Medical and Physical Complications Flashcards
orthostatic HTN, aspiration pneumonia, and DVT are what kinds of brain injury complications?
chronic cardiopulmonary issues
DVT = deep vein thrombosis
dysautonomia
aka autonomic storming, sympathetic storming, autonomic dysreflexia
occurs generally at GCS 3-8, usually resolves in early recovery
a patient presents with HR 69, BP 140/85, respiration 18 breaths per minute. Which vital sign is abnormal?
HR: 60-90 bpm
BP: 100/65 - 137/84 (this is high in patient presenting)
respiration: 12-20 breaths per minute
heterotopic ossification
abnormal bone growth in soft tissue adjacent to joints
involuntary exaggerated deep tendon reflexes
hyperreflexia
involuntary increased muscle tone
spasticity
contractures
abnormal, usually permanent condition of joints - often in flexed position, fixation due to wasting away/shortening of muscle fibers and loss of skin elasticity
what interventions can be used for spasticity and contractures that are secondary to brain injury?
exercise, casting, e-stim to improve flexibility and tone, oral anti-spasticity meds, nerve blockers, botox, surgically implanted baclofen pump
why might a surgically implanted baclofen pump be used following a TBI?
to treat musculoskeletal complications of spasticity/contractures
T/F: metabolism decreases following mod-severe brain injury
FALSE: metabolism increases (~40% more calories)
G-tube vs J-tube
G-tube: surgically placed into stomach or small bowel
J-tube: through skin of abdomen into midsection of small intestine
pulmonary/ lung aspiration
breathing in foreign substance (food, liquid, mucus, medicine, saliva, etc)
can lead to choking or aspiration pneumonia
describe the 3 phases of swallowing
1: oral preparatory stage - mastication, bolus formation, propulsion of bolus into pharynx
2: pharyngeal phase - bolus passes epiglottis and upper esophageal sphincter. tongue blocks oral cavity, epiglottis blocks larynx, soft palate blocks nasal cavity
3: esophageal phase - bolus moves towards lower esophageal sphincter
compare level 1 dysphagia diet to level 3
level 1 dysphagia requires pureed food (nothing that requires bolus formation)
level 3 dysphagia allows all food except hard, sticky, crunchy
cause of and medication to treat diabetes insipidus
diabetes insipidus due to decreased vasopressin (ADH) –> decreased fluid levels
treat with desmopressin
pressure sores and how to prevent them
areas of bony prominence (shoulders, elbows, lower back, hips, etc)
prevent by keeping skin clean/dry, changing position every 2 hours, using pressure-relieving devices (mattresses, cushions, tilt-in-space wheelchairs)
what are the stages of pressure ulcers
stage 1: intact skin
stage 2: skin breaks open
stage 3: deep wound, full thickness tissue loss, subcutaneous fat may be visible
stage 4: very deep tissue loss, exposed bone/tendon/muscle
unstageable: full thickness tissue loss, but actual depth of ulcer is obscured by slough or eschar in wound bed
deep tissue injury: discolored intact skin or blood-filled blister, area around may be warmer or cooler
immediate post-traumatic convulsions (IPTC)
occur within moments of injury, considered to represent non-epileptic events, associated with low risk for recurrent seizures
T/F: EPTS do not increase risk of secondary brain damage
FALSE: early post-traumatic seizures (1 week or earlier AI) are a strong risk factor for development of late post-traumatic seizures (LPTS). Detection and treatment of EPTS is necessary to minimize potential secondary brain damage
missile wounds, bilateral or multiple contusions, and multiple craniotomies are the strongest risk factors of (EPTS/LPTS)
late post-traumatic seizures
LPTS are a strong predictor of recurrent seizures
status epilepticus
seizures that last longer than 5 minutes, seizures so close together that person cannot recover in between
high mortality risk
benzodiazepine is the first line of treatment (tx), provides rapid seizure control
what is benzodiazepine used for
first line of treatment for rapid seizure control (esp. status epilepticus)
phenytoin
anticonvulsant, antiepileptic prophylaxis for adult patients with severe TBI, given for 7 days to decrease risk of early post-traumatic seizures
T/F: continuing antiepileptic prophylaxis such as phenytoin, carbamazepine, or valproate beyond the first week AI has been shown to decrease risk of LPTS
FALSE
