Consciousness & Cognitive function (Mental status) assessment
Altered mental status : Arousal and content of consciousness
Arousal : Wakefulness and basic alerting (level of consciousness) 醒不醒
Arousability and responsiveness to stimuli
Arousal 覺醒 : Responsiveness to external stimulation 對外在刺激的反應
臨床上呈現 醒 的狀態 (睜眼反應)
腦幹網狀系統 (RAS) 活動的表現
Content of consciousness : Awareness, memory, language, reasoning,
spatial relationship integration, emotions, complex attention,
and the myriad integration processes that make us human.
知不知道在幹嘛
Awareness 覺察 : State of awareness of self and environment
察覺自我及環境的狀態
綜合認知和情感之腦功能(有意義的動作和語言)
主要為大腦半球的功能
Level of consciousness 描述性名詞
- Alert
- Confusion :
對人事時地物 disoriented
Impaired thinking
Difficult following command
- Drowsiness, Lethargy :
Reduced alertness
愛睡愛睡, 還是叫的醒
Response to verbal or touch stimulation
- Obtundation :
比 Lethargy 更差一點
Lessened interest in the environment
Slowed responses to stimulation, need repeated stimulation
- Stupor 木僵 :
非常強烈且重複的刺激 (to pain)
才可以有一點反應
Unresponsiveness but rousable,
response minimally to vigorous stimulation
response minimally to vigorous stimulation
- Coma : 無反應 (Unarousable)
GCS : 3-15
V :
Oriented
Disoriented 答錯答案
Inappropriated, incoherent 文不對題, 根本不是在問這個
Incomprehensible 聽不懂的咿咿啊啊
No response
M :
Obey
Localized
Withdraw
Decorticate
Decelebrate
No response
- Mild brain injury : >13
- Moderate : 9~12
- Severe : < 8
Coma : failure of both arousal and content functions of consciousness.
Coma is a state of reduced alertness and responsiveness from which the patient cannot be aroused.
Delirium : acute state of fluctuating attention and change in cognition
Dementia : chronic disorder of deteriorating cognition, with or without behavioral disturbances
Cognitive (Mental status)
JOMAC :
Orientation : 人事時地物
Memory 1 : 藍色 / 太陽 / 摩托車
(不用提示病人等下會再問, 只要複誦一次就好)
- 我現在要說三樣東西, 請你注意聽, 然後複誦一次 -
Abstract : 香蕉, 橘子的共通點
Judgement : 情境題 (家裡失火怎麼辦)
Calculate : 100-7 (再減 7)
Memory 2 :
* MMSE :
這是什麼 : 茶杯, 手錶, 聽診器
再講一遍 : 家和萬事興
- 我現在要說一句話, 請你注意聽, 然後複誦一次 -
閉眼 : 在紙上寫閉眼
- 請你做出紙上所寫的動作 -
造句 : 在紙上寫一句話
畫圖
三個動作 : 用你的左手拿這張紙, 對折一半, 然後還給我
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