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ACUTE CARE MODULE 2 > TBI > Flashcards

TBI Flashcards

1
Q

what is the leading cause of TBI

A

falls (40%)

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2
Q

how can you classify head injuries using the GCS

A

scaled on a 3-15 scale

8 or less = coma
9-12 = moderate head injury
13-15 mild head injury

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3
Q

headache, confusion, lightheadedness, and blurred vision are characteristics of what level of TBI

A

mild head injury

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4
Q

changes in memory, concentration, and attention are characteristics of what level of TBI

A

mild head injury

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5
Q

fatigue and changes in sleep patterns are characteristics of what level of TBI

A

mild head injury

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6
Q

nausea and vomiting are characteristics of what level of TBI

A

moderate to severe

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7
Q

dilation of one or both pupils, coordination loss, and extremity weakness/numbness are characteristics of what level of TBI

A

moderate to severe

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8
Q

slurred speech, confusion, restlessness, agitation are characteristics of what level of TBI

A

moderate to severe

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9
Q

symptoms of concussion

A

dizziness, diorientation, burred vision, concentration difficulty, sleep alterations, nausea, headache, balance deficits

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10
Q

what is a contusion in the context of TBI

A

brain surface hemorrhage of small vessels

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11
Q

which areas of the brain are most susceptible to diffusion axonal injury

A

corpus callosum, basal ganglia, white matter, superior cerebellar peduncles

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12
Q

what is a diffuse axonal injury

A

subcortical axon shearing within the myeling sheath due to high velocity acceleration/deceleration forces

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13
Q

what typically causes a epidural hematoma

A

blow to side of head or MVA

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14
Q

describe the pathogenesis of an epidural hematoma

A

alert > unconscious > lucid; rapid deterioration of the condition

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15
Q

in what patient population do we typically see a subdural hematoma?

A

older adults after a fall or blow to the head

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16
Q

describe the pathogenesis of a subdural hematoma

A

hematoma accumulates more slowly over hours to a week

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17
Q

how does a subdural hematoma generally present

A

sxs mimic a CVA

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18
Q

in what population do we typically see an intracerebral hematoma

A

acceleration/deceleration forces that shear cortical vessels beneath a skull fracture

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19
Q

what is required for a functional arousal response

A

ARAS needs to be intact (upper 2/3 of brainstem connecting the thalamus to the cerebrum)

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20
Q

what qualifies an intact arousal response

A

since its a primitive response, it is intact if the patient opens eyes spontaneously or in response to external stimulus

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21
Q

T/F: awareness (of self and environment) is a primitive response

A

false: it is complex and requires cerebral function

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22
Q

describe coma in two words, then define

A

unarousable unawareness: complete failure of arousal, no spontaneous eye opening, and no response to vigorous stimuli

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23
Q

describe a vegetative state

A

arousal in the absence of awareness combined with sleep and wake cycles with either full or partial preservation of hypothalamic and brainstem autonomic function

24
Q

describe a minimally conscious state

A

demonstrated minimal but definite behavioral evidence of self or environmental awareness

25
Q

which three things qualify brain death

A

coma, absent brainstem reflexes, and apnea

26
Q

what is the most reliable and valid scale for determining recovery from a coma

A

DOC Scale CRS-R (coma recovery scale - revised)

27
Q

T/F: premorbid status influences TBI outcomes

A

true, disease and neural loss can negatively affect outcomes

28
Q

what three things are cause primary neurological damage

A
  1. focal lesions
  2. coup-countrecoup trauma
  3. DAI
29
Q

what is the most common source of secondary neurological damage

A

increased ICP

30
Q

what four things most commonly raise ICP

A
  1. cervical flexion
  2. coughing
  3. body position changes
  4. increased blood and abdominal-thoracic pressure
31
Q

what is a typical precaution noted for patients with an ICP bolt

A

HOB at 30-45

32
Q

which areas of the brain are most susceptible to secondary hypoxia ischemia

A

hippocampus (memory), cerebellum, and basal ganglia

33
Q

what happens during a post-traumatic seizure

A

sudden, explosive, disorderly discharge of cerebral neurons causing transient alteration in brain function

34
Q

why do seizures hold potential for progressive brain injury and irreversible damage

A

during a seizure, oxygen is consumed about 60% more than normal, glucose is depleted, and lactate accumulates.

35
Q

what is auto-destructive cellular phenomena

A

surges of excitatory NTs which can contribute to further neural destruction following an DAI

36
Q

What can a RLA cognitive screen help you to determien

A

it can predict the sequence of cognitive and behavioral recovery in patients with TBI

37
Q

T/F: patients with severe cognitive issue will have severe motor issues

A

false: any cognitive function can be paired with any level of physical function

38
Q

what are the 8 levels of RLA from worst to best

A
  1. no response
  2. generalized response
  3. localized response
  4. confused-agitated
  5. confused-inappropriate
  6. confused-appropriate
  7. automatic-appropriate
  8. purposeful-appropriate
39
Q

what is a RLA generalized response

A

response is inconsistent but has gross verbal or motor response

40
Q

what is a RLA localized response

A

different responses based on different stimulus/location of stimulus

41
Q

what is a RLA confused-agitated response

A

combative heightened state of activity

42
Q

what is a RLA confused-inappropriate response

A

inappropriate responses must be redirected

43
Q

what is a RLA automatic-appropriate response

A

robotic movements, aware of environment, independent, slow learning

44
Q

what are the two major and two minor direct impairments related to TBI

A

cognition and behavior are major; communication and neuromuscular are minor

45
Q

what is the key strategy for addressing behavioral deficits

A

structure, consistency, positivity, and calmness

46
Q

what are goals of low level 1-3 treatment

A
  1. prevent secondary impairment
  2. minimize immobility
  3. manage tone
  4. interact with environment
  5. behavioral correction
47
Q

describe manual technique to normalize tone

A

slow repetitive rotation to dampen general motor response/hypertonicity/posturing

48
Q

what can be done in TBI neuro patients to facilitation muscle contraction?

A

tapping the muscle belly

49
Q

what is a technique to relax the muscle

A

provide constant pressure across the muscle

50
Q

what is the first joint you should address when concerned about UE tone and ROM

A

ST joint

51
Q

how often should the coma stimulation approach be used

A

several times a day and 15 min per session

52
Q

how is the coma stimulation approach organized

A

1-2 multisensory modalities at a time allowing adequate response time in a controlled environment

53
Q

what is the goal of level 4 TBI management

A

minimize loss of function

54
Q

what is the goal of level 5-6 TBI management

A

maximize function through consistent patient participation and conditioning

55
Q

what is the goal of level 7-8 TBI management

A

wean from structure and reintegration into the community and decision making

ACUTE CARE MODULE 2 (9 decks)

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