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NEUROMUSCULAR > Traumatic brain injury > Flashcards

Traumatic brain injury Flashcards

1
Q

what are 3 early medical management for TBI

A
  • establish open airway
    -vital signs , fluid replacement
  • neuro checks q 15 to 30 mins
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2
Q

what are the 3 things Glasgow coma scale is used for

A

 Used at the scene of accident, ER, and throughout
acute care
 Used as a predictor of outcome
 Used in research

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3
Q

does the GLasgow coma sacle have low or high inter rather reliability

A

high

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4
Q

what is range of scores u can see for the Glasgow Coma Sclae

A

3-15

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5
Q

what do the Glasgow coma scale scores mean

A

3 to 8 - severe injury (defines coma in 90% of cases)
9 to 12 - mod injury (15%)
13 to 15 - mild injury (41%)

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6
Q

what are the 4 limitations of GCS

A

 Pre-existing conditions (language)
 Aphasia
 Alcohol or medications
 Other

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7
Q

what is local brain injury

A

localized to the site of impact on the skull

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8
Q

what is a diffuse brain injury

A

widely scattered shearing of axons (DAI: diffuse axonal injury)

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9
Q

is raised intracranial pressure a secondary or primary insult

A

secondary

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10
Q

what is the normal intracranial pressure while lying down

A

0-10 mmHg

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11
Q

what intracranial pressure is definitely abnormal and what is a definite contraindication for P/.T

A

20 mmHg is definitelyabnormal.
Above 20 is definite contraindication for P.T

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12
Q

what intracranial pressure casues neurologic dysfunctions

A

20-40 mmHg

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13
Q

what intracranial pressure almost always results in death

A

60 mmHg

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14
Q

what is cerebral arterial vasospasm measured by

A

transcranial doppler

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15
Q

Brain’s ___ properties allow it to move
away from the mass lesion

A

viscoelastic

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16
Q

Brain’s viscoelastic properties allow it to move
away from the mass lesion causing what 3 things

A

 Distortion
 Midline shift
 Herniation through foramen magnum

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17
Q

hypoxia and ischemic brain damage is most commonly seen in what 4 things

A

hippocampus, basal ganglia,
scattered sites of cerebral cortex, and cerebellum

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18
Q

what is the difference between hypoxia and ischemia

A

hypoxia is absence in O2 from problems with breathing. system and ischemia is blood loss to area bc it is blocked

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19
Q

what are the 2 what u can evacuate the hematoma

A

craniotomy or craniectomy

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20
Q

what is done to minimize infection of compound wounds

A

debridement and lavage of compound wounds

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21
Q

what is a Ventriculostomy

A

measures and drains CSF

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22
Q

what does a Bolt do

A

measures CSF only

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23
Q

for the EVD the pressure transducer is at the same horizontal level as ____ and what is the landmark

A

ventricles and external auditory meatus

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24
Q

prior to moving someone with w EVD what needs to be clamped

A

EVD must be clamored by nurse or by pt/ot w nerve permisson

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25
Q

if you have a EVD what must happen every time the patient moves

A

EVD must be releveled

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26
Q

-osmotic therapy
-sedative/hyponotic drug therapy
-vasoreductive therapy
-skeletal mm paralytics and/or relaxants
- core temperature/therapeutic hypothermia

  • these are treatments of for what
A

ICP

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27
Q

what is the metabolic care for ICP

A

 In-dwelling catheter with strict intake/output
 Serum electrolytes
 Artificial feedings once bowel sounds return

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28
Q

what is neurogenic pulmonary edema associated with

A

associated with increased pulmonary microvascular permeability

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29
Q

what are pulmonary complications that could arise from a tBI

A

 Fat embolism in lung
 Respiratory acidosis from artificial ventilation
 Pneumonia
- neurogenic pulmonary edema

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30
Q

fever can be a sign of infection most commonly of what

A

respiratory and urinary tracts

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31
Q

fever can be caused by damage to ___ and called what

A

hypothalamus
“neurogenic fever”

32
Q

what 2 things do fevers cause

A

increased caloric demand and metabolic demands of the brain

33
Q

a fever can be a sing of what

A

irritation with brain herniation

34
Q

what can systemic arterial hypertension result in

A

blood- brain barrier disruption, causing more brain edema.

35
Q

what can systemic arterial hypertension be caused by

A

noxious stimuli

36
Q

loss of autoregualtion of cerebral blood flow does what

A

increases blood brain volume leading to intracranial hypertension

37
Q

what is HR controlled by

A

various regions in diencephalon caudally to myelencephalon (medulla)

38
Q

what HR problem is most common is TBI

A

tachycardia

39
Q

 Disability Rating Scale (DRS)
 Craig Handicap Assessment and Reporting Technique (CHART)
and Short Form
 Participation Objective/Participation Subjective (POPS)
 Supervision Rating Scale
 Discharge placement
 Employment

these are all examples of what ICF level outcome

A

participation

40
Q

 Universal Data System-Functional Independence Measure (UDS-
FIM)
 UDS-FIM + FAM (Functional Assessment Measure)

these are all apart of what ICF level outcome

A

activity

41
Q

 Glasgow Coma Scale (GCS)
 Rancho Levels of Cognitive Function
 JFK Coma Recovery Scale Revised
 Agitated Behavior Scale
 Moss Attention Rating Scale

these are all apart of what ICF level outcome

A

body structure/functionn

42
Q

what is the disability rating scale used to track

A

ppl from coma to community

43
Q

what are the 6 things that the craig handicap assessment and reporting technique go over

