Werk 8 Flashcards

Question

Open head injury (OHI

Answer 1

occurs when the skull is penetrated, such as by a bullet, and typically involves focal damage (confined to a small part of the brain

Answer 2

does not involve penetration of the skull but results in both focal and broad diffuse damage (occurring throughout the brain).

Answer 3

When a TBI is the result of a car accident or other external force to one side of the head, a “coup-contra-coup” (front-to-back or side-to-side) effect can occur—that is, bouncing back and forth within the skull injures the area of the brain opposite the initial injury

Answer 4

Not caused by a blow or impact to the head, but by the brain moving with acceleration and deceleration as well as compression and stretching inside the skull, often causing injuries to many parts of the brain. ▪The axon get broken and stretched in many places. This shearing injury, or tissue sliding over tissue results in the death of brain cells, which also causes swelling. ▪ Once those nerve cells are disrupted and the links between them are broken, the signal process cannot occur, and such functions as movement, speech, and even those that support life cannot occur.

Answer 5

▪Anoxic brain injury can also be called cerebral hypoxia or hypoxic–anoxic injury and is a serious and life-threatening insult to the brain. ▪After 4 minutes of significantly low oxygen levels, brain cells begin to die, and after 5 minutes, permanent anoxic brain injury can result. The greater the lack of oxygen, the more widespread and serious the injury will be.

Answer 6

Measures three parameters—eye movements, verbal responses, and motor responses; overall scores can range from 3 to 15. Lower scores indicate a more severe brain. ▪Used in acute stages

Answer 7

▪8-10 Levels ▪Do all clients go through all levels in order? ▪OT intervention is often planned and structured based on client’s LCFS level.

Answer 8

▪Does not respond to external stimulation. Clients at level I do not open their eyes and do not respond to painful stimuli. ▪Acute care or ICU ▪Position to prevent skin breakdown and manage tone ▪Provide PROM to prevent contractures ▪Educate family

Answer 9

Reacts to stimulation inconsistently in a nonspecific, non-purposeful manner and is considered to be in a vegetative state. May be in an acute care hospital, LTAC, or inpatient rehabilitation facility. ▪OT Treatment: Positioning; PROM; use of orthotics, sensory stimulation; and family education.

Answer 10

▪Client responds in a specific manner to stimuli, but responses may be delayed and inconsistent ▪Minimally conscious state and OT is focused on sensory stimulation and family education ▪Acute, Rehab Hospital, or LTAC ▪Treatment: ▪May have increased tone (hypertonicity or spasticity), and OT will include positioning and possibly orthoses for management of increased tone. ▪PROM to prevent contracture

Answer 11

Behavior may be bizarre and inappropriate, with poor attention and short-term memory. ▪May demonstrate impulsivity, balance deficits, poor safety awareness, and agitation ▪May be in an inpatient rehabilitation facility unless the medical condition requires a higher level of care. The client is also likely exhibiting poor insight into the deficits ▪May require restraints because of their poor safety awareness. ▪OT plan of care is focused on attention, safety awareness, behavior management, and ADLs/IADLs. ▪Therapeutic use of self is crucial, as the demeanor and tone of voice used by the OT practitioner can affect the client’s

Answer 12

Confusion and inappropriate responses, but the individual is no longer as agitated. Memory and attention continue to be impaired and the client is not able to retain new information ▪May still be in an inpatient rehabilitation facility or subacute rehabilitation facility or may have transitioned to his or her home with 24-hour supervision and home health or outpatient OT services.

Answer 13

Continues to demonstrate difficulties with recent memory but is able to use external cues for direction ▪Responses are typically appropriate in the context of the situation. Twenty-four-hour supervision is likely still required because of memory deficits, and the client may be in a rehabilitation facility or at home with home health or outpatient services, depending on the client’s medical status and the families’ ability to provide care.

Answer 14

Behavior is becoming more appropriate in familiar settings and carryover of new learning is beginning to be evident, although at a slower rate than before the TBI. At this point, the client is likely receiving OT services in an outpatient or home health setting, and vocational rehabilitation services may be involved to address skills needed to return to work.

Answer 15

Appropriate responses to the environment. Vocational rehabilitation services assist the client in developing the skills needed to return to a previous job or a different job. ▪OT plan of care focused on higher-level cognitive skills, including medication management, money management, community integration, and home management, and driving