tbi quiz 11/17 Flashcards
A non-congenital or non-degenerative insult to the brain caused by an external force
The definition of TBI
Children under 4 adolescents 15-19 Adults over 75 people with previous tbi persons with history of drug/alcohol use
High risk groups for a tbi
Object penetrates the skull and brain
Open brain injury
Acceleration, deceleration, and rotational forces
Closed brain injury
Direct hit on the head
Coup
The result of the brain moving inside the skull from the coup impact
Contrecoup
Occurs at the time of the trauma and is caused by localized contusions
Primary injury
Results from stretching and shearing forces occuring in the tissues of the brain
Diffuse axonal injury
Results from a series of chemical reactions in the brain that can occur immediately after the injury, his or days later, and significantly worsen the damage caused by primary injury
Secondary injury
Stabilize the patient medically
treat for shock or respiratory arrest
assess for other injuries
spinal or soft tissue injuries, wounds, internal injuries
Immobilization: halo, cast, traction
Craniotomy if needed to decrease intracranial pressure or bleeding
Meds for pain or seizures
meet nutritional needs with IV fluids or NG tube PRN
in the ICU the neurologic status is frequently reassessed
Medical management
Baseline cognitive status address areas of basic ADLs ensure the practice of basic hygiene skills bed and sitting position maintain ROM facilitate responses to stimuli increase endurance for activity
OT in the ICU
Decreased ability to recall information from before the brain injury
Retrograde amnesia
Decreased ability to recall new information
Anterograde amnesia
A confusional state with prominent ongoing difficulty laying down new memories. Best way to monitor the impact and course of tbi
Post traumatic amnesia
Loss of consciousness for 5 minutes or less
initial Glasgow coma scale (GCS) of 13 or 15
post traumatic amnesia of less than 1 hour
Mild tbi
Loss of consciousness for greater than 5 minutes but less than 6 hours
initial gcs of 3 to 8
post traumatic amnesia of 1 to 24 hours
Moderate tbi
Loss of consciousness of 6 hours or more
initial gcs of 3 to 8
post traumatic amnesia for more than 24 hours
Severe tbi
Total the scores for eye opening, motor response, and verbal response
15 is normal
13-14 is associated with mild head injury
8-12 is associated with moderate head injury
Glasgow Coma Scale
Level 1- no response:total assistance
level 2- generalized response: total assistance
level 3- localized response: total assistance
level 4- confused/agitated: maximal assistance
level 5- confused, inappropriate non - agitated: maximal assistance
level 6- confused, appropriate: moderate assistance
level 7- automatic, appropriate: min assist of ADLs
level 8- purposeful, appropriate: stand-by assistance
level 9- purposeful, appropriate: stand-by assistance on request
level 10- purposeful, appropriate: modified independence
Rancho los amigos
Motor problems
abnormal reflexes (atnr) and (stnr)
abnormal muscle tone
muscle weakness
Impairment after tbi
Posturing is an indicator of the severity of brain damage
Not a question just a hint
Elbows, wrists, and fingers flexed; legs extended and rotated inward
Decorticate
Head arched back, arms extended by sides, and legs extended. Patient is rigid with teeth clenched
Decerebrate
Caused by imbalance muscle tone, deficits in righting reactions, impaired muscle control, or deficits in vision, cognition, and perception
Postural dysfunction
Dulling or loss of light touch, sharp-dull discrimination, proprioception, kinesthesia, or stereognosis
Sensory changes
Sensory changes, decreased functional endurance, and dysphagia
Additional impairment after tbi
Double vision reduced gaze stability Poor attention poor visual memory glare sensitivity impaired balance visual-spatial misperception Loss of coordination
Post traumatic vision syndrome
Visual agnosia right-left discrimination figure-ground discrimination Topographic perception depth perception tactile agnosia body scheme left unilateral neglect apraxia
Perceptual impairments
Disorientation reduced attention and concentration impaired initiation impaired memory decreased safety awareness delayed processing of information impaired executive function & abstract reasoning
Cognitive dysfunction
Reduced frustration tolerance
refusal to cooperate
tasks that are too difficult can increase agitation
Combativeness
disinhibition
lack of social awareness
emotional liability
exaggerated emotional response
affective mental functions
social support is a strong predictor of success
Premorbid psychiatric or emotional problems may be worsened by tbi
reactive depression to losses associated with tbi
family structure is disputed
client and family may benefit from counseling
Behavioral dysfunction
