Test 1: Mental Status and Alertness

Question 1

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

Answer 1

pt history
assessing A&O
behavior signs
cognitive status
memory

Question 2

A&O x4 means what

Answer 2

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

Question 3

how to test for memory/cognitive screen

Answer 3

“retention and recall”

repeat 3 words

Question 4

define level of consciousness

Answer 4

measurement of a person’s alertness

arousal and responsiveness to stimuli from environment

Question 5

what is arousal

Answer 5

stimulation to action/readiness for activity

level of excitability - state of responsiveness to sensory stimuli

is the level appropriate for the situation?

Question 6

what is attention?

Answer 6

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

direction of awareness

necessary to perform conscious task

Question 7

what is consciousness

Answer 7

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

Question 8

what is orientation

Answer 8

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

Question 9

how would a person who is lethargic act

Answer 9

mildly depressed level of consciousness or alertness

Question 10

how would a person who is obtund act

Answer 10

significantly diminisehd level of consciousness and cant be fully aroused

responds to noxious stimuli and appears confused

Question 11

how would a person in a stupor act

Answer 11

not able to be aroused from sleep like state

requires vigorous unpleasant stimuli for minimal arousal

Question 12

how would a person in a coma act

Answer 12

unconscious

inability to make purposeful response

no arousal

Question 13

what is a minimally conscious or vegetative state

Answer 13

pt is aroused (conscious)

unaware of environment

no purposeful attention or cognitive response

Question 14

what is a persistent vegetative state

Answer 14

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

Question 15

characteristics of a hyperaroused pt

Answer 15

unable to attain/maintain alert state

restless/agitated

irritable

unable to self console

hyperactive movements

increased intensity of voice

Question 16

characteristics of hypoarousal

Answer 16

unable to attain/maintain alert state

lethargic/obtunded

labile

poor response to verbal communication

poor processing

Question 17

normal arousal is characterized by

Answer 17

quite attention

follows commands relative to cognotive abilities

responds to cues

Question 17

factors that affect arousal level

Answer 17

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)

Question 17

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

Answer 17

eye motor
motor response
verbal response

glasgow coma scale
NIHSS (stroke specific)
MARS

Question 17

what is the glasgoq coma scale used for

Answer 17

outcome measure for arousal

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

Question 18

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

Answer 18

eye opening
motor response
verbal response

Question 19

describe the numeric scale for the glasgow coma scale

Answer 19

ranges from 3-15

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

Question 20

what is the NIHSS

Answer 20

NIH stroke scale

outcome measure for stroke severity

stroke specific

Question 21

interventions to improve arousal

Answer 21

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

Question 22

examples of noxious stimuli

Answer 22

sternal rub nail bed pressure

Question 23

definition of coping

Answer 23

making adaptations to meet personal needs and responing to environment demands

Question 24

what is focused attention

Answer 24

ability to process and respond to specific info or input

Question 25

what is sustained attention

Answer 25

ability to perfrom an activity continuously over a period of time

Question 26

what is selective attention

Answer 26

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

Question 27

what is alternating attention

Answer 27

ability to shift focus of attention between multiple stimuli

Question 28

what is divided attention

Answer 28

ability to repsond to multiple stimuli simultaneously

Question 29

how to test selective attention

Answer 29

digit span task repeat a short list of numbers forward and backward

Question 30

how to test divided attention

Answer 30

walk while counting or naming objects

Question 31

factors that play a role in attention

Answer 31

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

Question 32

What is the MARS

Answer 32

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

Question 33

what does it mean if a pt is ditractable

Answer 33

inable to fixate or sustain attention

Question 34

what does it mean if a pt is perseverative

Answer 34

unable to disengage or switch attention

Question 35

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

Answer 35

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

Question 36

what does it mean if a pt has poor recall

Answer 36

unable to manipulate new info and attend to previous info

Question 37

what does vigilance mean

Answer 37

ability to sustain attention over time

Question 38

what does affective status mean

Answer 38

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

Question 39

what is apathy

Answer 39

shallow affect and blunted emotional response often misconstrued as depression or poor motivation

Question 40

what is euphoria

Answer 40

exaggerated feelings of well being

Question 41

what is social inappropriateness

Answer 41

missed social cues or inappropriate comments poor safety awareness/judgement

Question 42

how might depression/withdrawal present in a patient

Answer 42

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

Question 43

how might irritability present in a patient

Answer 43

changes in ability to sense, move, communicate, think, or act as before become frustrating create high levels of stress for patients with strokes

Question 44

what is the pseudobulbar affect

Answer 44

emotional lability emotion dysregulation syndrome 18% stroke cases emotional outbursts of uncontrolled or exaggerated laughing or crying that are inconsistent with mood

Question 45

what is aphasia

Answer 45

communucation disorders

Question 46

what is verbal apraxia

Answer 46

slurred speech

Question 47

what is phonation

Answer 47

sound production tone of voice

Question 48

what are pragmatic language behaviors

Answer 48

tangential speech taking turns talking

Question 49

what areas are you observing when checking mental status

Answer 49

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

Question 50

what is dementia

Answer 50

pathological condition of mind global decline can be caused by persistent delirium

Question 51

what is delirium

Answer 51

impaired sensorium (reduced level of consciousness)

Question 52

what is depression

Answer 52

disturbance in mood low vital sense and poor attitude

Question 53

what is age associated cognitive decline

Answer 53

not quite dementia loss of cognition

Question 54

what is wernicke/Korsakoff's

Answer 54

an encephalopathy (brain disease disorder) thaiamine deficiency primarily seen with alcoholism

Question 55

what might you see with alcohol withdrawal

Answer 55

neurologic features resemble those of hypocalcemia irritability, agitation, seizures, tremors, and hyperreflexia

Question 56

what is sundowning

Answer 56

increased agitation in late agfternoon/early evening part of dementia unknown cause could be pharmacy, patient affect, etc

Question 57

what is alcohol withdrawal delirium

Answer 57

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