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Neuromuscular (KK) > exam 3: severe TBI > Flashcards

exam 3: severe TBI Flashcards

1
Q

to be classified as a severe TBI:
- GCS score is:
- Post-traumatic amnesia (PTA) O-log score ____ for _____days
- loss of consciousness:

A
  • 3-8
  • < 25 for > 7 days
  • > 24 hours
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2
Q

Glasgow Coma Scale includes 3 subdivisions which are ?
a lower score indicates:

A

eye opening, best motor response, and verbal response
- more severe

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3
Q

unable to remember events on an ongoing basis for a period of time after the traumatic event.
results in confusion and disorientation.

A

post-traumatic amnesia (PTA)

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4
Q

______ amnesia = loss of events before the injury
_____ amnesia = loss of events after injury

A

retrograde
anterograde

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5
Q

the Galveston Orientation and Amnesia Test (GOAT) assesses ______ and ______ in patients who have had a _______ ____

A

PTA and retrograde amnesia (RA) ; severe TBI

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6
Q

a score of ______ on the GOAT = PTA

A

< 75/100

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7
Q

levels of consciousness:
- complete absense of arousal or awareness
- arousal without awareness
- minimal, reproducible, but inconsistent awareness

A
  • coma
  • vegetative state
  • minimally conscious state
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8
Q

describe the following Rancho levels:
- I
- II
- III

A
  • no response: patient in deep sleep, unresponsive to any stimuli
  • generalized response: patient reacts inconsistently and non-purposefully to stimuli in a non-specifc manner
  • localized response: patient reacts specifically but inconsistently to stimuli, may follow simple commands in an inconsistent delayed manner
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9
Q

imaging for TBI
- initially:
- 24-48 hours later:

A
  • CT head
  • MRI of brain for higher sensitivity or if CT initially negative
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10
Q

what is one of the more common types of severe TBI and how does it often happen?

A

Diffuse axonal injuries –> microscopic injury, often misdiagnosed or undiagnosed
most common in the acceleration/deceleration mechanism of injury (high-speed MVAs)

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11
Q

what might you gather from a patient’s history of someone with a severe TBI?

A
  • arousal, consciousness, and behavior limitations (perform in low stim closed environment or rely on family members)
  • PLOF and CLOF
  • co-morbidities
  • consult with RN prior to eval
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12
Q

what are indications that you would not treat the patient?

A
  • ICP >20 mmHg
  • MAP < 60mmHg
  • CPP <60 mmHg
  • SpO2 < 90%
  • vent settings too high
  • vitals outside treatable limits
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13
Q

what are the 3 appropriate outcome measures to test arousal/attention/cognition in a TBI pt?

A
  • coma recovery scale
  • moss attention rating scale
  • rancho levels of consciousness scale
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14
Q

Coma recovery scale:
- higher score = ____
- recommended for ______

A
  • increased consciousness
  • all disorders of consciousness
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15
Q

MARS:
- measures:
- ________ damage affects attention
- what do you need to be careful of when using this rating scale?

A
  • attention related behaviors after TBI
  • frontal lobe
  • some items are flipped (positives vs. negatives)
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16
Q

what elements make up a neuromuscular screen for a TBI patient?

A
  • passive motion testing –> tone
  • motor exam
  • sensory exam
  • reflexes
17
Q

what are the two primary considerations when doing a cardiopulm screen on a TBI patient?

A
  • ICP under 22mmHg (under 20 is ideal)
  • CPP between 60-70 mmHg
    CPP = MAP-ICP
18
Q

what do you screen for in a MSK screen?

A

heterotopic ossification
contracture risk

19
Q

what is heterotopic ossification?

A

the abnormal development of bone in areas of soft tissue

20
Q

HO occurs in _______% of adult patients with TBI

A

10-20%

21
Q

early symptoms of HO appear as _________ and can lead to _____

A

inflammatory
contractures, pressure injuries, impaired mobility

22
Q

what are the two things you screen for in an integumentary screen with a TBI patient?

A

wounds (from accident)
pressure ulcers (from immobility)

23
Q

what do you check in a GI/GU screen in a TBI patient?

A

foley catheters
fecal management systems
overactive or neurogenic bladder

24
Q

when examining a patient, you find abnormal posturing, sensorimotor impairment, and synergy patterns present. You forgot to chart review before seeing the patient. Based off their presentation, what are two diagnoses you are debating?

A

stroke and TBI –> can have similar examination findings!

25
Q

what are two important considerations when forming interventions for a severe TBI patient?

A

patient’s available resources (family support, PLOF, CLOF)
attainable goals (DC plan)

26
Q

what is PTs role in the acute phase with TBI patients?

A

early mobilization
prevent compensations and learned helplessness
monitor patient’s status and VS

27
Q

to increase stimulation provide ____ ______ –> what is it? give examples

A

sensory stimulation: used to increase level of arousal and elicit movement in those with low levels of arousal
- upright interventions
- hand over hand
- auditory
- nail bed pressure

28
Q

to decrease stimulation limit ____, ____, and ______

A

touch, sound and visual stimulus

29
Q

______ and _____ change increase arousal due to the ______ _____ system.
–> to do this, start by ________

A

vestibular and positional ; reticular activating system
–> raising HOB

30
Q

the HOB should never be below _____ degrees in a TBI patient for ICP purposes

A

30 deg

31
Q

what type of wheelchair is a great option to get a TBI patient upright?
–> why?

A

tilt-in-space
tilt for pressure relief moving pressure from ischials to sacrum

32
Q

to prevent contractures and promote function at all major joints, what would be a good intervention?

A

PROM

33
Q

what is serial casting?

A
  • joint immobilized at end-range for 2-5 days at a time
  • cast is removed and further stretching is performed and new cast is set with new ROM
  • repeat until significant gains in ROM are achieved
34
Q

serial casting does not improve ______ but rather it can improve ____

A

spasticity
muscle tissue length

35
Q

what are contraindications of serial casting?

A

risk of skin breakdown
monitor distal to cast for swelling or circulation problems

36
Q

explain how positioning can be used as a type of intervention for TBI patients.

A
  • wounds: “turning” schedule, off weight pressure areas
  • contractures: influence of hypertonicity (prevent certain positions)
  • cardiopulm considerations: BP management and pneumonia prevention
37
Q

what are some things to teach the family or caregiver how to manage?

A

stimulation schedule
splinting schedule
PROM
turning schedule
equipment use
bowel/bladder management
body mechanics

38
Q

what is the most appropriate discharge location from acute care for a TBI patient?

A

LTACH

39
Q

*** case study at end of lecture

A

Neuromuscular (KK) (21 decks)

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