Neuro - TBI Flashcards
(23 cards)
Traumatic Brain Injury (TBI)
disruption in brain function caused by external force (blow, jolt, or penetrating injury)
Closed (non-penetrating) TBI
Skull stays intact
Falls, MVCs, sports injuries
Open (penetrating) TBI
Skull is fractured or object enters brain
Gunshot, stabbing, shrapnel
Primary injury TBI
Occurs at moment of trauma
Contusions, lacerations, hemorrhages
Secondary injury TBI
Evolving damage from inflammation, ischemia, ICP
Cerebral edema, hypoxia, herniation
Coup-contrecoup
Brain injury on both sides (point of impact + opposite side)
Diffuse Axonal Injury (DAI)
Widespread shearing of axons; often in severe TBI
Rancho Los Amigos Levels
Describes stages of cognitive recovery (Levels I–X)
think RCA
R- response (1,2,3)
C - confused (4,5,6)
A - appropriate (7,8)
Post-Traumatic Amnesia
Time from injury until patient regains continuous memory
(RLA) level I
No Response to stimulus
Coma
Bed bound
(RLA) level II
Generalized response
Non-purposeful whole body, vocal
Inconsistent
Not specific
(RLA) level III
Local response
Purposeful
Local and specific
Inconsistent
Follows simple commands –
close eyes, squeeze hands
How to Manage Level I, II, III
Positioning: Head neutral, prevent ulcer, sit (if stable)
Gentle PROM: Joint integrity, skin integrity
Respiratory care: Postural drainage, percussion, vibration
Educate family: What to expect, how to be more involved
(RLA) level IV
Confused and Agitated
Behavior:
* Heightened activity, just coming out of coma
* Aggressive: Doesn’t cooperate, verbalization is incoherent,
confabulations (making up stories)
Attention:
* No selective attention = can’t focus for too long
Memory:
* No long- and short-term memory
(RLA) level IV - confused treatment
- Consistent: Same therapist, same staff, family introduce yourself daily.
ESTABLISH A ROUTINE
- Orient the patient: Calendar, clock
closed and quiet environment
(RLA) level IV - memory treatment
NO CARRYOVER: Chart and graph to measure progress
whiteboard and diary
(RLA) level IV - agitated treatment
Calm behavior. DO NOT confront!
- Environment – Closed – prevent harm to others
distract!! stay calm with them
(RLA) level V
Confused Inappropriate
Behavior:
* Responds consistently to simple commands
* Responds inconsistently to complex commands
* With structure, able to socialize for short period
Memory: Memory impaired. Inappropriate use of objects. Can’t learn new task.
(RLA) level VI
Confused Appropriate
Behavior:
* Follows simple instruction consistently
* Goal oriented behavior with external input
Memory: Carryover of previous skills present (self-care)
(RLA) levels V and VI
treatment:
Follow goals from level IV
Complex commands cannot be followed - Avoid more complex
open environments
(RLA) level VII
Automatic Appropriate
Oriented in home and hospital
Daily routine - automatic but robot-like
Judgement impaired
Able to initiate social or recreational activity with structure
= because routine or told to - WHY is still missing
(RLA) level VIII
Purposeful Appropriate
Carryover of new skills present
Impaired judgement in an emergency situation, abstract reasoning and reduced tolerance for stress
= they know the WHY
How to Manage Levels VII, VIII
Focus on re-entry to work and community
Emphasize skills related to problem solving, social interaction
Trial period of independent living
Adaptation at work or school to return to normal life
