Lecture 6, management of moderate brain injury

Question 1

What levels of rancho are a moderate brain injury

Answer 1

4, 5 ,6

Question 2

How will these patient’s (mod brain injury) cognition present

Answer 2

decreased command following

memory loss

orientation/confusion

decreased attention

poor abstract thinking

lack of insight

reduced problem solving and executive functioning

Question 3

how will these patient’s present w/ behavior and personality

Answer 3

agitation

aggression

disinhibition

impulsiveness

perservation

decreased judgement

reduced insight to deficits

sexual inappropriateness

Question 4

What rancho level patient will over-react to stimuli (cry, hit, scream, abusive language, need to be restrained)

does not discriminate among people or objects

brief nonselective attention

lack of short/long term recall

Answer 4

confused agitated

Level 4

Question 5

Definition of Agitation

Answer 5

subtype of delirium in which individual is in state of post traumatic amnesia. Excessive behavior that include some combination of aggression, akathisia, disinhibition, emotional lability

Question 6

What does the Galveston Orientation and Amensia Test (GOAT) measure?

Answer 6

determines the length and severity of post traumatic amnesia

greater than or equal to 75+ on 3 consecutive tests

Question 7

What does the O-Log (orientation log) measure

Answer 7

measures orientation to time, place, circumstance

Question 8

Post Traumatic Amnesia ratings

Answer 8

Under 5 min - very mild

5 min to 60 mins - mild

1-24 hours - moderate

1-7 days - severe

1-4 weeks - very severe

over 4 weeks - extremely severe

Question 9

How is the agitated behavior scale scored?

Answer 9

14 items

21 or below: behavior normal

22-28: mild occurence

29-35- moderate

35+ severe agitation

Question 10

What does the MARS (Moss Attention Rating Scale) rate?

Answer 10

Attention-related behavior after TBI

Higher score = better attention

Question 11

Should you tie a patient’s wrist down who has motor restlessness and agitation

Answer 11

no they have to be free to move and expend their energy, in a safe way

Question 12

How do you get a patient to stop pulling your hair

Answer 12

Don’t pull away, try to hold their hand and stay close so they cannot pull it out…

Try to distract them and they will let go because their attention span is short

Question 13

Can a rancho 5 patient become violent?

Answer 13

Yes, patients can fluctuate up and or down levels

Question 14

It is appropriate to give patients an outcome measure where they will score a 0.

example: BERG of a 0

Answer 14

yes you can still administer them and its helpful to show progress over time