental State Examination and what does it screen?
Purpose = screen for cognitive dysfunction
Screening items for orientation, registration, attention and calculation, recall and memory
Describe the scoring for the Mini Mental State Examination.
Maximum score of 30:
21-24 = mild cognitive impairment
16-20 = moderate impairment
15 or less = severe impairment
What is delirium?
A state of consciousness that is characterized by quiet behavior, confusion, agitation and loudness
What is the purpose of the Ranchos Los Amigos Scale?
Assess cognitive recovery from TBI
List the 8 levels of behavior on the Ranchos Los Amigos Scale.
I. No response II. Generalized response III. Localized response IV. Confused-agitated V. Confused-inappropriate VI. Confused-appropriate VII. Automatic-appropriate VIII. Purposeful-appropriate
Describe no response and generalized response on the Ranchos Los Amigos Scale.
No response = patient is completely unresponsive to any stimuli
Generalized response = Patient reacts inconsistently and non-specifically to stimuli
Describe localized response and confused agitated on the Ranchos Los Amigos Scale.
Localized response = Patient reacts inconsistently but specifically to stimuli.
Confused agitated = Patient is in heightened state of activity. Behavior is bizarre and non purposeful relative to immediate environment. Recall and attention span are poor.
Describe confused inappropriate on the Ranchos Los Amigos Scale. (3)
Able to respond to simple commands but not do complex tasks.
Verbalization is inappropriate
Memory is severely impaired
Describe confused appropriate on the Ranchos Los Amigos Scale.
Patient is dependent on external input but can perform consistently.
Memory is improved.
Describe automatic appropriate on the Ranchos Los Amigos Scale.
Can perform automatically and appropriately in structured environments.
Judgement remains impaired
Describe purposeful appropriate on the Ranchos Los Amigos Scale.
Patient acts appropriately though not perfectly.
Can have some problems in stressful or unusual circumstances.
What is anterograde amnesia?
Inability to create new memories
Anterograde memory is usually the last to recover after a comatose state. Contributing factors include poor attention, distractibility, and impaired perception of stimuli.
What is post traumatic amnesia?
The time between the injury and when the patient is able to recall recent events. The patient does not recall the injury or events up until this point of recovery. Used as an indicator of the extent of damage.
