Understanding Traumatic Brain Injury: Prevalence, Mechanisms, and Long-Term Effects, Exams of Nursing

Download Understanding Traumatic Brain Injury: Prevalence, Mechanisms, and Long-Term Effects and more Exams Nursing in PDF only on Docsity! CBIS Exam| 215 Questions all Answered 100% Correctly Acute Brain Injury An injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma Traumatic Brain Injury An alteration in brain function, or other evidence of brain pathology, caused by an external force 2 Mechanisms *trauma impact * traumatic inertial forces Non-traumatic brain injury Lack of O2, decreased nutrients to cells, exposure to toxins, pressure from tumor or blockage or other neuro disorder ABI Prevalence 2nd most prevalent disability in U. S. * 13.5 million Americans Children & TBI * non-accidental trauma cause of 80% of deaths in children under 2yo * 2/3 of children under 3yo that are abused have TBIs *falls cause 1/2 of TBI in 0-14yo domestic violence 67% of women in domestic violence had TBI symptoms Mild TBI *concussion *LOC > 30 min *loss of memory >24hrs *CGS 13-15 *normal CT or MRI *any AMS at time of incident Moderate TBI *LOC up to 24hrs *neuro signs of brain trauma * CGS 9-12 *may have focal findings on CT Severe TBI *LOC <24hrs *GCS 3-8 Rare, progressive, degenerative condition of central nervous system that is seen and repetitive brain trauma Dementia, memory loss, aggression, confusion, depression Hebbian Learning Neurons that fire together, wire together Experience independent learning " use it or lose it" Synaptogenesis The process by which neurons form new connections Disorders of consciousness Coma, Vegetative State, minimally conscious state Coma * no evidence of arousal * no response to internal or extrnal stimuli * May have reflexive response * resolves in 2 to 4 weeks Vegetative state Transition of severely brain damaged patients from a coma to wakefulness without awareness Can be months to years in this state Minimally conscious state condition in which someone has brief periods of purposeful actions and speech comprehension Emergence from DOC Requires at least one criteria: * functional communication by verbal or gestural Y/N response * functional use of 2 or more objects Automatic dysfunction syndrome Episodes of: dystonia (abnormal muscle tone), tachycardia, diaphoresis (sweating), hyperthermia, hypertension, tachypnea (rapid breathing) *occurs in 15%-33% of severe TBI Sleep Complications Hypogenic hallucinations - vivid dream like auditory, visual, or tactile sensations on experiences between sleep and wake Cataplexy - feature of narcolepsy. Sudden loss of muscle tone. Consciousness remains clear, memory not impaired and respirations intact Immediate post Trumatic convulsions (seizures) LOC & involuntary movements within seconds of impact *can be asymmetrical, short period of AMS & retrograde amnesia Early post Trumatic seizures *occurs within the first week *results from primary direct effect of trauma *risk factors: severe TBI, depressed skull fx , penetrating head injury, sub dural hematoma, entercerebral hematoma, epidural hematoma, portable contusion Late post Trumatic seizures * within 18 to 24 months however can be years later * also called post dramatic epilepsy * strongest risk factors are missile wounds, multiple contusions, multiple craniotomies tension headache nonmigraine headache in which pain is felt in all or part of the head *Trigeminal nerveC1-C3 nerve roots, occipital nerves Cervicogenic Headache Generated primarily from the cervical spine *C1 -C2 periorbital region *C2 - C3 parietal & frontal regions *C3 - C4 upper thoracic & lateral cervical region Craniomandibular Headache * subtype of tension headache that can cause difficulty with eating and talking Nocioceptive pain *ideational- unable to perform automatic tasks *buccofacial- limitations and performing purposeful movement of lips, cheeks, tongue, larynx and pharynx central cord syndrome Presents as weakness & numbness in arms * results from fall in with neck in hyperextention or with arthritis or spondylosis * bowel/bladder issues * able to walk however unable to grasp things Brown-Sequard Syndrome 1 side of spinal cord injured Ipsilateral paralysis, loss of light touch sensation on side of lesion, loss of pain & temperature sensation on contralateral side Anterior cord syndrome Loss of muscle control, pain & temperature sensation below lesion No loss of proprioception or touch sensation posterior cord syndrome Strength with no proprioception cognition A complex collection of mental activities such as attention, perception, comprehension, remembering and language Domains of cognition Attention, categorization, memory, processing speed, executive functions, metacognition Attention Divided, alternating, selective, sustained, focused Attention process training program (APT) Process specific approach to cognitive rehab. Hierarchy organized by difficulty Categorization Important in the speed of processing, problem-solving, and other higher order cognitive processes. * BI pt tend to categorize by single attribute only Stages of Memory Encoding, Storage, Retrieval Long term memory Explicit vs implicit Executive