Comparison of Post Concussive Syndrome and Traumatic Brain Injury, Exams of Nursing

Download Comparison of Post Concussive Syndrome and Traumatic Brain Injury and more Exams Nursing in PDF only on Docsity! 1 due Nov 4 Rubric Course Hero 1 Example Week 1: Compare and Contrast Assignment No unread replies.No replies. Compare and contrast the following diagnoses as assigned: Student Last Name -Topic (Find the corresponding first letter of your last name to find your topic assignment for this discussion) A-I - Compare and Contrast Dementia and Delirium J-Q = Compare and Contrast Post Concussive Syndrome and Traumatic Brain Injury R-Z = Migraine Headache and Post Concussive Syndrome First post due by Wednesday, 11:59 p.m. MT Please see the assignment guidelines and grading rubric in the course resource section. INITIAL POST DUE WEDNESDAY: Professor and Class, I will compare and contrast post concussive syndrome (PCS) and traumatic brain injury (TBI) in the following areas: presentation, pathophysiology, assessment, diagnosis, and treatment. TBI has many definitions that include an insult to the brain from an external mechanical force, with an associated diminished or altered state of consciousness, leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions. PCS is often the result of a mild TBI and includes symptoms of headache, dizziness, agitation or anxiety, and cognitive impairment. The pathophysiology and other aspects of TBI is much less 2 controversial and more understood compared to PCS; however, up to 80% of patients with mild to moderate TBI will experience some PCS. Presentation Post Concussive Syndrome and Traumatic Brain Injury 4 spatial, and motor deficits. The presence and severity of PCS is determined by the amount of time the brain stays in this dysfunctional state, not the severity of the impact. Calcium inside the cell is cytotoxic and is allowed into the cells for about four days post-concussion. In response, the cell binds the calcium up in the mitochondria but this prevents the production of ATP. It is in this stage that cell death can occur. Because of these changes, the neurons cannot talk to each other and that is why patients have amnesia or loss of consciousness. Three days post- concussion, the brain stimulation from the individual neurons that usually increases blood flow and consequently glucose stops working. This results in the neurons starving to death. If a second injury occurs during these states where the neurons are non-functional, even more cell death will occur. Patients who are young and health are able to bounce back from these injuries faster than older patients (Appenteng et. al., 2018). Assessment Traumatic brain injury (TBI) • Assessment will show which type of TBI is involved: closed or open head, penetrating, diffuse axonal, or contusion injuries • Common assessment findings include prolonged or permanent changes in a person's state of consciousness, awareness or responsiveness. The Glasgow coma scale (GCS) is used to assess these findings of TBI. • Always assess airway, breathing, respirations, and vital signs followed by a head to toe assessment. • Drug or alcohol intoxication (Bramley, Hong, Zacko, Royor, & Silvis, 2016). Post Concussive Syndrome and Traumatic Brain Injury 5 Post concussive syndrome (PCS) • Detailed history of injury Post Concussive Syndrome and Traumatic Brain Injury 6 • Ask about any changes to mood, personality, or sleep patterns • Ask about presence of headaches, dizziness, or memory problems (Bramley, Hong, Zacko, Royor, & Silvis, 2016). Diagnosis Traumatic brain injury (TBI) • Glasgow Coma Scale (GCS) is frequently used to diagnose the severity of the injury. Post concussive syndrome (PCS) • Standardized assessment of concussion (SAC) or sports concussion assessment tool 2 (SCAT2) • MRI or CT if criteria met in assessments (Center for Disease Control and Prevention, 2017). Treatment Traumatic brain injury (TBI) • Stabilize the patient • Supportive care while unconscious • Rehab to regain physical function (Algattas & Huang, 2013). Post concussive syndrome (PCS) Post Concussive Syndrome and Traumatic Brain Injury 9 (Algattas & Huang, 2013). (Appenteng et. al., 2018) Post Concussive Syndrome and Traumatic Brain Injury 10 (Bramley, Hong, Zacko, Royor, & Silvis, 2016). (Center for Disease Control and Prevention, 2017). (Sharp & Jenkins, 2015). (Hebert, Schlueter, Hornsby, Van Gorder, Snodgrass, & Cook, 2016). (Neuroscience Education Institute, 2017). PEER DISCUSSION PART 2: “responds substantively to at least one peer including evidence from appropriate sources, and all direct faculty questions posted…. enters peer/faculty response by Sunday 11:59 p.m. MT.” Collapse SubdiscussionMarcela Andreotti Marcela Andreotti YesterdayOct 31 at 8:15pm Manage Discussion Entry Ann, Welcome to week 1. Good start with your comparison of TBI and PCS. I see you mentioning that an