III. Medical and physical Issues (EBIG 5, 6, 7, 9) 12%

Question 1

what is autonomic storming?

Answer 1

disruption in heart rate, blood pressure, temperature, as well as muscle overactivity, posturing, dystonia, rigidity and spasticity

aka dysautonomia

Question 2

Describe DVT/PE in r/t TBI

Answer 2

incidence is as high as 54%

complications of DVT can result in pulmonary embolism and death

Results from immobility or paralysis and prophylaxis should be started immediately including elastic compression stockings, intermittent pneumatic compression, vena cava filters, and medications

Question 3

Describe bladder issues in r/t TBI

Answer 3

associated with the presence of bilateral central lesions as well as poor functional status

Most commonly, the affected individual may have altered bladder sensation, less capacity, more sense of urgency, and greater frequency, resulting in incontinence

often includes difficulty with the ability to attend to bladder-filling stimulus as well as the inability to empty the bladder d/t poor tone or tight bladder sphincter activity

Question 4

what are signs of UTI

Answer 4

frequent/painful urination

fever

possibly increased agitation

possibly decreased level of alertness

Question 5

what body systems are affected by brain injury?

Answer 5

cardiopulmonary & vascular

muskuloskeletal

elimination

gastrointestinal

metabolic and endocrine

reproductive

skin

infection

sleep

neurological

Question 6

How is the cardiopulmonary system affected by TBI?

Answer 6

can occur immediately, chronically, or emerge as late complications

associated with increased mortality and morbidity

Question 7

what are chronic cardiopulmonary issues r/t TBI?

Answer 7

orthostatic hypotension

aspiration PNA (2’ dysphagia)

DVT

Question 8

how is the metabolic/endocrine system affected by people s/p TBI?

Answer 8

may present with:

• metabolic syndrome
• hypothalamic-pitutiary changes
• growth hormone dysfunciton-
• hypopituitarism
• gonadotropin deficiency

**These problems tend to be diagnosed a year o more post-injury and occur in up to 30% of individuals with MOD-SEV TBIs

Question 9

disruption the reproductive system may be caused by

Answer 9

migraines and may require hormone replacement therapy

Question 10

what are common skin problems s/p TBI?

Answer 10

wounds

abrasions

lacerations

pressure sores

Question 11

how can pressure sores be prevented?

Answer 11

keeping skin clean and dry

changing positions q2hrs

using pressure-relieving devices including: specialty mattress, cushions, and til-in-space wheel chairs

Question 12

when are individuals with TBI most susceptible to infection?

Answer 12

when they have open wounds, use in-dwelling devices, or are immunosuppressed

Question 13

what are neurologic complications s/p TBI?

Answer 13

seizures, Pain, headaches

Question 14

after a TBI, how much m ore likely are individuals more likely to die of a seizure disorder than that of the general population?

Answer 14

22x more likely

Question 15

what is the occurrence of post-traumatic seizures:

Answer 15

4-53%

Question 16

what are seizures caused by?

Answer 16

an abnormal, disorderly discharge of activity in the nerve cells of the brain

Question 17

what is the definition of status epileptics?

Answer 17

includes seizures that last too long (>5 miles) as well as those so close together that the person does not recover from one before another begins

status epileptics carries a high mortality rate

Question 18

describe seizure first aid

Answer 18

Do not force any object into the person’s mouth or try to hold the tongue

Clear the environment of harmful objects

Ease the individual to the floor to prevent injury from falling

Turn the person to the side to keep the airway clear and allow saliva to drain from mouth

Put something soft under the head and along bedrails, if in bed

Loosen tight clothing around the neck

Do not attempt to restrain the person

Do not give liquids during or just after the
seizure

Continue to observe the person until fully alert, checking vital signs such as pulse and respirations periodically

Give artificial respiration if person does not resume breathing after seizure

For Status Epilepticus call 911 within 3-5 minutes or based on physician recommendations

For Seizures that are prolonged or different than a person’s normal baseline seizure, call 911

Question 19

what are the 3 types of post traumatic seizures

Answer 19

immediate post-traumatic convulsions

early post-traumatic seizures (within the first week)

late post-traumatic seizures