Altered Mental Status PDF

Altered Mental Status  Altered Mental Status · A disruption in wakefulness or arousal the reticular ~ controlled by bilateral...

Altered Mental Status  Altered Mental Status · A disruption in wakefulness or arousal the reticular ~ controlled by bilateral activating system hemisphere alterations can be affected by consciousness · in Cerebral cortex ↳ affected by alteration Persistent Vegetative State · can be awake but has no cortical function , Mneumonic Metabolic (hypercalcemia,hyponatremia) SeizuresA Trauma Oxygen (hypoxia) Uremia Vascular (MI , Breed CVA) , Psychiatric Endocrine (hypothyroid, hypoglycemiaInfections Drugs , Alconol  How Do We Assess this Patient ? "When we read , we Check them begin w/ ABC" Check for BRHRCardiac Rhythm of a alteration in:OxygenLerespgiveO ! Opiods Give Narcan) check medications : · Benzo Give Romazicon) · given Also Assess #msee · Best Verbal Best Eye Opening & Pupil reaction  Generalized us Focal Findings Generalized /Global Findings · systemic cause (alcoholic , on drugs , low · Depressed level of consciousness fiucose Bilateralextremity weakness · symmetrical pupils · have slurred speech may · Focal Findings · more like may or not have depressed Lo may - · unilateral extremity weakness · have facial droop may have slurred speech or aphasic may · Level of Consciousness : Alteration in Alertness/ Mentation/Language Lethargy · La Stimulus will wake up the patient A Obtundation · needs constant stimulation to stay awake Stupor · L cannot awake even with stimulus stay Coma · ↳ does not awaken even with painful stimuli S pr Orientation · Name , PlaceTime, and Purpose knowledge of current events · Caution : Many its may · be able to answer but are still confused Language Expressive , receptive,or global aphasia · ↳ disorders of comprehension, fluency , namingor writing Dysarthria :slaned speech · Lcoordination problems of breath , vocal cords, and /or life larynx , palate,tongue, Dysphonia · difficultyvolvoiceproductioa or cranial newe problem)  Glascow Coma Scale " Score based on the best score * than 15 less than 3 can't be higher · or Noxious stimuli · must be administered centrally not peripherally Based on Eye opening · · Verbal · Motor(UE)  Assessment Eye Eye Movement · Gazes : eye deviate toward a lesion from hemiparesis Eyes deviate away · movement of the Mystagmus : involuntary eyes · Pupillary Movement The baseline examination is the · most important Reaction to light · Size · Direct light reflex ~ Shape · consensual light reflex · Symmetry · · Accommodation  CN111 · Oculomotor Nerve Resides in the Dorsal Midbrain · D · Vunerable to compression Controls several muscle around the · eye movement up , down , left, eye right - - ciliary muscle; lens shape ,focus on close up objects - sphincter pubillae :constricts pupil  Pupil Size A · PinPoint [Miosis > - ↳ Opiods Mid-position · · normal is bilaterat Dilated · emidriasis > - Call Damage Pupil Shape · Round > - nnormal · Ovid -increased ICP > - early naniation · keyhole > cataract surgery - post  Symmetry · Anisocoria · unequal pupils 15 % population more than Imm difference Rarely · than in dark · Never greater in light · Without ptosis Lupper eye lid drooping # All unsymmetrical pupils must be if this is valuated especially a change from baseline Oculomotor newe compassion · Constriction defect · Eye does not respond to light of newe ofIT compression Cerebral edema Lucal herniation  Motor Assessment · Range of motion , strength , coordination ,and sensation strength for each limb · ot5 full ROM ,full strength · a full Romless than normal strength to can · raise but not extremity against resistance extremity but not lift it +2 can move · · I slight movementmuscle twitch · O no movement /no muscle concentration Motor Assessment If no movement - must deliver Stimulus NIH Stroke Scale The the Higher the score, worse the stroke  know the of Stroke symptoms a or is number Face inneven smile; one side of face droops Armsione am drifts down when raising both or is other weaker and more numb than StabilityDizzinesshardtimekeepingbalanc.. Talking ;understood Slurred words Unable to speak Hard time. or understanding speech. being Eyes i Difficulty seeing out of one orboth eyes. Double vision React ! Call even if symptoms Call all Immediately Remember when go away. symptoms first began  Sodium Abnormalities Hyponatremia · - hypovolemic - euvolemic hypervolemic - Hypernatremia · · S/S : AMS?, Seizures , coma to the brain? · What water does It expands it What salt does to the brain ? · replacing too fast ; central pontine myelinolysis  Delirium us Dementia Acute Confusion State/Delirium symptoms develop quickly over short period oftime · · Reduced ability to maintain attention Disorganized thinking · Rambling · speech perceptual disturbances illusions, hallucinations, · - misinterpretations · Disorientation Cognitive Impairment Dementia - Progressive decline in cognitive function · disease in brain di damage or  Causes of Delirium - manid Neurotransmitter dysfunction - CNS process - - systemic dx - toxins/meds - infections hypoxia - - severe urination retention withdrawal drug - abnormalities electrolyte -  Neurological Emergencies · CUA · ICH Pupillary changes · · Status epileptions spinal cord compression · · head trauma Encephalopathies Wernickes; acute mental confusion ,ataxia Bophthalmoplegi · , thiame deficiency in alcoholics ofnoxic · Hepatic Hypertensive · ouremic Toxic Diabetic ·