TBI #2

Question 1

Normal ICP

Answer 1

5-10 mmHg

Question 2

Abnormal ICP

Answer 2

greater than 20 mmHg

Question 3

What activities can increase ICP?

Answer 3

Cervical flexion, percussion & vibration, coughing

Question 4

Signs and symptoms of ICP:

Answer 4

Decreased responsiveness, impaired consciousness, severe HA, vomiting, irritability, papilledema, ↑d BP & ↓d HR

Question 5

How much oxygen does the brain demand?

Answer 5

20% of body’s oxygen

Question 6

Areas vulnerable to lack of oxygen

Answer 6

Hippocampus (Memory storage area)
Cerebellum
Basal Ganglia

Question 7

Seizure:

Answer 7

discrete clinical event reflecting temporary, physiologic brain dysfunction, characterized by excessive hypersynchronous cortical neuron discharge

Question 8

Events that trigger seizures:

Answer 8

Stress, poor nutrition, electrolyte imbalances, missed mediations or drug use, flickering lights, infection, fever, worry, and fear

Question 9

GCS mild:

Answer 9

13-15

Question 10

GCS moderate:

Answer 10

9-12

Question 11

GCS severe:

Answer 11

less than 8

Question 12

Stage 1 of Recovery Stages from Diffuse Axonal Injury

Answer 12

coma

Question 13

Stage 2 Recovery Stages from Diffuse Axonal Injury

Answer 13

Unresponsive Vigilance/vegetative state

Question 14

Stage 3 Recovery Stages from Diffuse Axonal Injury

Answer 14

Mute responsiveness/minimally responsive (pt. is not vegetative and DOES show signs, even if intermittent, of fluctuating awareness

Question 15

Stage 4 Recovery Stages from Diffuse Axonal Injury

Answer 15

Confusional State (disturbance of attention mechanisms; all cognitive operations are affected, patient is unable to perform new memories. Can have hyper/hypo arousal)

Question 16

Stage 5 Recovery Stages from Diffuse Axonal Injury

Answer 16

Emerging Independence (confusion is clearing and some memory possible, significant cognitive problems and limited insight, socially uninhibited)

Question 17

Stage 6 Recovery Stages from Diffuse Axonal Injury

Answer 17

Intellectual/Social Competence (increasing independence, although cognitive difficulties (problem solving, reasoning) persist along with behavioral and social problems)

Question 18

Stage 7 Recovery Stages from Diffuse Axonal Injury

Answer 18

Patient can plateau at any stage or regress under conditions of stress or repetitive brain injury

Question 19

What does Glascow Coma Scale measure?

Answer 19

Pupillary response
Motor activity
Ability to verbalize

Question 20

Arousal

Answer 20

Primitive state of being awake or alert

Reticular activating system is responsible for level of arousal

Question 21

Awareness

Answer 21

Conscious of internal & external environmental stimuli

Question 22

Consciousness

Answer 22

State of being aware

Question 23

Coma

Answer 23

State of decreased level of awareness; Usually not > 3 weeks
State of unconsciousness in which the patient is neither aroused nor responsive to the internal or external environments (Rappaport et al., 1992)
Eyes are closed
Unable to initiate voluntary activity
Sleep & wake cycles cannot be distinguished on EEG

Question 24

Vegetative State

Answer 24

Return of brainstem reflexes, sleep-wake cycles but remains unconscious
May experience periods of arousal & spontaneous eye opening without tracking

Question 25

Persistent Vegetative State

Answer 25

A vegetative state for a year or longer

Question 26

Stupor

Answer 26

Condition of general unresponsiveness

Question 27

Obtundity

Answer 27

Occurs in individuals who sleep a great deal of time

Question 28

Delrium

Answer 28

Characterized by disorientation, fear, and misperception of sensory stimuli

Question 29

Clouding of Consciousness

Answer 29

State of being confused, distracted and having poor memory

Question 30

LOCF I

Answer 30

No Response

deep sleep, unresponsive to any stimuli

Question 31

LOCF II

Answer 31

Generalized Response
patient reacts inconsistently and nonpurposefully to stimuli in a nonspecific manner. Response may be physiological changes, gross body movements and or vocalization

Question 32

LOCF III

Answer 32

Localized Response
patient reacts specifically but inconsistently to stimuli. Responses are directly related to type of stimuli. May follow commands (closing eyes) in an inconsistent, delayed manner

Question 33

LOCF IV

Answer 33

Confused-Agitated
heightened state of activity. behavior is bizarre and nonpurposeful. Does not discriminate among persons or objects; unable to cooperate directly with treatment efforts. Verbilizations are incoherent/inappropriate. Confabulation maybe present. Lacks short term and long term recall. Gross attention brief, selective attention nonexistent

Question 34

LOCF V

Answer 34

Confused-Inappropriate
able to respond to simple commands consistently; increased complexity of commands responses nonpurposeful, random. Gross attention highly distractable, lacks ability to focus on a specific task. Maybe able to converse on social level for short periods of time. Verbalization often confused and confabulatory. Memory impaired.Unable to learn new information

Question 35

LOCF VI

Answer 35

Confused-Appropriate
shows goal oriented behavorior but dependent on external input or direction. follows simple directions consistently and shows carry over. Responses maybe incorrect due to memory problems, but are appropriate to situation

Question 36

LOCF VII

Answer 36

Automatic-Appropriate
Appears appropriate and oriented, goes thru daily routine automatically, but frequent robot-like. Shows minimal confusion and shall recall of activities. Carry over for new learning, but at decreased rate

Question 37

LOCF VIII

Answer 37

Purposeful-Appropriate
able to recall and integrate past and recent events, aware and responsive to environment, shows carryover. may show decreased ability relative to premorbid abilities, abstract reasoning, tolerance for stress ad judgement in emergencies or unusual circumstances.