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Neuromus 2 > disorder of cog - TBI > Flashcards

disorder of cog - TBI Flashcards

1
Q

what is disordered cog

A

is a state where consciousness has been affected by damage to the brain

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2
Q

what is a DOC program

A

is a specialized program designed to improve function and quality of life for patients who are minimally conscious

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3
Q

what is the GCS, LOC, and rancho of a person with a severe brain injury

A

GSC: 3-8

LOC: >6 hr

ranch: I - III

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4
Q

what is rancho 1 level

A

unconscious

they do not react to any stimuli

this can last for a varied amount of tome

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5
Q

what is rancho 2 level

A

the person will react but the reaction of inconsistent and without purpose

reaction is often a broad body movement

the reaction is the same, regardless of the stimuli

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6
Q

when is a reaction mostly seen in rancho level 2

A

with an painful stimulus

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7
Q

what is the limitation with rancho and GCS

A

they have limited ability to objectivly measure change therefore a new category was created DOC

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8
Q

what is a coma

A

a persistant state of unconsciousness

absent of spontaneous eye opening

sleep wake cycles

no purposeful response to the environment

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9
Q

what is a vegetative state

A

persistent unconsciousness

intermittent arousal: periodic spon or stimulated EO

no sustained, reproducible purposeful responses

no voluntary movement

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10
Q

what is min conscious

A

partial con

reproducible behavior and evidence of awareness of environment after simple commands

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11
Q

what is emerged MCS

A

full con

consistent behavior of awareness of self or environment

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12
Q

what is arousal

A

a state of wakefulness

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13
Q

what is awareness

A

ability to interact with the environment in a purposeful manner

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14
Q

normal con- A and A

A

highest level both

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15
Q

coma - A and A

A

lowest level both

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16
Q

vegetative state - A and A

A

arousal: high

awareness: lowest

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17
Q

min con state: A and A

A

arousal: highest

awareness: lower

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18
Q

locked in syndrome: A and A

A

higest for both

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19
Q

how can pain be managed

A

positioning

education

meds

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20
Q

how do we treat for DVT and PE

A

anticoagulants

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21
Q

how is cere edema managed

A

meds and surgery

surgery: craniotomy

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22
Q

what is a craniotomy

A

part of the brain is temporally removed

23
Q

what is sympathetic storming

A

increase in activity of the sympathetic nervous system created by a disassociation or loss of balance between the sympathetic and parasympathetic nervous systems

24
Q

how often does sym storming occur

A

15-33% of those with a GCS of 3-8

25
Q

how long does sym storming last and when does it start

A

24 hr after injury

lasts for weeks after

26
Q

what are the sym of sym storming

A

alterations in level of consciousness, increased posturing, dystonia, hypertension, hyperthermia, tachycardia, tachypnea, diaphoresis, and agitation

27
Q

what is Dystonia

A

a movement disorder that causes the muscles to contract involuntarily

28
Q

is storming thought to be a step forward or back

A

forward

29
Q

what is used to treat storming

A

medication that suppress the CNS

heating and cooling blankets used to regulate temp

30
Q

storming and the ICU

A

the pt is not cleared to leave the ICU until storming is over

31
Q

what is the coma scale used for

A

assist with differential diagnosis, prognosis, and treatment planning for those with DOC

32
Q

what are the subscales of the coma scale

A

audiotory

visual

motor function

oral motor function

communication

arousal

33
Q

audiotory and vision in the coma scale is what in the neuro PT exam

A

cog and CN

34
Q

motor in the coma scale is what in the neuro PT exam

A

cog

sensation

motor

35
Q

oral motor function, communication, arousal in the coma scale is what in the neuro PT exam

A

motor and cog

36
Q

what part of the neuro PT exam does the comma scale not cover

A

coordination

balance

function

37
Q

when doing a cog eval do you have sitting or laying down

A

sitting

laying down means that it is time to sleep

38
Q

what is the purpose for a DOC program

A

to emerge from a stage of lower con

39
Q

what are the interventions for DOC programs

A

functional mobility: tolerance to upright, transfers, BM, sitting balance, object manipulation

arousal: multisensory stim

cog: command following

family education: HEP, positioning, preventing 2ndary complications

40
Q

how do we manage spasticity

A

meds

stretching program

serial casting

41
Q

meds for spasticity

A

botoc

baclofen

42
Q

stretching program for spasticity

A

this needs to be completed daily

stretch splints: worn at night or scheduled throughout the day

43
Q

serial casting and spasticity

A

provides a prolonged stretch - watch for skin breakdown

once set allows for WB through the extremity

44
Q

is spasticity common with TBI

A

yes

45
Q

candiates for spasticity casting

A

severe spasticity

low tolerance to stretch

alerted function 2ndary to spat

46
Q

contraindication of spat casting

A

fracture

HO

edema

mod/severe vascular disease

skin integrity

47
Q

precuations for casting for spat

A

hyperhtermia

elevated ICP

Qol

POC

bony promiences

48
Q

daily check with spat casting

A

temp toes

cap refill

dorsalis pedis pulse

cast edges - skin and spaces

look for bumps and cracks

49
Q

serial spat casting

A

multiple applications

molded cast in a sub max stretch

50
Q

inhibitive spat casting

A

use of pressure point to decrease tone

51
Q

cynlidrical spat casting

A

pro: constant stretch

cons: limited access to skin, timely

52
Q

bivalve spat casting

A

pro: use of joint outside of the cast, skin inspections

con: more likely to have a misalignment

53
Q

plaster spat cast

A

pro: mold to joint, does no dry quickly

con: prone to indentations, high pressure areas, heavy messy

54
Q

fiber glass spat cast

A

pro: dries quickly, light, faster application

con: less moldable, splintering, sharp edges

Neuromus 2 (17 decks)

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