Ch 6: Medical Complications Flashcards
How many people in the US are living with a long term disability as the result of brain injury?
- 2 to 5.3 million
1. 1 to 1.7% of the US population
What is DVT and what is the incidence in TBI? How is it treated?
Deep vein thrombosis- blood clot forms in vein
54%
Treatment- prophylaxis, compression stockings, vena cava filters (metal device that traps blood clots), intermittent pneumatic compression (device to prevent blood clot)
What are some musculoskeletal complications of TBI? What are common treatments?
Spasticity
Hyperreflexia- involuntary increase in muscle tone and deep tendon reflexes
Contractures- a condition of joints, reduced range of motion
Heterotopic ossification- abnormal bone formation after injury
Tx include:
Exercise, casting/orthotic techniques, ultrasounds/estim, meds, surgery/radiation
Dysphagia level 1 (National Dysphagia Diet Level)
Puréed diet
Mod-severe
Foods requiring bolus formation, manipulation and chewing are not allowed
Dysphagia level 2 (National Dysphagia Diet Level)
Mechanically altered
Mild to moderate and/or pharyngeal dysphagia
Moist, soft and easily form bolus
Dysphagia level 3 (National Dysphagia Diet Level)
Dysphagia advanced
Mild
Includes most textures except hard, sticky, or crunchy foods
Requires chewing ability
In comparison to pre injury, how many calories should a person consume during the acute phase of TBI healing? Why?
40% more calories
Metabolic needs increase significantly following a moderate to severe injury as the body works to heal the brain
What is diabetes insipidus and how is it treated?
Occurs when too little vasopressin is produced and the person produces significantly more urine leading to increased thirst.
Treated with increased fluid and desmopressin
Syndrome of inappropriate anti diuretic hormone (SIADH)
Caused by changes to the hypothalamus or certain medications
Blood sodium level is low and urine is not concentrated
Symptoms: nausea, vomiting, irritability, confusion, seizures, coma
**fluid restriction
Metabolic syndrome
Combination of medical disorders that increase the risk for both cardiovascular disease and diabetes.
Marked by abdominal obesity, insulin resistance, HTN, and dyslipidemia
Affects 40% of adults over 60
What is the frequency of UTI after brain injury?
60% experience UTI within the first 6 weeks after TBI
What percent of brain injury patients report sleep disorders?
30-70% of TBI patients
Post traumatic hypersomnia
Excessive sleepiness that occurs as a result of traumatic event involving CNS; daytime sleepiness; cognitive and physical fatigue
What is the treatment for insomnia?
Treatment includes:
Lifestyle changes, exercise, reg sleep schedule, avoiding naps, limiting fluid before bed, and decreasing caffeine
What is the reported occurrence of post traumatic seizures and what are the three categories?
4-53%
3 different categories of seizures
Immediate post traumatic convulsions (IPTC)
Early post traumatic seizures (EPTS)
Late post traumatic seizures (LPTS)
Immediate post traumatic convulsions (IPTC)
+LOC and involuntary movement within seconds of impact
Non epileptic events that are more likely passing out
Brief period of tonic positioning followed by clonic or myoclonic jerks of less than 2-3 min
Altered state of consciousness with associated retrograde and anterograde amnesia
Brief traumatic functional decerebration- loss of cerebral brain function
Early post traumatic seizures (EPTS)
Occur within 1st week (up to 7 days) following brain injury
Result from primary direct effects of trauma
Incidence report: 2-10% and can occur in mTBI
50% occur within 24hrs of impact; 25% 1st hr
Strong risk factor for LPTS
Status epilepticus
Seizure that lasts longer than 5 minutes or seizures that occur close together without recovery between seizures; common in children
Late post traumatic seizures (LPTS)
Occur later than 1 week post injury , but usually within the first 18-24 months (has been reported later)
Interchangeable with post traumatic epilepsy as the occurrence of one seizure likely leads to more
Common in 65+
Post traumatic headache (PTH)- when does it start and how prevalent is it?
Starts within 14 days of LOC
More prevalent in mTBI (95%) in comparison to 22% of mod-severe reporting pain
Most common type of headache reported by all TBI pts?
Migraine
Peripheral nocioception
Peripheral receptors in the head and neck which are very sensitive to pain
Located on the ends of nerves that initiate near the spinal cord and communicate back to pain centers in the brain
Those involved with post traumatic headache:
CN 5 trigeminal, CN 9 glossopharyngeal, CN 10 vagus nerve, greater occipital nerve, lesser occipital nerve
Primary headache
No specific cause
Secondary headache
Identifiable cause that can be determined
Chronic headache
Occurs at least 15 days per month for at least 3 months, not linked to overuse or withdrawal of medication
What is a tension type headache?
How is it treated?
Most common form of primary headache
Presents with bilateral pressing head pain
Do not worsen with activity and patients do not present with other symptoms
Treatment- Non-steroidal anti-inflammatory drugs or aspirin or acetaminophen
Long term- low load craniocervical mobilization, botulinum toxin, antidepressants, anticonvulsants
Migraine headache
usually affects one side of the head, are throbbing, and worsen with physical activity, associated nausea or vomiting
Cervicogenic headache
Pain generated from the cervical spine; treatment- nerve injections, severing nerves
Craniomandibular headache
Subtype of tension headache that causes pain in jaw with eating and talking
Treatment- bite blocks, diet changes, surgery
Which cranial nerve plays a role in the pathophysiology of headaches?
CN5 trigeminal
What are the 4 phases of migraine?
Prodrome- early symptoms
Aura
Headache
Postdrome- other symptoms following the headache
Having low sodium levels is a risk for _______.
Seizures
Neuralgia
Type of pain that is caused by damage or change to a nerve
Neuroma
Nerve becomes entrapped in scar tissue
C-O-L-D-E-R Acronym- Headache review of systems
Character: throbbing, sharp, dull etc & severity
Onset: does anything set off the headache? Prior hx of headaches, migraines, neck pain, or other related pain involving the head
Location: one side of the head, or both? Front or back? Start in neck? Shooting or radiating?
Duration/freq: when did it start and how often?
Exacerbation: anything that makes it worse?
Relief: does anything help to relieve/resolve the headache?
What are complications with functions of elimination after TBI? How treated?
Urinary or fecal incontinence, urinary tract infections
Treatment- suprapubic or foley catheter, timed voiding, anti-cholinergics
Dysphagia Level 4 (National Dysphagia Diet Level)
Regular diet, all foods as tolerated
Why are tube feedings important?
provide hydration and calories to promote their metabolism and overall health
What is the treatment for pressure sores?
keep skin clean and change positions every two hours, use of pressure relieving devices;
Oral antibiotics, antifungal creams
Periodic limb movement disorder
periodic episodes of repetitive and highly stereotyped limb movements during sleep
What is the preferred initial medication for aborting a migraine?
AAC- aspirin, acetaminophen and caffeine
