NURSING nr 603Week 1 - Compare and Contrast Post Concussive Syndrome and Traumatic Brain Injury

Week 1 - Compare and Contrast Post Concussive Syndrome and Traumatic Brain Injury Rubric Week 1: Compare and Contrast Assignment No unread replies.No replies. Compare and contrast the following diagnoses as assigned: Student Last Name -Topic (Find the corresponding first letter of your last name to find your topic assignment for this discussion) A-I - Compare and Contrast Dementia and Delirium J-Q = Compare and Contrast Post Concussive Syndrome and Traumatic Brain Injury R-Z = Migraine Headache and Post Concussive Syndrome First post due by Wednesday, 11:59 p.m. MT Please see the assignment guidelines and grading rubric in the course resource section. INITIAL POST DUE WEDNESDAY: Professor and Class, I will compare and contrast post concussive syndrome (PCS) and traumatic brain injury (TBI) in the following areas: presentation, pathophysiology, assessment, diagnosis, and treatment. TBI has many definitions that include an insult to the brain from an external mechanical force, with an associated diminished or altered state of consciousness, leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions. PCS is often the result of a mild TBI and includes symptoms of headache, dizziness, agitation or anxiety, and cognitive impairment. The pathophysiology and other aspects of TBI is much less controversial and more understood compared to PCS; however, up to 80% of patients with mild to moderate TBI will experience some PCS. Presentation Traumatic brain injury (TBI) • Lacerations • Hematomas • Fractures • Altered or decreased level of consciousness • Intoxication from alcohol Post concussive syndrome (PCS) • Sometimes there is a brief loss of consciousness • Patients with PCS will frequently tell bystanders that they are ok right after impact but others will notice mild changes in behavior. • Irritability, sleeplessness, depression, and malaise can persist for months after the injury. Pathophysiology Traumatic brain injury (TBI) • A brain impact causes glutamate to be released which then causes potassium to leave the cells, leaving the neurons depolarized. This can result in loss of consciousness (Algattas & Huang, 2013). Post concussive syndrome (PCS) • PCS is a neurochemical and metabolic cascade that occurs after shear forces with a TBI. In order to get the potassium back in so the neurons can function, ATP is used to power the sodium potassium pumps. This requires a tremendous amount of energy, 200 times the normal rate, and tires the brain out. Sugar is the main source of energy for the brain but it is not used properly in this depolarized state so anerobic metabolism happens with resulting lactic acid accumulation. This causes the neurons to be dysfunctional, not ischemic or dead, just dysfunctional. At this time adenosine is released and the brain is depressed showing cognitive, spatial, and motor deficits. The presence and severity of PCS is determined by the amount of time the brain stays in this dysfunctional state, not the severity of the impact. Calcium inside the cell is cytotoxic and is allowed into the cells for about four days post-concussion. In response, the cell binds the calcium up in the mitochondria but this prevents the production of ATP. It is in this stage that cell death can occur. Because of these changes, the neurons cannot talk to each other and that is why patients have amnesia or loss of consciousness. Three days post- concussion, the brain stimulation from the individual neurons that usually increases blood flow and consequently glucose stops working. This results in the neurons starving to death. If a second injury occurs during these states where the neurons are non-functional, even more cell death will occur. Patients who are young and health are able to bounce back from these injuries faster than older patients (Appenteng et. al., 2018). Assessment Traumatic brain injury (TBI) • Assessment will show which type of TBI is involved: closed or open head, penetrating, diffuse axonal, or contusion injuries • Common assessment findings include prolonged or permanent changes in a person's state of consciousness, awareness or responsiveness. The Glasgow coma scale (GCS) is used to assess these findings of TBI. • Always assess airway, breathing, respirations, and vital signs followed by a head to toe assessment. • Drug or alcohol intoxication (Bramley, Hong, Zacko, Royor, & Silvis, 2016). Post concussive syndrome (PCS) • Detailed history of injury • Ask about any changes to mood, personality, or sleep patterns • Ask about presence of headaches, dizziness, or memory problems (Bramley, Hong, Zacko, Royor, & Silvis, 2016). Diagnosis Traumatic brain injury (TBI) • Glasgow Coma Scale (GCS) is frequently used to diagnose the severity of the injury. Post concussive syndrome (PCS) • Standardized assessment of concussion (SAC) or sports concussion assessment tool 2 (SCAT2) • MRI or CT if criteria met in assessments (Center for Disease Control and Prevention, 2017). Treatment Traumatic brain injury (TBI) • Stabilize the patient • Supportive care while unconscious • Rehab to regain physical function (Algattas & Huang, 2013). Post concussive syndrome (PCS) • Rest • Low stimulation • Many details are controversial (Sharp & Jenkins, 2015). In summary, the difference between TBI and PCS is both subtle and very drastic. PCS cannot happen without a TBI but not all TBIs evolve into PCS. The development of PCS is not completely understood but it occurs more often at age extremes and in patients with poor health. PCS is also more severe when there are multiple injuries, meaning a repeat TBI happens while the neurons are still dysfunctional. --Annie References Algattas, H., & Huang, J. (2013). Traumatic brain injury pathophysiology and treatments: Early, intermediate, and late phases post-injury. International Journal of Molecular Sciences, 15(1), 309-341. doi:10.3390/ijms. Appenteng, R., Nelp, T., Abdelgadir, J., Weledji, N., Haglund, M., Smith, E., … Staton, C. (2018). A systematic review and quality analysis of pediatric traumatic brain injury clinical practice guidelines. PLoS ONE, 13(8), 1–17. https://doi- Bramley, H., Hong, J., Zacko, C., Royer, C., & Silvis, M. (2016). Mild traumatic brain injury and post-concussion syndrome. Sports Medicine and Arthroscopy Review, 24(3), 123-129. doi:10.1097/jsa.. Center for Disease Control and Prevention. (2017). Traumatic brain injury & concussion. Retrieved October 28, 2018, from Sharp, D. J., & Jenkins, P. O. (2015). Concussion is confusing us all. Practical Neurology, 15(3), 172-186. doi:10.1136/practneurol-. (Algattas & Huang, 2013). (Appenteng et. al., 2018)