Traumatic brain injury Flashcards by sophia carrasco

what are 3 early medical management for TBI

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

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what are the 3 things Glasgow coma scale is used for

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

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

high

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

3-15

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what do the Glasgow coma scale scores mean

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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what are the 4 limitations of GCS

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

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what is local brain injury

localized to the site of impact on the skull

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what is a diffuse brain injury

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

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is raised intracranial pressure a secondary or primary insult

secondary

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what is the normal intracranial pressure while lying down

0-10 mmHg

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

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

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what intracranial pressure casues neurologic dysfunctions

20-40 mmHg

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what intracranial pressure almost always results in death

60 mmHg

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what is cerebral arterial vasospasm measured by

transcranial doppler

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

viscoelastic

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

 Distortion
 Midline shift
 Herniation through foramen magnum

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

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

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what is the difference between hypoxia and ischemia

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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what are the 2 what u can evacuate the hematoma

craniotomy or craniectomy

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what is done to minimize infection of compound wounds

debridement and lavage of compound wounds

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what is a Ventriculostomy

measures and drains CSF

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what does a Bolt do

measures CSF only

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

ventricles and external auditory meatus

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

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

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

EVD must be releveled

-osmotic therapy -sedative/hyponotic drug therapy -vasoreductive therapy -skeletal mm paralytics and/or relaxants - core temperature/therapeutic hypothermia - these are treatments of for what

ICP

what is the metabolic care for ICP

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

what is neurogenic pulmonary edema associated with

associated with increased pulmonary microvascular permeability

what are pulmonary complications that could arise from a tBI

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

fever can be a sign of infection most commonly of what

respiratory and urinary tracts

fever can be caused by damage to ___ and called what

hypothalamus “neurogenic fever”

what 2 things do fevers cause

increased caloric demand and metabolic demands of the brain

a fever can be a sing of what

irritation with brain herniation

what can **systemic arterial hypertension** result in

blood- brain barrier disruption, causing more brain edema.

what can systemic arterial hypertension be caused by

noxious stimuli

loss of autoregualtion of cerebral blood flow does what

increases blood brain volume leading to intracranial hypertension

what is HR controlled by

various regions in diencephalon caudally to myelencephalon (medulla)

what HR problem is most common is TBI

tachycardia

 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

participation

 Universal Data System-Functional Independence Measure (UDS- FIM)  UDS-FIM + FAM (Functional Assessment Measure) these are all apart of what ICF level outcome

activity

 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

body structure/functionn

what is the disability rating scale used to track

ppl from coma to community

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

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

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

37%

__ % require some supervision 2 years post injury.

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

Hi - level mobility assessment tool

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

independent walking 20 meter without gait aids

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

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

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

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

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

1. no response

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

2. Generalized response.

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

3. localized response

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

4. confused , agitated

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

5. Confused, inappropriate, non-agitated

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

6. confused , appropriate

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

7. automatic , appropriate

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

8. purposeful , appropriate

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

coma

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.

persistent vegetative state

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

JFK coma/near coma scale

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

minimally conscious state” … level 3

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

JFK coma/ near coma scale

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

post traumatic amnesia

what will happen when the pateint wakes up from a coma

often not remember the accident or evens immediately after it

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

GALVESTON ORIENTATION AND AMNESIA TEST (GOAT

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

3 consecutive scores of > 75

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

agitation

what do temporal lobe seizures casues

aggression

what are environments casues of agitation

sensory overload and deprivation

what are the cut off scores for agitated behavior 21 or less: 22-28: 39-25: >35:

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

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

moss attention rating scale

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

better then attention

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)

mild TBIq

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

30 13-15 24

what are the most common things reported with a mild TBI

headaches

when do activity and participation levels tend to plateau for TBI

1-2 years post injury

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

1 year

Traumatic brain injury Flashcards

(77 cards)