Exemplar 11.C - Traumatic Brain Injury (TBI)

Traumatic brain injury occurs when which of the following causes some degree of impairment to brain structure or function? A) Congenital disorder B) External force C) Infection D) Stress reaction

B) External force Traumatic brain injury occurs when an external force causes some degree of impairment to brain structure or function. The damage caused by this external force is referred to as the primary injury. Traumatic injury is not congenital and does not follow from infection or psychologic stress.

The school nurse is teaching a group of adolescent athletes about reducing the risk for sustaining traumatic brain injuries (TBI). To provide client-centered education to this population, which information is most appropriate for the school nurse to include in the teaching session? A) "A fall from even a low height can cause traumatic brain injury." B) "A traumatic brain injury can occur to anyone from a wide range of causes." C) "If you are injured in a game or practice, don't play through the pain." D) "Wearing seat belts can protect against injuries in motor vehicle collisions."

C) "If you are injured in a game or practice, don't play through the pain." Adolescents often downplay their injuries or do not report them for fear of looking weak or being unable to participate in sports and other activities. This greatly increases their risk of being injured again and developing second impact syndrome, which can be fatal. Nurses play a vital role in helping prevent both first-time and repeated TBIs by providing appropriate client teaching. Although the other statements are true, they don't specifically address the prevention challenges for TBIs that adolescents present.

A nurse is planning a teaching exercise on prevention of traumatic brain injury and identifying examples of people with a higher risk of TBI. Which of the following people is not in a higher-risk group for a TBI? A) A 2-year-old child B) A 13-year-old adolescent C) A 44-year-old office worker D) A 77-year-old retiree

C) A 44-year-old office worker The office worker is not in a professional occupation involving a high risk of physical impact and so would not be in a higher-risk group for TBI. Because TBI is often the result of an accident, every individual is at risk for TBI. However, some individuals have a higher risk than others. Children, especially children under the age of 4, are at increased risk for TBI due to falls or abuse. Adolescents and young adults are at increased risk for TBI due to interpersonal violence and sports. Older adults are at increased risk for TBI due to falls, which are usually related to sensory perception changes or medication side effects.

Which clinical manifestation is associated with a mild concussion? A) Bleeding in the brain B) Difficulty breathing C) Acute headache D) Prolonged unconsciousness

C) Acute headache Acute headache is a clinical manifestation of a mild concussion or traumatic brain injury. Bleeding in the brain, difficulty breathing, and prolonged unconsciousness are all clinical manifestations of moderate to severe traumatic brain injury.

Which types of sports are most likely to cause concussion and traumatic brain injury? A) Competitive B) Energetic C) High-impact D) Team

C) High-impact High-impact and extreme sports such as boxing, football, hockey, and skateboarding carry a higher risk of concussion and TBI. Team sports might be competitive and energetic without being high impact.

Which of the following infant clients presenting with traumatic brain injury (TBI) is least likely the victim of child abuse? A) Infant with contusion sustained from fall from high chair B) Infant with contusion, unknown cause C) Infant with diffuse axonal injury following involvement as passenger in a vehicle collision D) Infant with diffuse axonal injury, unknown cause

C) Infant with diffuse axonal injury following involvement as passenger in a vehicle collision Assaults/child abuse are the leading cause of death for infants and children with TBI. Injury patterns will depend on the cause of injury. For example, an infant who suffers a TBI from shaken baby syndrome will exhibit diffuse axonal injury, whereas a toddler who suffers a fall may have a local contusion with edema from a coup-contrecoup injury. The fall from a high chair could have happened accidentally or have been caused to happen, and either a contusion or a diffuse axonal injury could be the result of abuse. A diffuse axonal injury following involvement in a vehicle collision, however, is most likely the result of the collision.

Which statement about cerebral edema or ischemia is true? A) It often causes a skull fracture. B) It is an example of a lacerating injury. C) It is an example of a penetrating injury. D) It is often secondary to a traumatic brain injury.

D) It is often secondary to a traumatic brain injury. Secondary injuries can be caused by intracranial damage or systemic insults to the brain. Some examples of secondary injuries include cerebral ischemia, cerebral edema, increased intracranial pressure (IICP), infection, hypoxia, hypotension, fever, and hyponatremia. Cerebral edema or ischemia might follow skull fracture but would not cause it, and neither is an example of a lacerating or penetrating injury.

A client presents with a mild concussion following a fall. Which nursing diagnosis is least likely to be made for this client? A) Acute Pain B) Acute Confusion C) Nausea D) Risk for Post-Trauma Syndrome

D) Risk for Post-Trauma Syndrome A client with a mild concussion following a fall might present with acute pain, acute confusion, and nausea, but a diagnosis of Risk for Post-Trauma Syndrome would be much more likely for a client with a moderate to severe traumatic brain injury.

A client is classified as Grade 4 for risk of cerebral vasospasm because of intracerebral clotting and absence of blood in the basal cisterns. Which diagnostic test is most useful to assess intracerebral hemorrhage and grade cerebral vasospasms? A) Cerebrospinal fluid (CSF) analysis B) CT scan C) MRI D) Transcranial Doppler

D) Transcranial Doppler Transcranial Doppler may be indicated for intracerebral hemorrhage and is especially useful with grading cerebral vasospasms that may accompany a subarachnoid hemorrhage. A CT scan is vital to the diagnosis of traumatic brain injury (TBI) because it can detect the presence and location of skull fractures, contusions, hematomas, hemorrhage, and other brain damage. MRI scans are beneficial for providing more detailed brain images, including axonal injury, once the client is stabilized. Any clear fluid that leaks from the client's nose or ears should be assessed for CSF (glucose will be present) because this may be indicative of a basilar skull fracture.