Traumatic Brain Injury (TBI)

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Questions and Answers

Which of the following best describes a primary traumatic brain injury (TBI)?

  • Physiologic responses to the initial injury.
  • Brain damage resulting from increased intracranial pressure after the initial impact.
  • Mechanical damage that occurs at the time of the traumatic event. (correct)
  • The development of cerebral edema days after the initial injury.

A patient involved in a motor vehicle accident presents with a basilar skull fracture. Which assessment finding would be most indicative of this type of fracture?

  • Break in the cranial bone at the base of the skull. (correct)
  • Localized bleeding and swelling outside the brain.
  • Tearing of nerve fibers in the white matter.
  • Localized bleeding and swelling inside the brain.

A patient is diagnosed with a contusion following a fall. What specific type of injury is a contusion?

  • Tearing of brain tissue.
  • Generalized disruption of neuronal function.
  • Localized bleeding and swelling inside the brain. (correct)
  • Functional injury without pathological injury.

Which of the following mechanisms primarily contributes to diffuse axonal injury (DAI) in traumatic brain injury?

<p>Shearing forces from rapid acceleration or deceleration. (D)</p> Signup and view all the answers

A patient with a traumatic brain injury is experiencing increased intracranial pressure (ICP). Which secondary injury is most directly related to this condition?

<p>Ischemia (B)</p> Signup and view all the answers

Which of the following is the MOST common cause of traumatic brain injury?

<p>Falls (A)</p> Signup and view all the answers

A patient presents with a mild traumatic brain injury. Which of the following symptoms is MOST indicative of this condition?

<p>Blurred vision (D)</p> Signup and view all the answers

Which of the following assessments is MOST important when recognizing cues related to neurological function in a patient with a traumatic brain injury?

<p>Mental status (A)</p> Signup and view all the answers

Which of the following nursing actions is MOST important for a patient with a traumatic brain injury?

<p>Airway/breathing management (B)</p> Signup and view all the answers

Which of the following therapies is considered a collaborative action in the care of a patient with a traumatic brain injury?

<p>Physical therapy (B)</p> Signup and view all the answers

What is the primary purpose of using diuretics in the pharmacotherapy of traumatic brain injury?

<p>To reduce intracranial pressure. (C)</p> Signup and view all the answers

What is the primary goal of performing a craniotomy on a patient with a traumatic brain injury?

<p>To relieve increased intracranial pressure. (D)</p> Signup and view all the answers

What is the difference between a concussion and a contusion?

<p>A concussion is a functional injury while a contusion is a structural injury. (C)</p> Signup and view all the answers

Which TBI is caused by tears or rupture in brain tissue/blood vessels?

<p>Laceration (D)</p> Signup and view all the answers

Which type of skull fracture consists of multiple breaks?

<p>Comminuted (B)</p> Signup and view all the answers

Which of the following signs and symptoms is indicative of a moderate to severe TBI?

<p>Seizure (B)</p> Signup and view all the answers

What is the purpose of monitoring Cushing's Triad in TBI patients?

<p>Detect impending herniation (B)</p> Signup and view all the answers

What is the purpose of ventriculoperitoneal shunt surgery?

<p>Alleviate intercranial pressure (C)</p> Signup and view all the answers

Which of the following assessments relates to musculoskeletal function?

<p>Coordination (D)</p> Signup and view all the answers

Which TBI cause is related to functional deficits without pathological injury?

<p>Concussion (B)</p> Signup and view all the answers

Flashcards

Traumatic Brain Injury (TBI)

Injury resulting from an external force causing disruption of normal brain function due to displacement of the brain within the skull.

Primary TBI

Results from mechanical injury at the time of trauma, such as skull fractures, contusions and diffuse axonal injury.

Secondary TBI

Physiologic responses to the initial injury like increased intracranial pressure and hypoxia.

Skull Fracture (Primary TBI)

A break in the cranial bone, which can be linear, comminuted, depressed, or basilar.

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Contusion (Primary TBI)

Structural injury involving localized bleeding and swelling inside the brain, often caused by blunt trauma or coup-contrecoup injuries.

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Concussion (Primary TBI)

Functional injury resulting in functional deficits without pathological injury, caused by a sudden blow or rapid movement of the head.

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Laceration (Primary TBI)

Tears or rupture in brain tissue or blood vessels of the brain, where the pia and arachnoid are also pierced, caused by blunt or penetrating trauma.

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Diffuse Axonal Injury (Primary TBI)

Traumatic shearing forces leading to tearing of nerve fibers in the white matter, caused by rapid acceleration, deceleration, or rotational forces.