Functions * complex cognitive processes that involve reasoning, planning, judgment, initiation and abstract thinking Cognitive rehab approaches *approach in systemic manner *analyzing problems *consider alternative solutions *prioritizing solutions *review outcomes Metacognition (n) Awareness of thoughts 3 levels of metacognition 1) awareness of deficits 2) awareness of functional implications 3) awareness to set realistic goals Anosognosia Diminished self awareness and failure to recognize a personal disability Cognitive Rehab - Compensatory Approach *assumes some cognitive functions can't be recovered *focus on development of strategies *functional application is important Cognitive Rehab - Restorative Approach *repeated exposure & repetition through experience *therapeutic exercise to re-establish/strengthen specific cog skills bipolar I disorder One or more manic episodes bipolar II disorder One or more depressive episode followed by one or more hypomanic episode cyclothymic disorder Chronic fluctuation mood disturbance including both depressive and hypo manic states Schizophrenia Disorder lasting for at least 6mo with minimum of a 1 month phase of symptoms that include: delusions, hallucinations, incoherent speech, Catalonia or avolition. personality disorders 23% of TBI pts Organic personality disorder Frontal Lobe Syndrome Symptoms of other psychiatric disorders including depression, psychosis, mood disorders and other various conditions however the patient does not recognize these conditions * The difference between frontal lobe injury and regular depression is the patient's ability to recognize and acknowledge the deficit SUD interventions Screens for SUD *AUDIT - alcohol use disorder identification test *CAGE: yes or no questions *CRAFFT: screen for adolescents *ASSIST: alcohol, smoking and substance use involvement screening test Cranial Nerves concomitant spinal cord injury Present of co-occurring spinal cord injury and brain injury *60% of SCI pt's Visual Functions Somatoagnosia Lack of awareness of body structure and body part relationships Meninges Vestibular conditions *labrynththine concussion *post-traumatic Ménière's disease *basilar skull fx *vestibular migraine *perilymphatic fistula *benign paroxysmal positional vertigo (BPPV) *B vestibular hypofunction *central vertigo Olmstead Decision A ruling made by the US Supreme Court requiring the provision of community based services with such services are available and not opposed by the patient in question, As opposed to being institutionalized. TBI model systems of care *16 centers in US * developing and demonstrating a model system of care for persons with TBI *Emphasizing continuity and Comprehensiveness of care * maintaining a standardized national database for innovative analysis of TBI treatment and outcomes Peak Maturation Milepost Most brain maturation occurs from birth to 6 years. Injury in that time frame may be the most devastating time for injury to occur ages 3-5 *period of rapid brain growth *perfecting ability to form images, use words, place things in serial order, beginning problem solving Ages 8-10 Minority group for independent living model Disability is collective concern of society Societies responsibility for accommodating patient rather than the patient accommodating to society Six principles of person centered care Autonomy, beneficence, non-maleficence, fidelity, justice, veracity Beneficence (Definition) The clinicians obligation to do good for the patient Fidelity Clinician should keep promises made Veracity The clinician to be truthful and professional interactions Section 504 of Rehabilitation Act Equal treatment, and appropriate education for people with disabilities Preferential seating, extended time on exams, test in quiet, rest breaks, shortened assignments, books on CD Individuals with disabilities education act (IDEA) Federal education mandate to provide free appropriate public education and special education and support services to children with eligible disabilities Military Primary Injury Direct impact from over-pressure wave. Compressed air filled organs, catapults body diagnostic indicators for SBS Bleeding from brain Brain swelling Bleeding in eyes Long term disabilities in SBS Behavioral problems, learning disabilities, blindness, deafness, seizures, cerebral palsy Individual Education Plan - IEP Student's academic goals based upon assessment and the method to obtain these goals via specially designed instruction and related services Timeline: 60 days to complete assessment and hold IEP meeting Military Secondary Injury Debris impacts head or body Military tertiary injury Body impacts ground or object Military Quaternary Injury Inhalation of toxic gases or substance Military acute concussion evaluation (MACE) TBI screening developed by defense and veterans BI center. Provides gross measures of cognitive domain TBI military prevalence mTBI only 56% mTBI & PTSD 44% Community integrated rehabilitation (CIR) Post acute brain injury rehabilitation programs designed to support persons with brain injury in the community. Can include neural behavioral programs, residential programs, day treatment