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Altered Mental Status: Symptoms & Treatment

Instructor: Alyssa Campbell

Alyssa is an active RN and teaches Nursing and Leadership university courses. She also has a Doctorate in Nursing Practice and a Master's in Business Administration.

Trauma, health ailments, and even stress may attribute to changes in the central nervous system and can result in altered mental status. Read this lesson to learn the common symptoms of this condition and how to treat it.

A Change in Mental Status

Mary is a 43-year-old homemaker and mother of two children. Upon coming home from work, her husband noticed that although Mary was awake, she had a blank stare. She also appeared lethargic (extremely tired, difficult to arouse), and disinterested. This was concerning to Mary's husband, because she is normally energetic, involved with the kids, and decisive. At first, her husband thought Mary might be tired or starting to feel sick. However, when he went to talk with Mary, he was unable to make out what she was trying to say.

Mary's husband helped her get into the family car, as she had some difficulty walking and appeared confused by the situation. They drove immediately to the local emergency department for evaluation.

Symptoms

Mary is seen immediately by a physician who quickly diagnosed her with Altered Mental Status. Altered Mental Status (AMS), can be described as a change in normal cognition (brain activity), and negatively affects an individual's ability to:

  • Reason
  • Make decisions
  • Communicate clearly
  • Stay alert
  • Concentrate
  • Control physical movement, lack of body control

Symptoms of AMS may present themselves over varying degrees of time and are dependent on the cause of the primary problem. In Mary's case, her husband noticed symptoms right away, leading to immediate treatment and a positive outcome. Other causes of AMS may slowly present with symptoms over the course of days, weeks, or even longer.

Individuals with altered mental status will each present differently, depending on cause of change in mental status, their age, and overall health and wellness.

Treatment

Even though Mary has a diagnosis of AMS, her physician continues to investigate the cause of her condition to find and treat the underlying problem at hand. The doctor knows that AMS can be caused by many different factors, and begins a physical assessment while interviewing Mary's husband to get more information.

1. Ensure the Person's Safety

Changes in mental status can easily lead to unintended harm for the affected individual. They are at high risk for falls, physical trauma, and loss of dignity. Mary's medical team in the emergency department ensured that Mary had a private room, and that her husband would stay at the bedside to watch over her. The staff explained that they would be in to check on Mary frequently and to alert them to any changes in her condition.

2. Find the Cause

  • Stress: The physician asks about Mary's stress level and learns that she is generally happy, energetic, and involved with her family. This is normal.
  • Trauma: No bruising, swelling, or bleeding is identified during the physical exam. It is likely that Mary has not experienced any physical trauma. Mary's husband denies any recent falls or accidents in the past few weeks. Trauma is not likely to be the cause of the AMS.
  • Brain: Because Mary's symptoms included lethargy and difficulty communicating, she went for diagnostic imaging (tests used to take pictures of organs, bones, and other body tissue) of her brain and spine. The brain and spine are critical aspects of the body's central nervous system. These diagnostic tests were negative.
  • Heart and Lungs: Diagnostic imaging of these organs revealed no issues; however, Mary's blood pressure, heart rate, and temperature were abnormal.
  • Infection: Due to Mary's symptoms, normal diagnostic imaging, and her vital signs, the physician started to believe that Mary may have a severe infection. Blood and urine samples were taken and high levels of white blood cells and bacteria were noted in her lab results. Upon further discussing the past day or so with Mary's husband, the physician finds that Mary complained of burning on urination, and later that day, was unable to urinate at all.

3. Treat the Underlying Cause

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