Understanding TBI Epidemiology, Symptoms, and Consequences, Exams of Nursing

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CBIS Exam-with 100% verified solutions- 2023 -

Why is Brain Injury considered the silent epidemic? Many problems that result from a brain injury are not always readily apparent. a. The effects of the brain injury (BI), such as changes in thinking, may not be readily apparent to an outside observer b. Negative consequences occur when the general public and medical providers do not recognize the effect of BI: i. Problems at work/ school ii. Changes in personal relationships iii. Legal problems iv. Homelessness True or False? Brain Injury is frequently not identified. True Define Acquired Brain Injury An injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma Acquired brain injury is an umbrella definition as it includes injuries caused by both __________ and __________ factors external; internal Match the following ABI with its cause: Traumatic Impact- Open & Closed

Causes (bank): Blast Assault GSW Hypoxia/ anoxia Fall Stabbing Ischemia Neurotoxic poisoning MVC Sports Tumor Infection CVA Open: GSW, stabbing, fall, sports, MVC Closed: Blast, Assault, Fall, Sports, MVC Match the following ABI with its cause: Traumatic Internal: (3) Sports, MVC, Fall Match the following ABI with its cause: Non-Tramatic Causes (bank): Blast Assault GSW Hypoxia/ anoxia Fall Stabbing Ischemia Neurotoxic poisoning MVC Sports Tumor Infection CVA Tumor, infection, CVA, hypoxia/anoxia, ischemia, neurotoxic poisoning. True or False? The importance of understanding the epidemiology of a brain injury assists in passing legislation. True True or False? 83% of all TBI's are mild False, 75% True or False?

After the first brain injury, a person is 3x more likely to have another brain injury and 10x more likely after a second to have a third. False, 8x Falls are the highest rate of TBI's in what age range? 0 - 4 y/o (50% of all TBIs) 65+ y/o (61% of all TBIs) Highest rate of TBIs from firearms are in what age ranges? 20 - 24 and 75+ y/o True or False? 2/3 children under the age of 3 y/o who are physically abused have TBIs True What percent of women who suffer domestic violence also have TBIs? A. 64% B. 67% C. 70% D. 72% B. 67% True or False? TBI signs and symptoms frequently go undiagnosed in the community, sports, prisons, military, children and domestic violence. True True or False? Progress along the continuum of care only goes in one direction

False What are the 2 national accreditation agencies? CARF, Joint Commission Annual cost of TBI (medical and lost productivity) are estimated at A. 75.6 million B. 76.5 million C. 75.6 billion D. 76.5 billion D. 76.5 billion Which of the following is not part of the Home and Community-Based waiver programs? A. Homemaker services B. Personal care C. Adult day D. All of the above D. All of the above Match the following: A. Rehabilitation Act of 1973 B. Olmsted Decision C. TBI Act of 1996 D. TBI Mod Systems E. Set the stage for funding of surveillance research on TBI, effectiveness research, and improvising systems of care. F. Conducts prospective, longitudinal research to demonstrate the course of recovery and outcomes following TBI

G. Typically contract with private brain injury service providers H. People should be allowed to live in the least confining setting that they qualify A, G B, H C, E D, F Those that have survived a TBI have a reduced life expectancy by how many years? A. 5 B. 6 C. 7 D. 8 C. 7 What percent of TBIs are considered to be Mild? A. 50% B. 65% C. 75% D. 85% C. 75% (may be higher due to lack of reporting) True or False? A mild TBI can be defined as any alteration in mental state True Additional issues that arise post mild TBI are all of the following except: A. Metabolic alterations B. Diffuse atonal injury C. Massive release of neurotransmitters glutamate

