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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
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Describe Rancho scale; ie what's worse
Level I is unresponsive, while level 10 is independent
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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)
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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
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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
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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
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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
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BMI equation
[wt (lb) / ht2 (inches)] x 703
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labs affected by dehydration & are they high or low
- Na: hypernatremia
- K+: low
- BUN/creatinine: >20:1 (higher number equals dehydration)
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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
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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
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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
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SCI: protein needs in chronic phase
- .8 g/kg if no wounds
- 1.5 g/kg if large pressure ulcers in advanced stages
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SCI: protein needs in acute phase
at least 2 g/kg but no more than 2.3-2.4 g/kg
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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
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How to calculate nitrogen balance immediately after injury
(24 hr protein intake (g)/6.25) - (24 hr UUN + 4)
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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
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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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