Care of Unconsciousness Patient

CARE OF UNCONSCIOUSNESS PATIENT

Loss of Consciousness is apparent in patient who is not oriented, does not follow commands, or needs persistent stimuli to achieve a state of alertness. A person who is unconscious and unable to respond to the spoken words can often hear what is spoken.

Consciousness is a state of being wakeful and aware of self, environment and time

Unconsciousness is an abnormal state resulting from disturbance of sensory perception to the extent that the patient is not aware of what is happening around him.

Levels of Unconsciousness

1. Alert :

- Normal consciousness

2. Automatism :

• Aware of surroundings  
• May be unable to remember actions later
• Possible abnormal mood, may show defects of memory and judgement

3. Confusion :

• Loss of ability to speak and think in a logical coherent fashion
• Responds to simple orders
• May be disorientated for time and space

4. Delirium/Acute confusion with agitation :

• Characterised by restlessness and possible violence
• Not capable to rational thought
• May be troublesome and not comply with simple orders

5. Stupor :

• Quite and uncommunicative
• Remains conscious but sits or lies with a glazed expression
• Does not respond to orders
• Bladder and rectal incontinence occur
• More serious than the previous wild stage

6. Semi-coma :

• A twilight stage
• Patients often pass fitfully into unconsciousness
• May be aroused to the stuporosed state by vigorous stimulation

7. Coma :

• Patient deeply unconscious 
• Can not be roused and does not wake up with vigorous stimulation

Causes of Unconsciousness :

• Head Injury
• Skull Fracture
• Asphyxia
• Fainting 
• Extremes of Body Temperature
• Cardiac Arrest
• Blood Loss
• Cerebro vascular Accident
• Epilepsy
• Infantile Convulsions
• Hypoglycemia
• Hyperglycemia
• Drug Overdose
• Hypothermia
• Poisonous Substances and Fumes

Assessment of unconscious patients:

History

Physical assessment

Glasgow coma scale

        Eye opening

                     spontaneous  -4

                     to speech       -3

                     to pain           -2

                     no response   -1

        Verbal response

                      oriented    -5

                      confused   -4

                      inappropriate words  -3

                      incomprehensible sounds-2

                      no response      -1

        Motor response

                      Obeys commands  -6

                      Localizes  -5

                      Withdraws  -4

                      Flexes  -3

                      Extends  -2

                      No response  -1

  TOTAL  SCORE:  3-15

Assessment of LOC

• Evaluation of mental status.
• Cranial nerve functioning.
• Reflexes.
• Motor and sensory functioning.
• Scanning, imaging, tomography, EEG.
• Glasgow coma scale.

Nursing Diagnosis

• Ineffective airway clearance related to altered level of consciousness
• Risk for injury related to decreased level of consciousness.
• Risk for impaired skin integrity related to immobility
• Impaired urinary elimination related to impairment in sensing and control.
• Disturbed sensory perception related to neurologic impairment.
• Interrupted family process related to health crisis.
• Risk for impaired nutritional status.

Management

1. Maintaining patent airway

• Elevating the head end of the bed to 30 degree prevents aspiration.
• Positioning the patient in lateral or semi prone position.
• Suctioning.
• Chest physiotherapy.
• Auscultate in every 8 hours.
• Endo tracheal tube or tracheostomy.

2. Protecting the client

• Padded side rails
• Restrains.
• Take care to avoid any injury.
• Talk with the client in-between the procedures.
• Speak positively to enhance the self esteem and confidence of the patient. 

3.Maintaining fluid balance and managing nutritional needs

• Assess the hydration status.
• More amount of liquid.
• Start IV line.
• Liquid diet.
• NG tube.

4.Maintaining skin integrity

• Regular changing in position. 
• Passive exercises. 
• Back massage.
• Use splints or foam boots to prevent foot drop. 
• Special beds to prevent pressure on bony prominences.

5.Preventing urinary retention

• Palpate for a full bladder. 
• Insert an indwelling catheter.
• Condom catheter for male and absorbent pads for females in case of incontinence. 
• Inducing stimulation to urinate.

6. Providing sensory stimulation

• Provided at proper time to avoid sensory deprivation.
• Effort are made to maintain the sense of daily rhythm by keeping the usual day and night patterns for activity and sleep.
• Maintain the same schedule each day.
• Orient the client to the day, date, and time accordingly.
• Touch and talk.
• Proper communication.
• Always address the client by name, and explain the procedure each time.

7. Family needs

• Family support.
• Educate the needs of client.
• Care to be provided.

8. Potential complications

• Respiratory distress
• Pneumonia
• Aspiration
• Pressure ulcer