D. Dilation of vessels that impacts neurological function (constriction) E. All of the above D. Dilation of vessels that impacts neurological function (constriction) Common symptoms after a mild TBI are all of the following except: A. Fatigue B. Blurred vision C. Headaches D. Balance problems E. Changes in behavior F. All of the above F. All of the above True or False? Post-concussion syndrome and Persistent Post-concussion syndrome refer to symptoms that persist weeks or months after TBI. True True or False? The correct order for the meninges (inner to outer) is Pia mater, Dura mater, Arachnoid. False; Dura mater, Arachnoid, Pia mater (DAP) Match: A. Pia mater B. Dura mater C. Arachnoid

D. Spider web E. Tough mother F. Tender matter A, F B, E C, D Term: Midbrain

• Smallest part
• Elementary forms of vision and hearing
• Vital role in alertness and arousal Term: pons
• Connects the cerebellum and cerebral cortex
• Essential for facial movements & sensation, hearing and coord eye movements Term: Medulla
• Merges with spinal cord
• Control center for involuntary
• Involved in basic living functions The Diencephalon-Thalamus is responsible for all of the following EXCEPT: A. Sensory inputs pass through to go to higher levels in the brain B. Sits at the top of the Brian stem

C. All senses relay impulses through the thalamus D. Injury causes a wide range of symptoms E. Controls sleep/ wake cycles F. All are related C. All senses relay impulses through the thalamus (not smell) Term: Limbic system

• Deep brain structure
• Highly connected to other areas of the brain
• Controls all internal and external responses and actions Term: Hippocampus
• In the temporal lobe
• Susceptible to anoxia and hypoxia
• Association with memory
• Injury causes impaired STM, transition from STM to LTM, difficulty organizing stored Data Term: Amygdala
• Evaluates for emotional content
• Tired to emotional memories Term: Basal Ganglia
• Receives input from the cerebral cortex
• Alert for when something is not working the way it should and determines what behaviors to execute

• Regulates activities of the motor and ore motor areas
• Handles physical movements by relaying information from the cerebral cortex to the brain stem and cerebellum Term: Cerebellum
• Located in the lower back portion of the brain
• Coordinated and modulates all body movement
• Controls the direction, rate, force and steadiness of movements
• Injury causes problems with fine motor, direction of movement, balance and proprioception. True or False The left hemisphere is involved in intuition False a. left- linear, verbal/analytic, logical, right side of body, speaking, reading, writing b. Right- holistic, visual spatial, intuitive, left side of body, music, art, shapes Term: Primary motor cortex Location, controls/ function, injury Location: curves over top of head C/F: voluntary movement Injury: causes weakness or paralysis on the opposite side of the body

Term: Pre-frontal cortex Location, c/f, injury L: front of head C/F: evaluates options, predicts outcomes and decides the best course of action, influences ability to learn from consequences. I: causes difficulty making decisions, organizing and prioritizing, initiating and inhibiting actions, controlling emotions and interacting socially Term: Temporal Lobe Location, c/f, injury L: each side around the ear C/F: memory, language, hearing I: auditory. Processing, new learning, understanding, storing, and retrieving new information. Term: Brocca's Area Location, c/f, injury L: Left frontal-temporal C/F: speech production I: language expression is impaired. Speaks haltingly with few words. Term: Wernicke's Area Location, c/f, injury

L: left frontal-temporal C/F: speech comprehension I: language comprehension is impaired. Speaks fluent moly but does not make sense Term: Occipital Lobe Location, c/f, injury L: back of head C/F: visual processing, interpret visual information, recognition of size, color, light, motion, dimensions, etc. I: cortical blindness, agraphia, field cuts, movement agnosia, visual agnosia Term: Parietal Lobe primary sensory cortex Location, c/f, injury L: 'headband' across top of head C/F: sensation and perception: responds to touch, temperature and pain, processes sensory information. I: difficult identifying sensation: location, type, temp, pain, movement Term: Parietal Lobe somatosensory Cortex Location, c/f, injury L: 'headband' across top of head C/F: sensory input integration, spatial awareness and perception- awareness of body parts in space. I: agraphia, acalculia, anosognosia, aphasia, impaired attention, neglect, left-right disorientation.

