TBI - 3a TBI Acute Management Flashcards
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
what are 4 positive influences on prognosis
support of fam/friends
early improvement in cog
access to specialized rehab
ed/vocational opportunities
why is the support of family and friends a positive influence on prognosis
salient perspective for motivating pts
why are many TBIs medically sedated acutely
give time to dec ICP and to stabilize them hemodynamically and metabolically
what should the ICP be acutely
0-15mmHg
how is the cerebral perfusion pressure (CPP) calculated
MAP - ICP
what are the norms for CPP
60-90mmHg
what can an ICP >20mmHg mean
red flag
- can lead to herniation and bleeding
what are common surgeries for an acute TBI (4)
decompression
drainage/ventricular shunt
remove foreign object
repair MS/integ issues
what are common meds for acute TBIs
sedation
mannitol
barbituates
anti-sz meds
what is a main goal of acute med management for a TBI
cardiopulm stabilization
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
what are s/sx of autonomic dysfunction
**HTN
**tachycardia
hyperthermia
diaphoresis
inc spasticity
dystonia
**ext posturing
pupil dilation
vomiting
what are 2 other terms synonymous w autonomic dysfunction
storming
sympathetic storming
how can autonomic dysfunction present
recurrent and episodic
what is autonomic dysfunction and what is it caused by
exaggerated response to noxious external stim
- ie bed sore, catheter, positioning
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
what are ex of primitive reflexes that may return
ATNR
STNR
what sz activity can be seen
partial - simple vs complex
generalize
- absent vs tonic clonic
what are changes in ms tone that can be seen
hypotonicity
spasticity
rigidity
- decorticate
- decerebrate
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
what are 6 NM/sensory clinical manifestations of acute TBIs
motor control
sensation
proprioception/kinesthesia
coordination
motor planning
ms atrophy
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
- establish means of communication
- picture or letter boards, augmented electronic devices, type/write
- co-tx w SLP
what are 5 memory interventions
- ask Qs frequently and provide correct answers if client is unable to
- utilize memory log/book
- written instructions and schedule
- adapt instructions and cues to enhance success
- 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
