Test 4 - TBI Flashcards
What is a hematoma?
Blood leak collects in a confined area of the brain or skull Subdural Between dura and brain Epidural Between skull and dura Intracerebral Deep in brain Subarachnoid In subarachnoid space
What is hard about anoxia/hypoxia
symptoms and dysfunction are scattered so you never know what the pt is going to have difficulty with
Diffuse axonal injury
Injury is not localized, involves multiple areas of the brain. Damage occurs to the axons that connect the different areas of the brain. This occurs when the brain tissue twists or rotates inside the skull at the time of injury.
coup-countercoup injury
Coup: injury at the site of impact
Coup/Contre-Coup: impact causes the brain to bump the opposite side of the skull. Damage occurs at the site of impact (coup) and on the opposite
Intervention to manage intracranial hypertension
Proper positioning of patient
Avoid overstimulation
Get ramped up because all incoming information
Decreasing agitation through sedation
Paralyzing voluntary muscles
Decreasing the metabolism of the brain through phenobarbital coma (cerebral blood volume)
Dehydrating the brain through mannitol infusion
Removal cerebrospinal fluid (CSF) through ventriculostomy drainage
When do you discontinue treatment with intracranial hypertension?
above 20 mm hg
DO NOT FLEX NECK IN SIDELYING
What are the altered stage
Coma: no arousal or awareness
Nothing there
Vegetative State: person appears awake but has no purposeful interaction with the environment (persistent=greater than 1 month)
Eyes open but not awake
Become ethical – you do not know how long you should see pt
Persistive : unethical to charge someone who is not awake
Locked-in Syndrome: person is awake & alert but can only communicate through eye movements. Computer technology.
What are the 6 progression of coma stages?
Stage 1 – patient exhibits no response
Stage 2 – patient exhibits deceberate rigidity or extensor posturing
Stage 3 – patient exhibits decorticate rigidity or flexor posturing; patient flexes upper extremities while extending lower extremities (Walk in, say “hello, Mr jones” goes into decorticate)
Stage 4 – patient has a massive withdrawal from the stimulus and may display nonpurposeful movement of limbs (touch with withdrawl, ¾ times responding to tactile, visual, auditory)
Stage 5 – patient begins to localize to stimulus
Stage 6 – patient responds appropriately to stimulus
Rancho Level I
No Response
Complete absence of observable change in behavior when presented with visual, auditory, tactile, proprioceptive, vestibular or painful stimuli.
Total Assistance
Rancho Level II
Generalized Response Non specific, Inconsistent, Non-purposeful reaction to stimuli Total Assistance
Rancho Level III
Localized Response
Response is directly related to type of stimuli
Response inconsistent
Response delayed
Total Assistance
Unresponsive when stimulus is non existent
May be able to track visual stimulus
Unable to initiate
Rancho Level IV
Confused/Agitated Response heightened Severely confused May be bizarre Maximal Assistance Big turning point When you know pt is heading in right direction
Time in between coma and confusion
Unable to process and interpret enviroment
Rancho Level V
Confused - Inappropriate Non-Agitated Some response to simple commands Confusion with more complex commands High level of distractibility Maximal Assistance
Rancho Level VI
Confused-Appropriate
Response more goal directed
Cues necessary
Moderate Assistance
Rancho Level VII
Automatic-appropriate Response robot-like Judgment & problem solving lacking Minimal assistance Doing high level tasks Going to grocery store BALANCING CHECKBOOK