True or False? The spinal cord receives messages from the brain through afferent nerve tracts. False, efferent List symptoms in each category: Central Cord Syndrome

• cervical area
• incomplete injury
• often result of a fall
• present as weak/numb UE
• often B/B incontinence List symptoms in each category: Brown-sequard syndrome
• only one side of SC is injured
• loss of pain and temp in same side
• paralysis and loss of touch on opposite side List symptoms in each category: Anterior cord syndrome
• loss of muscle control

• loss of pain and temp
• no loss of proprioception
• no loss of touch sensation List symptoms in each category: Posterior cord syndrome
• strength intact
• no proprioception below level of injury Describe/ Define mechanisms of injury: Acceleration/ deceleration: Rapid acceleration of the brain followed by a rapid deceleration, results in the shearing of axons and blood vessels throughout the brain, rendering white matter tracts (bundles of axons) non-functional, this is termed Diffuse Axonal Injury, or DAI. White matter (the neuron's myelinated axons) and gray matter (the neuron's cell bodies, dendrites and axon terminals) have different densities. The junction between gray and white matter is where DAI is more frequent. The corpus callousness is often injured in this fashion. Describe/ Define mechanisms of injury: Coup/ Contrecoup Initial site of injury (coupe), secondary contrecoupe. The bouncing of the brain in the skull can result in injury's opposite of each other. Describe/ Define mechanisms of injury:

Intracranial Pressure The brain can bleed and swell when injured. This can lead to pressure on the brain tissue and blood vessels, depriving the brain of oxygen, leading to additional injury. Describe/ Define mechanisms of injury: Hypoxia Lack of oxygen causes brain cells to die. When cells die, they release chemicals that can cause further damage to the brain Describe/ Define mechanisms of injury: Penetrating Injuries: When an object penetrates the skull and enters the brain True or False? Synaptogenesis is the formation of synapses between neurons True Neuroplasticity post- TBI involves all of the following EXCEPT: A. Structural changes in the brain at the site of the injury and around it B. Modulated by experience C. Compensates for the injury D. Involves directed exercise as well as constraint induced movement E. All the above

E. All Secondary injuries of a TBI include the following EXCEPT: A. Apoptosis (sudden death of cells) B. Edema (swelling) C. Excitoxicity (nerve cells suffer damage/ death) D. Mechanical damage E. All the above D. Mechanical damage True or False? Cardiopulmonary issue involves possible ventilator and/or medications abs are usually only the result of secondary damage from TBI False (pg. 98) True or False? Dysautomia or 'autonomic storming', usually resolves in early recovery True The following are examples of musculoskeletal earlier complications except: A. Hyperreflexia B. Contracture C. Spasticity D. Heterotopic Ossification

E. Osteoporosis F. All of the above E. Osteoporosis (chronic or late effect) How does a urinary tract infection effect therapy participation? A. Decreased level of alertness B. Increased agitation C. Pain D. Fever E. All of the above F. None of the above- no effect E. All of the above Nutrition after brain injury is complicated by A. Availability of food B. Safety awareness C. Restraints D. Lack of utensils B. Safety awareness Match phases of swallowing: A. Oral preparatory/ oral stage B. Pharyngeal phase C. Esophageal phase

D. Includes movement of the bolus past the epiglottis, through the pharynx and past the upper esophageal sphincter E. Mastication, bolus formation, and propulsion of the bolus into the pharynx F. Bolus moves through the esophagus toward the lower esophageal sphincter A, E B, D C, F What percentage of severe TBIs has difficulty with swallowing? A. 65% problems at oral phase B. 73% problems at the pharyngeal phase C. 84% D. 90% D. 90% problems with swallowing What percentage of brain injuries has difficulties with libido, arousal and sexual performance? A. 30-40% B. 30-50% C. 50-60% D. 40-60% D. 40-60% Pressure sores can be prevents by which of the following? A. Keeping skin clean and dry B. Changing positions C. Keeping pt in a supine position with decreased pressure on honey areas

