Lecture 2 - Exam 1 Flashcards by Cidney Woodard

Why do we perform a neuro screen

Screen for red flags
Screen for referral
Differential diagnosis
Establish baseline
Observe for changes

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What is the first step in a neuro screen?

How is this assessed?

Mental status

Pt history
Assessing A & O
Behavior signs
Assessing cognitive status
Assess memory

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What does A&O x 4 mean

Pt is oriented to person, place, time, situation

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During your subjective exam, you should note…

Behavior
Language
Attention
Affect

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What is level of consciousness (LOC)

Measurement of a person’s alertness

Arousal and responsiveness (attention) to stimuli from the environment

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What is arousal

Stimulation to action/physiologic readiness for activity

Level of excitability - state of responsiveness to sensory stimulation

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What is attention

Directing of consciousness to a person, thing, of a part/aspect of the environment

Direction of awareness

Selective responsiveness to one class of stimuli

Necessary to perform a conscious task

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What is consciousness

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

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What is orientation

Ability to comprehend and to adjust oneself with regard to time, location, and identification of self

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What is A&O x 3

Alert and oriented to time, person, place

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What is A&O x 4

Alert and oriented to time, person, place, circumstance/situation

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Define lethargic

Mildly depressed level of consciousness/alertness

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Define o tune

Significantly diminished level of consciousness and cannot be fully aroused responds to noxious stimuli and appears confused

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Define stupor

Not able to be aroused from a sleep-like state, requires vigorous unpleasant stimuli for minimal arousal

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Define coma/unconscious

Unconsciousness, inability to make any purposeful response and no arousal

May/may not be ventilator dependent

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What does it mean if the patient is minimally consciousness or in a vegetative state

Pt is aroused/conscious but remains unaware of their environment and no purposeful attention of cognitive response

Return of irregular sleep-wake cycles and normalization of the vegetative functions (respiration, digestion etc)

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What if the patient is in a persistent vegetative state

Pt remains in vegetative state for 1+ years after TBI or longer for ABI

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Describe the characteristics of hyperarousal

Unable to attain/maintain an alert state
Restless, agitated
Irritable
Unable to self console
Hyperactive movements
Increased intensity of voice

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Describe the characteristics of hypoarousal

Unable to attain/maintain an alert state
Lethargic/ontunded
Labeled
Poor response to verbal communication
Poor processing

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What factors affect levels of arousal

Disease/pathology
Acute change in behavior
Acute change in Bain chemistry

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What 3 areas of function are examined to assess arousal for hypoaroused patients

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Eye opening
Motor response
Verbal response

What is the Glasgow Coma Scale

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Outcome measure for arousal

Gold standard instrument used to document level of consciousness in acute brain injury

Used immediately following a head injury to assess arousal and neurological function

What is the range for the Glasgow Coma Scale

Rate the severities

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3-15

Mild: 12-15
Moderate: 9-11
Severe: 3-8

What is the NIHSS and what is it used for

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NIH stroke scale

Examines pt’s level of consciousness, arousal, cognition following a stroke to determine severity

Define coping

Process of making adaptation to meet the personal needs and respond to the demands of the environment

What are the 5 categories of attention

Focus attention Sustained attention Selective attention Alternating attention Divided attention

Define focused attention

Ability to process and respond to specific info or input

Define sustained attention

Ability to perform an activity continuously over a period of time

define selective attention

Ability to perform an activities in the presence of distracting stimuli, inclining ignoring irrelevant information Ex) digit span task: repeat a short list of numbers fwd/bkwd

Define alternating attention

Ability to shift the focus of attention between multiple stimuli

Define divided attention

Ability to respond to multiple stimuli simultaneously E) walk while counting or naming objects

T/f Can behavior play a role in attention

True Behavior can be intentionally distracted or obstinate

What is Moss Attention Rating Scale (MARS) Items are grouped in to what 3 major factors

Outcome measure for attention Standardized objective measure of attention to characterize behavioral responses after brain injury Restlessness/distractibility, Initiation, Sustained/consistent attention

Define distractable

Unable to fixate or sustain attention

Define perseverative

Unable to disengage or switch attention

Define limited capacity/flexibility

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

Define poor recall

Unable to manipulate new information and attend to previous information

Define vigilance

Positive sign Ability to sustain attention over time

What is affective status

A patient’s affect is a collection of behaviors that describe their emotional state or mood

What is apathy

Shallow affect and blunted emotional responses Occurs in ~22% of pts Frequently misconstructed as depression or poor motivation

What is euphoria

Exaggerated feelings of well being

What is social inappropriateness

Decreased pragmatism Missed social cues or makes inappropriate comments Poor safety awareness or judgement

What is depression/withdrawal

Poor perception of one’s self and environment may lead to increasing isolation and social withdrawal

What is irritability/frustration

Changes in the ability to sense, move, communicate, think, act as before are enormously frustrating by themselves and create high stress levels fro the patient with stroke

What is pseudobulbar affect/emotional lability

Emotional dysregulation syndrome 18% of stroke patients Characterized by emotional outbursts of uncontrolled/exaggerated laughing/crying that are inconsistent with mood

What are the 3Ds

Dementia Delirium Depression

Define dementia

Pathological condition of the mind Global decline can be caused by persistent delirium

Degine delirium

Impaired sensorium/reduced level of consciousness

Define depression

Disturbance in mood Low vital sense and poor attitude

Describe alcohol withdrawal delirium (AWD)

Severe delirium and delusion association with fever and other metabolic symptoms Most serious symptoms; 48-72 hours - 5 days Not appropriate for physical therapy

Lecture 2 - Exam 1 Flashcards

(50 cards)