UNCONSCIOUSNESS

Consciousness refers to the normal level of wakefulness which is dependent upon the interaction of a functioning cerebral cortex and an intact reticular activating system.

CONSCIOUSNESS

1) Orientation to time, place, and person

2) Alert and awake 3) Awareness to the environment 4) Ability to answer questions appropriately

5) Intact recent and remote memory

Characteristics of consciousness

Confusion: • Loss of the means to think clearly and quickly.• Impaired judgement and decision making. Disorientation: • Disorientation to time or place.• Impaired memory.• Lack of recognition of self.• Lethargy• Restricted unprompted speech or movement.• Easy to arouse by normal speech or touch.• Potential disorientation to time, place or

person.

ALTERED LEVELS OF CONSCIOUSNESS

Obtundation: Mild to modest reduction in arousal Clouding of consciousness. Constrained responsiveness to surroundings. Ability to fall asleep easily. Ability to reply to questions with minimum

response. Stupor: An excessively long sleep-like state. A state of deep sleep or unresponsiveness. Arousable to verbal response only and to

vigorous and repeated stimulation, for example, shouting or shaking.

Withdrawal or grabbing response to stimulation.

Coma : A state of complete unresponsiveness. Lack of motor or verbal responses to

external surroundings or to any stimuli. No response to noxious stimuli for example,

deep pain. The person cannot be aroused at all by any

stimulus.

Seizure Cerebrovascular causes Tumour Cardiac arrest Heart or lung disease Asphyxiation Alcohol Carbon monoxide Drugs Infections

CAUSES OF ALTERED CONSCIOUSNESS

Normal conscious behaviour is dependent on an intact and fully functioning brain

RAS is responsible for arousal from sleep and maintaining consciousness.

RAS includes the mesencephalon (upper pons and mid-brain) and the thalamus

The RAS receives input signals from the senses

Disorders that affect any part of the RAS can produce coma.

PATHOPHYSIOLOGY

Direct compression or destruction of the structures

Decrease in availability of oxygen or glucose

Toxic effects of substances on the structures of the RAS

UNCONSCIOUSNESS

Assessment identification of major etiological factors history, neurologic examination, identification of related signs and symptoms

and significant diagnostic tests

NURSING CARE OF UNCONSCIOUS CLIENT

Eye response 1.No eye opening

2.Eye opening in response to pain

3.Eye opening to speech

4.Eyes opening spontaneously

Glassgow Coma Scale

Motor response

1.No motor response

2.Extension to pain

3.Abnormal flexion to pain

4.Flexion/Withdrawal to pain

5.Localizes to pain.

6.Obeys commands

Verbal response

1.No verbal response

2.Incomprehensible sounds

3.Inappropriate words

4.Confused

5.Oriented

Alert: this refers to spontaneous eye-opening, speaking and intact motor functions, for example, able to move limbs

Voice: responds when spoken to. The response may be the spoken word (speech) or a grunt

Pain: responds to pain, for example, the sternal rub

Unresponsive: if no response to pain, such as no eye, voice or motor movement

AVPU Scale

Ineffective airway clearance Impaired gas exchange Alteration in tissue perfusion, cerebral Sensory perceptual alterations Alteration in nutrition less than body

requirements Alteration in bowel elimination Alteration in patterns of urinary elimination Self care deficit: feeding, bathing, dressing,

toileting Impaired physical mobility Potential for impaired skin integrity

Nursing Diagnoses

Assess respiratory status, oral cavity, and oxygen saturation

Oropharyngeal airways Oxygen therapy Chest PT Lateral recumbent position Suctioning ET tube insertion and mechanical

ventilation

Respiratory function

Monitor pulse, B.P Passive limb movements I/O chart Antiembolic stockings Anticoagulants as ordered

Cardiovascular function

Monitor S. electrolytes Maintain I/O chart Monitor urine protein Sliding scale insulin Enteral feeding Parenteral feeding and IVF

Nutrition and hydration

Maintain adequate hydration Monitor bowel pattern, bowel sounds Maintain I/O chart Administer laxatives as ordered

GI function

Monitor urine out put Adequate fluid intake Urinary catheter Catheter care

Genitourinary function

Assess skin colour, turgor, and integrity Change position frequently Use pressure relieving matresses Ensure that skin is dry after bed bath Cut nails short Oral hygiene Eye care

Hygiene and skin care

Positioning Maintain body alignment Lateral recumbent position Position feet at 90° to the leg

Communication Reassure the patient Explain all the procedures Talk to the patient

Thank you !