A
  1. physcial indepence
  2. mobility
  3. occupation
  4. social integration
  5. economic self sufficiency
  6. cognitive independence
44
Q

___ of individuals require some level of supervision at 1 year post injury.

A

37%

45
Q

__ % require some supervision 2 years post injury.

A

31

46
Q

what is a Reliable and valid scale designed to
assess high-level motor performance in patients with TBI

A

Hi - level mobility assessment tool

47
Q

what is the minimum mobility requirement for the Hi level mobility assessment toll

A

independent walking 20 meter without gait aids

48
Q

there are 13 items of teh HI level mobility assessment tool what are the the 5 things they are assessing

A

 Walking, running
 Jumping, balance
 Stairs
 Hopping
 Skipping

49
Q

what the 8 levels of the ranchos los amigos for cognitive functioning scale

A

1 No response
2 Generalized response.
3 Localized response
4 Confused, agitated.
5 Confused, inappropriate, non-agitated.
6 Confused, appropriate
7. Automatic, appropriate
8. purposeful , appropriate

50
Q

if a patient is Unresponsive to any stimulus what rancho levle would u give them

A
  1. no response
51
Q

if a patient is Limited, inconsistent,
non-purposeful responses, often to pain only. what rancho levle would u give them

A
  1. Generalized response.
52
Q

if a patient has Purposeful responses; may
follow simple commands; may focus on presented
object. what rancho levle would u give them

A
  1. localized response
53
Q

if a patient has Heightened state of activity;
confusion, disorientation; aggressive behavior; unable to do self-care; unaware of present events; agitation appears related to internal confusion. what rancho levle would u give them

A
  1. confused , agitated
54
Q

if a patient has Appears alert; responds to commands; distractible; does not concentrate on task; verbally inappropriate, does not learn new information. what rancho levle would u give them

A
  1. Confused, inappropriate, non-agitated
55
Q

if a patient is Good directed behavior,
needs cueing; can relearn old skills (ADL); serious
memory problems; some awareness of self and others what rancho levle would u give them

A
  1. confused , appropriate
56
Q

if a patient has Robot-like appropriate
behavior with minimal confusion; shallow recall; poor insight into condition; initiates tasks but needs
structure; poor judgment, problem-solving and
planning skills what rancho levle would u give them

A
  1. automatic , appropriate
57
Q

if a patient is Alert, oriented; recalls and
integrates past events; learns new activities and can
continue without supervision; cognitively independent in living skills; capable of driving; defects in stress tolerance, judgment, abstract reasoning persist; many function at reduced levels in society. what rancho levle would u give them

A
  1. purposeful , appropriate
58
Q

A patient in ___ appears asleep. There is no eye
opening, even spontaneously, nor movements or
vocalization. Usually no longer than 2 weeks.

A

coma

59
Q

A patient in ___ can have eyes open, move
spontaneously, but is unable to follow commands
or speak. This patient has sleep-wake cycles. Can
last indefinitely.

A

persistent vegetative state

60
Q

what Scale is used to monitor levels of alertness for patients in coma/persistent vegetative state

A

JFK coma/near coma scale

61
Q

Shows emergence from coma/persistent vegetative
state into which ranchos level

A

minimally conscious state” … level 3

62
Q

what scale is a huge implications from DC placements from acute care

A

JFK coma/ near coma scale

63
Q

what is the period of time from the accident to the
time that the patient starts to have on- going short-term memory.

A

post traumatic amnesia

64
Q

what will happen when the pateint wakes up from a coma

A

often not remember the accident or evens immediately after it

65
Q

what is Used to determine when a patient is progressing out of PTA (post traumatic amnesia)

A

GALVESTON ORIENTATION AND AMNESIA
TEST (GOAT

66
Q

on the GALVESTON ORIENTATION AND AMNESIA
TEST (GOAT) the pateint must have what scored to be out of PTA

A

3 consecutive scores of > 75

67
Q

injury to the front ortbial , anterior temporal lobes and slyivan fissues causes what

A

agitation

68
Q

what do temporal lobe seizures casues

A

aggression

69
Q

what are environments casues of agitation

A

sensory overload and deprivation

70
Q

what are the cut off scores for agitated behavior

21 or less:
22-28:
39-25:
>35:

A

 21 or less: within normal
limits
 22-28: mild agitation
 29-35: moderate agitation
 >35: severe agitation

71
Q

what is an Observational tool to
measure attention-related
behaviors after TBI

A

moss attention rating scale

72
Q

the higher the score on the moss attention rating scale means what

A

better then attention

73
Q

what is Defined by a traumatically induced disruption of brain function, as manifested by at least one of these:
 Any period of loss of consciousness
 Any loss of memory for events immediately pre- or post-
accident
 Any change in mental state at the time of the accident
 Focal neuro deficits (transient or lasting)

A

mild TBIq

74
Q

severity of injury for a mild TBI does not exceed a loss of consciousness for ____ mins , after 30 mins an initial GCS of ____ and PTA not greater than ___ hours

A

30
13-15
24

75
Q

what are the most common things reported with a mild TBI

A

headaches

76
Q

when do activity and participation levels tend to plateau for TBI

A

1-2 years post injury

77
Q

for a TBI , importovemtns continues to be seen at ___ post injury and is considered period of “rapid recovery”

A

1 year

NEUROMUSCULAR (15 decks)

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