Head Injury
What are the 2 types of TBIs and explain the difference
Open head injury- foreign object inters or penetrates the skull
closed head injury- head suffers a concussive or forceful blow
A closed brain injury occurs when acceleration, deceleration and rotational forces occur and cause brain tissue to shear apart.
Is decorticate posturing or Decerebrate posturing considered a worse state after TBI?
Both are signs of severe brain damage, but typically, decerebrate is considered worse.
List at least 3 common symptoms of hypoglycemia
shaking or trembling, faster HR, extreme hunger, dizzy, sweaty, confusion/difficulty concentrating
What level of SCI can a patient survive without respiratory support/a ventilator?
Sometimes at C4, for sure at C5
Why could alcoholism be more difficult to detect in an older adult vs a younger adult?
Overlap with aging symptoms (fatigue, confusion, diff. with coordination, weakness, depression) Alcohol can amplify side effects of meds- dizziness and confusion
How many points is the range of the Glasgow coma scale?
What are the ranges with severe, moderate and mild?
3-15
•Severe: GCS 3-8 (You cannot score lower than a 3.)
•Moderate: GCS 9-12
•Mild: GCS 13-15
List at least 4 of the skins functions
•Protection from infection
•Conserving body fluids
•Regulating body temperature
•Producing vitamin D
•Cosmetic covering
•Sensation
•Allows movement
Give an example of a physical AND a chemical restraint
Physical- Vests, straps, wrist ties, splints, mitts, belts, recliners, geri-chairs, and bedside rails
Chemical- Anti-anxiety, antidepressant, sedatives and antipsychotic meds
What level of spinal cord injury can you start incorporating the functional application of tenodesis?
C6
At what ACL level do patient's typically have trouble with new learning
•Level 4: Functioning at basic level, but difficulty with new activities
Describe what errorless learning is and give an example
Presenting information in a way that the learner does not have the opportunity to give or choose a wrong answer…done through repeated exposure to the correct answer and the use of prompting.
Today is Monday. You are at …..”
(Avoid saying “Do you know what day it is? Where are we?)
“It’s time to comb our hair”
(Then hold your hand on top of theirs and guide the combing if needed.)
“Hi, John. It’s Sally from your neighborhood.”
(Avoid saying “Do you know who I am?”)
What hand impairment results from the inability to extend DIP joint
Mallet Finger
List the 5 stages of grief in order
Denial
Anger
Bargaining
Depression
Acceptance
What are some S&S of orthostatic hypotension?
What should you help your patient do if this happens?
dizziness, nausea, loss of consciousness, tinnitus, see black spots in vision
"Raise the tail"
Recline gradually until recovery and possibly use a tilt function or tilt table.
What are 3 strategies to increase food intake for those with dementia?
•Offer finger foods
•Limit the # of utensils given
•Provide high contrasting tableware
•Limit # of choices
•Keep the same routine the client is used to
The strongest influence for long term recovery with a patient who has had a TBI.......
Family support
List 4 ways to use desensitization for the hypersensitive hand
1- Variety of textures- progressing form soft to hard to rough (and alternate pressure)
2- Start to use it as you are able
3- Percussion- tapping
4- Vibration
5- Heat and contrast baths
List 3 pieces of AE for medication management
Calendars
Pill storage boxes
Insulin holders
Pill splitters
Pill crushers
Talking alarms, watches, Rx bottles
Medication diary
Storage cups
Which type of spinal cord injury is characterized by damage to only one side of the cord, resulting in motor paralysis on the same side as the injury?
Brown-sequard syndrome
List 3 strategies to decrease wandering for someone with dementia
•Deterrents : signs as “Detour”, “out of order”, “use other door”, "Closed"
•Camouflage: concealing doors and windows, wall murals with homelike scenes
•Diversions: Get interested in a different activity
For Level 5 on the Ranchos Los Amigos Scale-Confused-Inappropriate, Non-agitated
Describe how a patient might present.
•Appears alert
•Able to respond to simple commands
•Agitated with external stimuli
•Highly distractible
•Confabulation, but often appropriate to the environment
•With structure, may increase socialization
•Memory is severely impaired, with confusion of the past and present
•Poor initiation
•Difficulty with new learning
•May wander randomly
Draw and label the Rule of 9s on the board.
Head- 4.5% on each side
4.5 each side of UE
18% torso on each side
9% each side of leg
1% groin
Name common side effects for medications to address CHF such as Digoxin and Lasix
Mental confusion, weakness, arrhythmias
What are the signs of autonomic dysreflexia? At what level do you need to be concerned about AD?
Overreaction of the ANS. Pounding headache, anxiety, sweating, flush, chills, nasal congestions, HTN, bradycardia
T6
Describe the 4 stages of Alzheimer's Disease
1- Early/mild- •memory loss with recent events, decrease decision making, attention, lack of spontaneity and less initiative, impaired word-finding and prefers familiar setting
2-Mid/Mod- difficulty spoken or written language, ask questions constantly, perceptual problems, possible delusions, hallucinations and agitation, able to respond to cues, pace, wander
3- Late/severe: •Dependent ADL, decreased appetite, chewing and swallowing, incontinence, does not recognize familiar people, increased falls and repetitious movement or sounds
4- Terminal- usually bed or w/c, decreased tracking, few incoherent words, little spontaneous movement