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Neuro Rehab 2 > TBI - 3a TBI Acute Management > Flashcards

TBI - 3a TBI Acute Management Flashcards

1
Q

what are 6 negative influences on prognosis

A

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

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2
Q

what are 4 positive influences on prognosis

A

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

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3
Q

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

A

salient perspective for motivating pts

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4
Q

why are many TBIs medically sedated acutely

A

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

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5
Q

what should the ICP be acutely

A

0-15mmHg

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6
Q

how is the cerebral perfusion pressure (CPP) calculated

A

MAP - ICP

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7
Q

what are the norms for CPP

A

60-90mmHg

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8
Q

what can an ICP >20mmHg mean

A

red flag
- can lead to herniation and bleeding

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9
Q

what are common surgeries for an acute TBI (4)

A

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

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10
Q

what are common meds for acute TBIs

A

sedation
mannitol
barbituates
anti-sz meds

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11
Q

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

A

cardiopulm stabilization

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12
Q

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

A

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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13
Q

what are s/sx of autonomic dysfunction

A

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

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14
Q

what are 2 other terms synonymous w autonomic dysfunction

A

storming
sympathetic storming

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15
Q

how can autonomic dysfunction present

A

recurrent and episodic

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16
Q

what is autonomic dysfunction and what is it caused by

A

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

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17
Q

what is the immediate response to autonomic storming

A

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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18
Q

what are ex of primitive reflexes that may return

A

ATNR
STNR

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19
Q

what sz activity can be seen

A

partial - simple vs complex
generalize
- absent vs tonic clonic

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20
Q

what are changes in ms tone that can be seen

A

hypotonicity
spasticity
rigidity
- decorticate
- decerebrate

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21
Q

decorticate vs decerebrate posturing: presentation and cause

A

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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22
Q

what are 6 NM/sensory clinical manifestations of acute TBIs

A

motor control
sensation
proprioception/kinesthesia
coordination
motor planning
ms atrophy

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23
Q

what are 3 cognitive clinical manifestations of acute TBIs

A

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

24
Q

what are 3 memory clinical manifestations of acute TBIs

A

post traumatic amnesia (PTA)
retrograde amnesia
anterograde amnesia

25
Q

what are 4 emotional clinical manifestations of acute TBIs

A

lability
depression
anxiety
agitation

26
Q

what are 5 behavioral clinical manifestations of acute TBIs

A

inappropriate behaviors
violent behaviors
impulsivity
hyperactivity
perserveration

27
Q

what are manifestations of vestib dysfunction

A

instability of VOR
- feeling dizzy w all mvmt

28
Q

what are sensory clinical manifestations

A

hearing
sight
- visual spatial deficits
proprioception
kinesthesia

29
Q

what are balance and postural instability clinical manifestations

A

static and dynamic in any or all positions

30
Q

what are clinical manifestations of speech issues

A

swallowing
articulation
word finding
aphasia
executive functioning

31
Q

what can chronic pain be commonly d/t

A

tone
posturing
joint contractures
inc wt bearing over bony prominences

32
Q

when can acute TBIs experience chronic pain

A

at rest
w ROM or mvmt

chronic HA

33
Q

what intervention may be contraindicated in acute TBIs

A

coughing w high ICP
- could inc pressures more

careful w pulmonary hygiene

34
Q

what intervention is contraindicated if the pt has high ICP

A

pulmonary hygiene

35
Q

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

A

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

36
Q

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

A

inc arousal

37
Q

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

A

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

early, frequent

38
Q

when is sensory stim for RLA 1-3 dc

A

when more complex activity is possible

39
Q

what is a concept for mobilization in acute TBIs

A

mobilize minimally responsive pts once medically stable

40
Q

what are equipment examples that can be utilized for early mobilization

A

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

41
Q

why is early mobilization important in minimally responsive pts

A

wake them up
WB in ankles
interact w environment

42
Q

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

A

upright tolerance
OH

43
Q

what are 3 communication interventions

A
  1. establish means of communication
  2. picture or letter boards, augmented electronic devices, type/write
  3. co-tx w SLP
44
Q

what are 5 memory interventions

A
  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
45
Q

what is the hippocampus associated w

A

episodic learning

46
Q

what is the striatum associated w

A

skill learning

47
Q

what is the neocortex associated w

A

perceptual learning

48
Q

what is the amygdala associated with

A

emotional memory

49
Q

what is the cerebellum associated with

A

processing procedural memories

50
Q

what structure is associated w episodic memory

A

hippocampus

51
Q

what structure is associated w skill learning

A

striatum

52
Q

what structure is associated w perceptual learning

A

neocortex

53
Q

what structure is associated with emotional memory

A

amygdala

54
Q

what structure is associated with processing procedural memories

A

cerebellum

55
Q

what are behavioral considerations for interventions (9)

A

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

56
Q

what are examples of behavior modification techniques

A

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

Neuro Rehab 2 (48 decks)

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