what are the two most common pain pathways in persons with TBI, and compare their respective pharmacological approaches
nociceptive pain - due to damage to tissue, pain related to peripheral nerve fibers. Treat with NSAIDS (aspirin, ibuprofen, naproxen), acetaminophen, anti-spasticity meds, opioids
neuropathic pain - damage to nerves (primary lesion). Treat with opioids, tramadol, anticonvulsants, antidepressants (including tricyclics), nerve blocks
which of these interventions would NOT be effective for managing neuropathic pain? opioids Lyrica anticonvulsants NSAIDS tricyclics/antidepressants epidural steroids
NSAIDS (useful for nociceptive pain)
criteria of chronic headache
occurs at least 15 days per month for at least 3 months
tension type headache (TTH)
bilateral head pain that feels like pressing/clamping
occurs from either neck or head muscle strain/injury
does not get worse with physical activity
does not present with hypersensitivity
treat with NSAIDs/ acetaminophen, antidepressants, botox
which of these is TRUE:
tension type headache worsens with physical activity
tension type headache does not present with hypersensitivity
TTH does not worsen with physical activity, does not present with hypersensitivity
craniomandibular headache is a subtype of ___
craniomandibular headache is subtype of tension type headache, associated with temporal mandibular join
cervicogenic headache diagnosis method and treatment?
defined as head pain from cervical spine
clinical diagnosis made by nerve block or provoking the headache by manipulation
treat with nerve injections (short term) or burning nerves to severe (long term)
T/F: migraines are usually bilateral
FALSE: migraines usually affect only one side (but not always). usually in back of head
4 phases of migraines
prodrome - food cravings, mood changes
aura - numbness, tingling, vertigo
headache - peaks 24 h
postdrome - similar to prodrome
tricyclic antidepressants (serotonin re-uptake inhibitors), topiramate (inhibits trigeminal nerve), beta-blockers, and calcium channel blockers are all preventative medications for ____
migraines
obstructive/ non-communicating hydrocephalus
obstruction/ blockage of CSF causing increased pressure (increased CSF in ventricles)
hydrocephalus ex-vacuo
brain tissue causes neuronal loss, brain tissue shrinkage, brain atrophy, but pressure is usually normal
spasticity as motor disorder is due to damage to (UMN/LMN)
UMN
heterotrophic ossification
formation of new bone around joints as consequence of trauma/ immobility
Heparin
anti-coagulant
can be used as prophylaxis to DVT
T/F: pulmonary embolism is the 3rd leading cause of death in those who survive first day of brain injury
TRUE
damage to corpus callosum can cause this kind of coordination disorder
interlimb coordination
damage to cerebellum can cause this kind of coordination disorder, affecting voluntary movements and decreasing coordination
ataxia
athetoid
slow, involuntary, convoluted writhing movements in fingers, toes, hands, feet
choreiform
continuous, rapid, unpredictable movements
anosognosia
deficit of awareness
somatognosia
unaware of a body part
apraxia
deficit in motor planning
diplopia
double vision
paraplegia vs tetraplegia
paraplegia - trunk/legs/pelvic organs paralyzed (SCI)
tetraplegia - arms, hands, trunk, legs, pelvic organs paralyzed (SCI)
what are the 3 levels of disorders of consciousness (DOC)
coma –> vegetative –> minimally conscious
criteria for emergence from DOC (disorder of consciousness)
must meet 1 of 2 behavioral criteria: functional communication (verbal/gestural answer to yes or no question) OR functional use of 2 or more objects (cup, toothbrush, etc)
a patient is unconscious for an extended period of time. They should spontaneous or stimulus-induced eye opening (due to sleep/wake cycle) and grimace to pain. Are they in a coma or vegetative state?
vegetative state
in coma there is no eye opening or behavioral signs of awareness
T/F: patients in minimally conscious state display spontaneous eye opening due to sleep-wake cycle
TRUE
Visual Analogue Scale for Fatigue
assesses fatigue and energy at a single point in time
Fatigue Severity Scale
assesses impact of fatigue on daily function using 7 point scale
periodic limb movement disorder
sleep disorder characterized by periodic episodes of repetitive and highly stereotyped limb (usually leg) movements during sleep