MRI or CT are appropriate tests, however, what is the criteria you would use to determine if it would be appropriate or not to order a MRI or CT scan? Is an MRI always indicated? Why or why not? Looking forward to your response. Dr. Andreotti Professor and Class, Computed tomography (CT) imaging is much more expensive than a Magnetic Resonance Imaging (MRI). CT scans also impart a lot more radiation than MRIs; however, they Post Concussive Syndrome and Traumatic Brain Injury 11 are much faster. Consequently, CT scans are frequently done in the emergency room (ER). Both CT scans and MRIs can measure the following injuries after a traumatic brain injury (TBI): Skull fracture, intracranial hemorrhage, and brain edema. MRIs have also been used in post-concussive Post Concussive Syndrome and Traumatic Brain Injury 14 prior injuries. This is incredibly important, especially if a prior injury was recent enough that the neurons are still in a compromised/depolarized state and anaerobic metabolism is still being used Post Concussive Syndrome and Traumatic Brain Injury 15 by the brain (Appenteng et. al., 2018). When the injury happens at this time it is referred to as “second impact syndrome (SIS)” and it is believed that it causes much more cell death as the neurons are already unable to get enough blood supply or produce enough ATP. However, I discovered that a SIS diagnosis is still somewhat hypothetical and has not yet been implemented into the World Health Organization (WHO)’s “Statistical Classification of Diseases and Related Health Problems (ICD)” 10th edition (Hebert, Schlueter, Hornsby, Van Gorder, Snodgrass, & Cook, 2016). Your “diagnosis” section was also great and had some pieces that I failed to mention in my initial post. I had listed out the different assessments that are used such as the Glasgow Coma Scale (GCS), Standardized assessment of concussion (SAC), and sports concussion assessment tool 2 (SCAT2). I liked that you listed out the diagnostic criteria and I feel that was a more elegant way to do it. As you stated, PCS diagnostic criteria includes history of a TBI and at least three of these symptoms: memory difficulty, difficulty concentrating, sleep disturbances, irritability, fatigue, dizziness, and headache. I did not come across psychoeducational interventions, like cognitive behavioral therapy (CBT), as treatment for PCS in my initial study but can see how useful that would be. Thanks for brining that up. PCS symptoms can last over a year and depression and insomnia are common sequela, so it makes sense. I knew that CBT was helpful for chronic illness, depression, and insomnia but had not connected the dots to PCS until I read your post. This also means that SSRIs can be helpful in treating PCS (Cooper, et al., 2015). Since my initial post, I have also learned that exercise can be helpful in treatment of PCS. In the initial period after a TIB, during the acute stage of PCS, it is important to have cognitive rest, but aerobic exercise might be helpful to restart sooner rather than later (Leddy et al., 2016). Post Concussive Syndrome and Traumatic Brain Injury 16 I had thought about exercise helping in the rehab post TBI to reinstate neuromuscular function for ADLS and I know exercise is healthy for our brains generally. However, I was hyper-focused on preventing “second impact syndrome” that I had not realized that it could be helpful in prolonged PCS. One thing exercise might help with is by improving balance. Vertigo is a common manifestation of PCS and exercise is known to be of some benefit there (Ellis et al., 2016; Neuroscience Education Institute, 2017). Since the data is not conclusive on SIS, I suspect I should implement the stronger research towards exercise for PCS. --Annie References Appenteng, R., Nelp, T., Abdelgadir, J., Weledji, N., Haglund, M., Smith, E., … Staton, C. (2018). A systematic review and quality analysis of pediatric traumatic brain injury clinical practice guidelines. PLoS ONE, 13(8), 1–17. https://doi- org.chamberlainuniversity.idm.oclc.org/10.1371/journal.pone.0201550 Cooper, D.B., Bunner, A.E., Kennedy, J.E., Balldin, V., Tate, D.F., Eapen, B.C., Jaramillo, C.A. (2015). Treatment of persistent post-concussive symptoms after mild traumatic brain injury: A systematic review of cognitive rehabilitation and behavioral health interventions in military service members and veterans. Brain Imaging and Behavior. Ellis, M., Leddy, J., & Willer, B. (2016). An evolving pathophysiological approach. Frontiers in Neurology. http://dx.doi.org/https://doi.org/10.3389/fneur.2016.00136 Hebert, O., Schlueter, K., Hornsby, M., Van Gorder, S., Snodgrass, S., & Cook, C. (2016). Post Concussive Syndrome and Traumatic Brain Injury 19 References Last Name, F. M. (Year). Article Title. Journal Title, Pages From - To. Last Name, F. M. (Year). Book Title. 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