D. Teach them to move independently in w/c E. A and B F. C and D G. All H. None E. A and B Match stages of pressure ulcers A. Stage I B. Stage II C. Stage III D. Stage IV E. Unstageable F. Deep Tissue Injury G. Intact skin w/ non-Blanche me redness of a localized area usually over a bony prominence H. Full thickness tissue kiss in which actual depth of the ulcer is completely obscured by slough and/or eschar in the wound bed. I. Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. J. Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, w/o slough. K. Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. L. Full thickness tissue loss with exposed bone tendon or muscle. Often includes undermining and tunneling. A, G B, J

C, I

D, L

E, H

F, K

True or False? Individuals with brain injuries are susceptible to infection when they have open wounds, use in-dwelling devices or are immune-suppressed. True After a TBI, individuals are ____% more likely to die of a seizure as compared to the general population. A. 19% B. 22% C. 26% D. 28% B. 22% List risk factors for each type of seizure: Early Post-Traumatic Seizures

• severe brain injury
• depressed skull fracture
• hematomas
• cortical contusion
• post traumatic amnesia more than 24 hrs

• chronic alcohol use List risk factors for each type of seizure: Late Post-Traumatic Seizures
• more frequently seen in people more than 65+ y/o
• usually from misslle wounds
• occur later than one week after initial head trauma
• stronger predictor for recurrent seizures List risk factors for each type of seizure: Status Epilepticus
• more than 30 mins of continuous seizure activity
• two or more sequential seizures without full recovery
• high mortality rate What is the difference between nocioceptive pain and neuropathic pain? a. Nocioceptive pain related to peripheral nerve fibers, pharmacological treatments include NSAID, acetaminophen, topical agents, opioids b. Neuropathic pain associated with primary lesion of dysfunction, medications include topical agents, opioids, tramadol, lyrica, anticonvulsants and antidepressants, tricyclics, trigger point injections, nerve blocks, epidural steroids. Study Headaches (Q53)

Q53 of guide True or False? The order of stages for a migraine are: Aura- Prodome- Headache- Postdrome False (pg. 123) Headache symptoms include all of the following EXCEPT: A. Character- sensation and intensity B. Onset- pattern to timing C. Location- where does it start? does it radiate? D. Duration- and frequency E. Exit- what action is taken to reduce headache? F. Relief- what reduces headache? E. Exit-what action is taken to reduce headache C.O.L.D.E.R. character, onset, location, duration, EXACERBATION-what intensifies the headache, relief. Match motor learning principles A. Cognitive B. Associative C. Autonomous D. How to succeed

E. What to do F. How to do it G. Learner begins to apply and self-monitor performance of task H. Learner acquires knowledge to perform task I. Learner consistently self-regulates and makes corrections to successfully perform task. A,E,H B,F,G C,D,I Risk factors for treatment of hydrocephalus include all EXCEPT: A. Headaches B. Brain bleed C. Fever D. Neck stiffness E. Change in level of alertness F. Dysphasia G. All F. Dysphasia List correct treatment options with the following conditions: Spasticity and Heterotrophic Ossification Bank: Oral Antispasmotics NSAIDS Neurotoxins Intrathecal Baclofen Pump Therapy Surgery Spasticity- oral antispasmotics, intrathecal baclofen pump, neurotoxins, therapy

Heterotrophic Ossification- NSAIDS, surgery Rate of vascular thrombosis embolism for individuals with multi system or major trauma exceeds: A. 45% B. 50% C. 55% D. 60% B. 50% Pulmonary embolism is the ______ leading cause of death in those who survived the first day post brain injury. A. 1st B. 2nd C. 3rd D. 4th C. 3rd