TBI - 3a TBI Acute Management Flashcards by Jenn Cantilli

what are 6 negative influences on prognosis

coma >1wk
PTA >4wks
inc ICP, sz
DAI, hypoxic/anoxic injuries
delayed access to med care
unchanged GCS/RLA 4wks

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what are 4 positive influences on prognosis

support of fam/friends
early improvement in cog
access to specialized rehab
ed/vocational opportunities

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why is the support of family and friends a positive influence on prognosis

salient perspective for motivating pts

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why are many TBIs medically sedated acutely

give time to dec ICP and to stabilize them hemodynamically and metabolically

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what should the ICP be acutely

0-15mmHg

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how is the cerebral perfusion pressure (CPP) calculated

MAP - ICP

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what are the norms for CPP

60-90mmHg

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what can an ICP >20mmHg mean

red flag
- can lead to herniation and bleeding

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what are common surgeries for an acute TBI (4)

decompression
drainage/ventricular shunt
remove foreign object
repair MS/integ issues

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what are common meds for acute TBIs

sedation
mannitol
barbituates
anti-sz meds

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what is a main goal of acute med management for a TBI

cardiopulm stabilization

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what are the main things to screen in an ICU assessment (8)

use the CRS-R as a guide

evidence of posturing
EO or EC
track auditory/visual stim
vocalize
active movmt- purposeful?
tactile/painful stim
VS change w external stim
tone

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what are s/sx of autonomic dysfunction

**HTN
**tachycardia
hyperthermia
diaphoresis
inc spasticity
dystonia
**ext posturing
pupil dilation
vomiting

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what are 2 other terms synonymous w autonomic dysfunction

storming
sympathetic storming

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how can autonomic dysfunction present

recurrent and episodic

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what is autonomic dysfunction and what is it caused by

exaggerated response to noxious external stim
- ie bed sore, catheter, positioning

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what is the immediate response to autonomic storming

let nurse know
- can be managed w meds (IV)
try to identify and remove external stim

family ed on what to avoid

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what are ex of primitive reflexes that may return

ATNR
STNR

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what sz activity can be seen

partial - simple vs complex
generalize
- absent vs tonic clonic

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what are changes in ms tone that can be seen

hypotonicity
spasticity
rigidity
- decorticate
- decerebrate

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decorticate vs decerebrate posturing: presentation and cause

decorticate
- flex UEs, ext LEs
- lesion above upper brainstem

decerebrate
- ext of UEs and LEs
- lesion in brainstem below superior colliculus

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what are 6 NM/sensory clinical manifestations of acute TBIs

motor control
sensation
proprioception/kinesthesia
coordination
motor planning
ms atrophy

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what are 3 cognitive clinical manifestations of acute TBIs

attention and memory
problem solving, resolving, and judgment
lack of initiation

what are 3 memory clinical manifestations of acute TBIs

post traumatic amnesia (PTA)
retrograde amnesia
anterograde amnesia

what are 4 emotional clinical manifestations of acute TBIs

lability depression anxiety agitation

what are 5 behavioral clinical manifestations of acute TBIs

inappropriate behaviors violent behaviors impulsivity hyperactivity perserveration

what are manifestations of vestib dysfunction

instability of VOR - feeling dizzy w all mvmt

what are sensory clinical manifestations

hearing sight - visual spatial deficits proprioception kinesthesia

what are balance and postural instability clinical manifestations

static and dynamic in any or all positions

what are clinical manifestations of speech issues

swallowing articulation word finding aphasia executive functioning

what can chronic pain be commonly d/t

tone posturing joint contractures inc wt bearing over bony prominences

when can acute TBIs experience chronic pain

at rest w ROM or mvmt chronic HA

what intervention may be contraindicated in acute TBIs

coughing w high ICP - could inc pressures more careful w pulmonary hygiene

what intervention is contraindicated if the pt has high ICP

pulmonary hygiene

what are common PT interventions to consider w acute TBIs (9)

get fam/friends involved prevent 2ndary impairments pulm hygiene address ms tone (casting) maintain ROM/flexibility functional mobility strength training endurance vestib and balance interventions

what is the goal of sensory stim for RLA 1-3

inc arousal

what type of sensory stim should be utilized for RLA 1-3? how should it be presented?

graded presentation of auditory, visual, olfactory, kinesthetic, tactile, and vestib stim - some saliency early, frequent

when is sensory stim for RLA 1-3 dc

when more complex activity is possible

what is a concept for mobilization in acute TBIs

mobilize minimally responsive pts once medically stable

what are equipment examples that can be utilized for early mobilization

tilt tables sitting EOB OOB to chair supported sitting on ball balance disk

why is early mobilization important in minimally responsive pts

wake them up WB in ankles interact w environment

why is tilt table a good piece of equipment to use w early mobilization in minimally responsive pts

upright tolerance OH

what are 3 communication interventions

1. establish means of communication 2. picture or letter boards, augmented electronic devices, type/write 3. co-tx w SLP

what are 5 memory interventions

1. ask Qs frequently and provide correct answers if client is unable to 2. utilize memory log/book 3. written instructions and schedule 4. adapt instructions and cues to enhance success 5. ask client to navigate in rehab unit for topographical memory training

what is the hippocampus associated w

episodic learning

what is the striatum associated w

skill learning

what is the neocortex associated w

perceptual learning

what is the amygdala associated with

emotional memory

what is the cerebellum associated with

processing procedural memories

what structure is associated w episodic memory

hippocampus

what structure is associated w skill learning

striatum

what structure is associated w perceptual learning

neocortex

what structure is associated with emotional memory

amygdala

what structure is associated with processing procedural memories

cerebellum

what are behavioral considerations for interventions (9)

structure treatment/environment behavior mod techniques identify motivators minimize use of restraints identify/avoid triggers dec stim calm demeanor consistent expectations w team work w neuropsych & behavior psych

what are examples of behavior modification techniques

reinforce positive behaviors and work to extinguish negative or unwanted behaviors - avoid punitive approach