TBI Flashcards

1
Q

how is TBI different from stroke

A

similar that it has neuromuscular deficits

diff bcs of cognitive and behavior deficits

neuromuscular
cognitive
behavior

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2
Q

what are the neuromuscular impairments in TBI

A

abnormal tone and gait - spasticity

sensory impairments

motor function

impaired balance

paresis

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3
Q

secondary impairments of TBI

A

atrophy

DVT

heterotrophic
ossification

pneumonia

fx

contractures

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4
Q

cognitive impairments of TBI

A

altered LOC

memory loss

altered orientation

attention deficits

impaired insight and safety

problem solving/reasoning impairments

perseveration

impaired executive functioning

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5
Q

behavioral impairments of TBI

A

disinhibition

impulsiveness

physical and verbal aggressiveness

apathy

lack of concern

sexual inappropriateness

irritability

egocentricity

impaired drive

dyscontrol

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6
Q

goals of acute care

A

improve respiratory function and prevent complication

prevent 2° brain damage

preserve MSK integrity

facilitate arousal and active engagement

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7
Q

how does one improve respiratory function

A

bed mob and GBRE

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8
Q

interventions if pt has hypoventilation and impaired mucociliary clearance

A

tapping and cupping if s chest tube

ankle pumps

make pt rest

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9
Q

interventions if pt has hyperventilation

A

brown bag technique to dec CO2

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10
Q

interventions if pt has ventilation/perfusion mismatch

A

alter position

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11
Q

indications for ventilation

A

PaO2 < 60 mmHg - hypoxemia

PaCO2 > 45 mmHg - hypercapnia

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12
Q

exp how inc ICP causes 2° brain damage

A

inc ICP = dec CPP since too much pressure in brain causes dec BF bcs more pressure is needed to supply

hence causing cerebral ischemia

inc ICP also inc BP = dec HR to reduce BP but irregular breathing will occur

dont control ICP padin more dec of BP para pababain = dec CPP = coma

cerebral hypoxia –> cerebral edema

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13
Q

how to control inc ICP

A

GBRE then monitor vitals

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14
Q

interventions in preventing MSK injury

A

PROM, stretching

positioning

serial casting

GBRE

sitting and standing

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15
Q

sitting and standing in TBI is only allowed if

A

voluntary control of breathing

no severe chest injury

no chest tube

no femoral/pelvic fx

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16
Q

benefits of upright position

A

bowel and bladder emptying

improved ventilation

dec ICP since inc CVR

17
Q

parameters in facilitating arousal and active engagement

A

timing - do interv when pt is most awake

family involvement, educ and counseling

limited carry over of training

re-establish: swallowing, breathing, coughing, comms

18
Q

LOCF 1-3

A

prevent contractures and tightness

improve arousal through sensory stim - talking, movement

manage spasticity - inhibitory techniques

early sitting - GBREs

educate family

monitor response

19
Q

early indicators of good prognosis

A

high GCS score

younger age

PLR

hypotension

CT scan - onti lng damage

20
Q

LOCF 4

A

maintain function s triggering patient

can do strengthening pero wag dumbells

use:
- isolation
- calm behavior
- consistency
- negative reinforcement
- flexibility
- safety measures
- fam educ

expect:
- no carry over
- egocentricity
- aggressive and inappropriate actions

21
Q

LOCF 5-6

A

rely heavily on routines - OC
- PT should not change; exercise should not change
- change = aggression

maximize functional recovery - compensatory approach or rehab approach

tasks progressed gradually

22
Q

LOCF 7-8

A

get them out of routine

community, social and daily living skills

involve pt in decision making and problem solving

more self monitoring

challenging tasks

endurance training

23
Q

how to manage cognitive and behavioral deficits

A

dont change environment and dont add stressors

proper positioning

24
Q

frontal pattern behavior is common in

A

coup injury

25
how to manage communication problems
be patient pertinent cues focus pt attention simplify language isolation use of natural context cues redirecting agitated behavior
26
unable to learn new info
RLA 1-5
27
carry-over for relearned tasks with little or no carry-over for new tasks
RLA 6
28
carry-over for new learning but decreased rate
RLA 7
29
carry-over for new learning and needs no supervision once activities are learned
RLA 8
30
decision making process in choosing a task
should be suitable not too complex and not to easy
31
discuss managing dysfunction
problem in ADLs for RLA 7-8 multiple steps and pwede group sessions simulation
32
compare antecedent and consequence focused
antecedent - warn lang of what u do if bad cla consequence - do the consequence; get out of room gnun
33
strategies for dec behavior
withhold rewards that maintain bad withhold positive reinforcement after bad apply penalty for bad stim control systematic desentisization extincition
34
strategies for inc behavior
reward good prompting chaining expanding rehearsal
35
how to manage incontinence
do not make them feel ashamed pt educ wiwi na before Tx
36
how to manage post-traumatic epilepsy
risk w/in 12 mo. post injury during attack - floor if exercising - put rails up onbed and surround c pillows - pull curtain on ward after attack - tell pt what happened - simple activities - dont put spoon in mouth