programs and home based programs Neural behavioral programs For Severe behavioral disturbances that require 24 hour supervision. Residential community program For those that cannot participate as outpatient, require 24 hour supervision or support Comprehensive holistic treatment/day treatments There is a need for intensive services and can benefit from improved awareness Home based program Client is able to resign at the home and able to self direct care Care management Premium is charged This covers doctors appointments and outpatient Medicare Part C Premium charged Optional cost saving managed care plan Medicare Part D Prescription drug coverage Omnibus Budget Reconciliation Act (OBRA) Authorizes the establishment of home and community based Medical services State Children's Health Insurance Plan (CHIP) Covers uninsured kids Affordable Care Act Mandate on individuals and employers to obtain or provide health insurance by 2014 or face penalties Early Measures Outcomes GCS, Abbreviated Injury Scale (AIS), LOC, JFK Coma Recovery Scale (JFK CRS-R), Post-traumatic amnesia (PTA), GOS Abbreviated Injury Scale (AIS) 1 time measure of severity Ranges 1 (minor) - 6 (unsurvivable) JFK Coma Recovery Scale Extended DOC 23 subscales, good for emerging consciousness Measures of Post-Traumatic Amnesia Longer the PTA, the more likely a person will have long term issues No formal scoring process Glasgow Outcome Scale 1-item descriptive outcome measure with 5 categories: Dead, vegetative, severely disabled, moderately disabled and good recovery Measures in Acute Rehabilitation Functional Independence Measure (FIM/FAM), Disability Rating Scale (DRS), Rancho Los Amigos Functional Independence Measure (FIM) 18-item, 7-level scale that assesses severity of disability in performing basic life activities Clinical tool Disability Rating Scale (DRS) 8 item assessment of impairment, disability & handicap or participation Research tool Post-Acute Measures Craig Handicap Assessment& Reporting Technique (CHART), Mayo Portland Adaptability Inventory (MPAI-4), Participation Assessment with Combined Tools- Objective (PART-O) Craig Handicap Assessment & Reporting Technique (CHART) 32 questions and 6 domains More for outpatient or home health Measures participation Objective measure of a persons engagement in societal roles Max score of 100 Mayo Portland Adaptability Inventory (MPAI-4) 35 item with 3 subscales measures problems after BI Rated 0-4 (no restrictions to severe restrictions) Participation Assessment & Reporting Technique (PART-O) Moderate to severe BI 3 legacy measures Quality of Life Mesures The quality of life scale is a valid instrument used to measure life satisfaction, usually in conjunction with a health issue of some kind. One of the most frequently used is the SF 36, a self report patient questionnaire mortality rates 37x more likely to die from seizures 12x more likely to die from septicemia 4x more likely to die from pneumonia 29% of death from circulatory problems CT Scan Standard test for head injuries Can determine: skull fx, hemorrhaging, blood clot, brain swelling or foreign object penetration Glial cells Noncommunicating cells which support and nourish the neurons Reticular activating system (RAS) Modulates or changes arousal, alertness, concentration in basic biological rhythms Functions like a dimmer switch Medulla oblongata Controls breathing, heart rate, blood pressure, swallowing, vomiting, sneezing Pons Essential for facial movements, facial sensation, hearing in coordinating Eye movements Midbrain Involved in elementary forms of seeing and hearing. Plays vital role in alertness and arousal Diencephalon Master really center for forwarding information, sensations and movement. sometimes considered part of the limbic system Thalamus Acts as a major relay station for incoming and outgoing sensory information. Injury to can cause: attention and concentration problems, difficulty with memory storage and retrieval, weekend mental stamina, decreased sensory information Hypothalamus Control center for hunger, thirst, sexual response, endocrine levels and temperature regulation Involved in flight or fight reaction's Works as the conductor of a person's emotional orchestra limbic system emotion and memory Mammalian brain Houses basic elemental drives, emotions and survival instincts Hippocampus Associated with memory Amygdala Ties emotional memories and reactions Primary motor cortex The section of the frontal lobe responsible for voluntary movement Prefrontal cortex part of frontal lobe responsible for thinking, planning, and language Primary sensory cortex Regions of the cerebral cortex that initially process information from the senses Broca's area Dysarthritic speech. Halted, labored speech Wernicke's area Can fluently talk but it won't make sense Major descending tracts spinal cord Anterior corticospinal tract, lateral corticospinal tract, rubrospinal tract, tectospinal tract Major ascending tracks spinal cord Fascuculus cuneatus and faniculus, lissauers tract, anterior and posterior spinocerebellar tracts, spinothalamic tract, spinoreticular tract, spinotectal tract Antidepressants Prozac, Elavil, Norpramin