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Ischemia (Secondary TBI)

Compromised blood flow to the brain tissue.

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Hypoxia (Secondary TBI)

Insufficient oxygen supply to the brain.

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Cerebral Edema (Secondary TBI)

Swelling of brain tissue.

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Increased Intracranial Pressure (IICP) (Secondary TBI)

Increased pressure inside the skull.

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Meningitis (Secondary TBI)

An infection of the membranes (meninges) surrounding the brain and spinal cord

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Epilepsy (Secondary TBI)

Seizures

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Mild TBI Symptoms

Indicates a mild TBI, including headache, memory problems, blurred vision, dizziness, fatigue, and sleeping difficulties.

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Moderate to Severe TBI Symptoms

Indicates a moderate to severe TBI, including persistent headache, profound confusion, slurred speech, seizure and coma.

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Musculoskeletal Assessment (TBI)

Motor function evaluations and inspection/palpation.

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Physical Therapy

This therapy improves patients strength, mobility, and overall physical function to regain independence.

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Occupational Therapy

This therapy helps people regain independence in all areas of their lives. OT can help patients recover from a TBI learn or relearn skills.

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Common causes of TBI

Falls, struck by object, motor-vehicle accidents and assaults.

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Study Notes

  • Traumatic Brain Injury (TBI) results from an external force

Overview

  • TBI disrupts normal brain function due to brain displacement within the skull
  • Primary TBI results from mechanical injury at time of trauma
  • Secondary TBI involves physiologic responses to the initial injury which can take seconds, minutes or days to appear

Primary TBI

  • Occurs immediately at time of trauma
  • Include skull fractures, contusions, concussions, lacerations, diffuse axonal injury, and intracranial hemorrhage
  • Caused by penetrating or non-penetrating injuries

Primary TBI: Skull Fracture

  • Break in the cranial bone
  • Types include linear, comminuted, depressed, and basilar fractures

Primary TBI: Contusion

  • Structural injury involving localized bleeding and swelling inside the brain
  • Caused by blunt trauma or coup-contrecoup injuries

Primary TBI: Concussion

  • Functional injury resulting in functional deficits without pathological injury
  • Caused by a sudden blow or rapid movement of the head through low velocity forces

Primary TBI: Laceration

  • Tearing or rupture in brain tissue or blood vessels
  • Pia and arachnoid layers are pierced
  • Caused by blunt or penetrating trauma

Primary TBI: Diffuse Axonal Injury

  • Traumatic shearing forces lead to tearing of nerve fibers in the white matter
  • Caused by rapid acceleration, deceleration, or rotational forces
  • Leading cause of long-term disability and trauma

Secondary TBI

  • Delayed from primary injury
  • Examples include Ischemia, hypoxia, hypotension/HTN, cerebral edema, increased intracranial pressure (IICP), hypercapnia, meningitis, epilepsy, and biochemical changes

Recognize Cues: Mild TBI

  • Presents with headache, memory problems, blurred vision, dizziness and fatigue, and sleeping difficulties

Recognize Cues: Moderate to Severe TBI

  • Presents with persistent headache, profound confusion, slurred speech, seizure, and coma

Neurological Cues

  • Assess mental status
  • Check pupillary response and Glasgow Coma Scale
  • Assess sensory function like facial movements, light touch, pain, stereognosis, and graphesthesia

Musculoskeletal Cues

  • Assess motor function through inspection/palpation
  • Measure limb size
  • Evaluate range of motion, muscle strength, gait, coordination/balance, and reflexes

Nursing Actions

  • Establish baseline, secure airway/breathing and monitor ABG's
  • Monitor vital signs, maintain cerebral perfusion pressure (CPP) and monitor for Cushing's Triad
  • Positioning of patient to promote perfusion
  • Implement neurologic examinations, check cranial nerves, Glasgow Coma Scale and monitor posturing

Collaborative Actions

  • Physical Therapy
  • Occupational Therapy
  • Speech and Language Therapy
  • Cognitive Rehabilitation
  • Psychological Support

Pharmacotherapy

  • Anticonvulsants
  • Barbiturates
  • Calcium Channel Blockers
  • Diuretics

Surgical Interventions

  • Craniotomy
  • Craniectomy followed by cranioplasty
  • Endoscopic Ventriculostomy
  • Ventriculoperitoneal Shunt Surgery

Traumatic Brain Injury Statistics

  • Leading causes include
    • Falls (28%)
    • Motor vehicle accidents (20%)
    • Struck by objects (19%)
    • Assault (11%)
    • Suicide (1%)

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