SCI TBI

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Author:
brandikh
ID:
239977
Filename:
SCI TBI
Updated:
2013-10-10 21:27:21
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SCI TBI
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SCI TBI
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  1. autonomic dysreflexia
    • (life-threatening response to a noxious stimulus [such as a full bladder] below the level of injury); severe headache, diaphoresis, bradycardia & fast rise in bp, possibly causing stroke; ):  strong sensory input that travels up the spinal cord & causes massive reflex sympathetic surge and vasoconstriction;
    • occurs in pts with upper thoracic and cervical spinal cord injury; may be asymptomatic or sudden increase in BP, bradycardia, anxiety, blurred vision, headache, flushing, sweating; pts often have low resting BP
  2. Describe Rancho scale; ie what's worse
    Level I is unresponsive, while level 10 is independent
  3. complication of severe brain injury is a syndrome of intermittent agitation, diaphoresis, hyperthermia, HTN, tachycardia, tachypnea, and extensor posturing
    paroxysmal autonomic instability with dystonia after brain injury (PAID)
  4. Diff b/w primary and secondary TBI
    • Primary:  direct injury to brain; can cause permanent brain damage due to direct tissue destruction; 
    • Secondary:  due to a natural inflammatory cascade that occurs subsequent to primary injury; often hypoxia or anoxia
  5. What are deficits that u see with TBI?
    • dysphagia; may need mechanical ventilation; delayed gastric emptying; spasticity, posturing, "storming"
    • inability to take in adequate fluid (dysphagia or altered consciousness
  6. Classification of severity of brain injury is based on 3 things:
    Indicate the parameters for mild, moderate, and severe
    • loss of consciousness (LOC), alteration of consciousness (AOC), posttraumatic amnesia (PTA)
    • Mild:  LOC=0-30 min; AOC=a moment up to 24 hrs; PTA= 0-1 day
    • Moderate:  LOC >30 min but <24 hrs; AOC >24 hrs; PTA >1 day but <7 days
    • Severe:  LOC >24 hrs; AOC >24 hrs; PTA >7 days
  7. SIADH (syndrome of inappropriate ADH)
    disorder of impaired water excretion caused by the inability to suppress the secretion of antidiuretic hormone; leads to water retention which leads to hyponatremia
  8. BMI equation
    [wt (lb) / ht2 (inches)] x 703
  9. labs affected by dehydration & are they high or low
    • Na: hypernatremia
    • K+:  low
    • BUN/creatinine: >20:1 (higher number equals dehydration)
  10. SCI pt:  how to adjust IBW for paraplegia, quadriplegia, and obesity
    • paraplegia:  -5-10% of IBW
    • quadriplegia:  -10-15% of IBW
    • obesity:  [(actual-ideal) x .38] + IBW
  11. SCI:  how to assess kcal needs in chronic phase
    • if mild or not in acute phase, use 20-25 kcal/kg;
    • 2 articles say paraplegia 28 kcal/kg; quadriplegia 23 kcal/kg
  12. SCI:  how to assess kcal needs in acute phase
    • if mod or severe, use harris-benedict x injury factor x activity factor (if necessary)
    • readings say to use harris benedict x activity factor 1.2 x injury factor 1.3
  13. SCI:  protein needs in chronic phase
    • .8 g/kg if no wounds
    • 1.5 g/kg if large pressure ulcers in advanced stages
  14. SCI:  protein needs in acute phase
    at least 2 g/kg but no more than 2.3-2.4 g/kg
  15. Wounds: kcal, protein, and fluid
    • kcal:  30-35 kcal/kg (if underwt or losing wt 35-40 kcal/kg OR if stage III or IV pressure ulcer)
    • protein:  1.25-1.5 g/kg (if >1 wound or stage IV ulcer OR if severely catabolic, 1.5-2.0 g/kg)
    • fluid:  30 mL/kg or 1.0-1.5 mL/kcal consumed
  16. How to calculate nitrogen balance immediately after injury
    (24 hr protein intake (g)/6.25) - (24 hr UUN + 4)
  17. Why is bowel care needed for SCI pts & what causes them to need bowel care? Negative consequence of not doing bowel care?
    • pts with SCI have neurogenic bowel (due to disruption in reflex pathways) so may not feel the urge to defecate and/or may have lost anal tone;
    • schedule of BMs to prevent bowel accidents using suppositories or mini-enema
    • autonomic dysreflexia
  18. PTRP pts:  long-term effect of TBI and why can lead to wt gain
    • pt may not be able to perceive that the stomach is full
    • alterations in hormones
    • depression
    • medications side effects
    • less physical activity

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