Care of unconcious patient

pictorial explanation of complete care of unconscious or bed ridden patients.
explanation of care using nursing diagnosis of patients.
level of consciousness.

1. TOPIC: CARE OF UNCONSCIOUS PATIENT SUBJECT: FUNDAMENTAL OF NURSING PRESENTED BY Victoria Angela Fernandez Clinical Instructor VCON

2. UNCONSCIOUS A condition In which there is a depression in cerebral function Ranging from stupor to coma.

3. Level of consciousness Alert (conscious) Open eyes spontaneously Respond to all stimuli appropriately. It is the state of wakefullness and responsiveness to the environment. Sleep Slow to respond but appropriate and oriented. It is a state of altered consiousness or Partial unconsiousness from which an individual can be aroused.

4. Contd...... Stupor Aroused by painful stimuli, Unclear conversation. Blinking amd swallowing reflex present. Coma Unresponsive , No reflexes Or voluntary movement.

5. Causes Cerebral Head injury Cerebral hemorrhage Tumors Cerebrovascular accident Disease ( meningitis, Encephalitis etc)

6. Contd..... Metabolic disease Hepatic coma Renal disease Hyperglycemia or hypoglycemia Dehydration Poisoning Septicemia

7. Clinical manifestations No response to external stimuli and no reflex action. Changes in vital signs Changes in Pupil size and reaction Changes in sphincter action Constipation Urinary incontinence Retention of Urine Fecal incontinence

8. Contd.... Signs of dehydration Skin chamges Abnormal Involuntary Movements Decortication (abnormal flexion) Decerebration (abnormal Extension)

9. Complications Head- lice /pressure sore Eyes- corneal ulcer Mouth –cracked lips, parotitis,Dry lips Lungs- pneumonia Foot drop or wrist drop Malnutrition

10. Contd.... Pressure sores Joint contractures Muscle wasting Dehydration and Urinary tract infections

11. Assessment Neurological assessment –glasgow coma scale Physical assessment Investigations

12. GLASGOW COMA SCALE (GCS) It is a scale that is used for neurological assessment of level of consciousness. Parameters :- Eye opening Verbal response Motor response We also check pupil size and shape Scoring :- >3 unconcious /comatose 15 fully conscious

13. Neurological assessment scale

14. Physical assessment Vital signs Eyes Facial symmetry Reflex action Swallowing Blinking Tendon reflexes

15. Contd .... Neck stiffness Motor response Paraplegia Hemiplegia Quadriplegia Decerebration Decortication Skin-pressure ulcer Fecal or urinary incontinence Edema

16. Investigation

17. Nursing Interventions

18. 1. To maintain airway patency Assess the respiratory status ( respiratory rate,SpO2, cynosis,Lung sounds and chest movement) Place in lateral or semiprone position Insert oropharyngeal airway to prevent tongue from falling back. Clear the airway from mucus by suctioning Provide humidified oxygen Provide chest physiotherapy

19. Contd..... Monitor ABG (arterial blood gas) Prepare for endotracheal Intubation if respiration is inadequate Provide artificial ventilator with Ventilator Provide special attention to the ventilated patient.

20. 2. To maintain optimal cerebral perfusion Assess GCS and vital signs at regular intervals Monitor Intracranial pressure (if possible) Maintain the head and neck allignment Keep the head elevated at 30 degree Administer O2 to prevent hypoxic brain injury Check ABG to assess CO2 level .

21. Contd..... Take measures to prevent increased intracranial pressure Give analgesic before suctioning of airway Give diuretics and dexamethasone Give stool softners to prevent straining (if patient have constipation)

22. 3. To prevent injury Assess risk factors that can cause injuries. Provide side rails and keep them padded Observe for convulsion attacks Allow one family member to be with patient Provide nail care to patient. And keep nails short Keep the bed linen clean,dry and wrinkles free .

23. 4. To maintain fluid balance Assess hydration status of patient. Monitor intake and output of patient. Administer IV fluids as prescribed initially. Initiate NG feed as soon as possible. Provide diuretic and dexamethasone if cerebral edema is suspected.

24. 5. to maintain thermoregulation Assess body temperature every 4 hourly Assess all possible sites for infections (urine ,wounds ,lungs, iv sites) Send specimen from all possible sites for routine and culture examination ( blood,urine,Wound swab, CSF) Provide proper ventilation in room Give antibiotics according to culture reports Give adequate fluids.

25. 6. To prevent corneal injury Assess eye for dryness, redness or any sign of Infections. Remove contact lenses if worn Clean eyes at regular intervals Instill artificial tears as ordered Administer eye drops And ointments as prescribed Use aseptic technique while giving eye care Cover eyes with sterile eye patches.

26. 7. To maintain intact oral mucus membrane Assess for dry ,cracked lips, coated white tongue patches. Remove dentures if worn Give mouth care every 2-4 hourly Provide glycerine on lips Put crushed Nystatin tablets or antifungal ointments for oral thrus if prescribed. Clean nostrils to avoid congestion Move endotracheal tube to other side daily.

27. 8. To maintain optimal Nutritional balance Assess bowel sound Give NG feed every 3-4 hourly if bowel sounds are present Give high calorie,high protein and vitamin rich diet in liquid form Give TPN (total parentral nutrition) of patient unable to tolerate NG feed Assess Signs pf complications while giving NG Feed or TPN

28. 10. To maintain normal urinary elimination Assess for any abnormalities in urination Insert a urinary catheter Provide catheter care to prevent from urinary tract infections Send urine sample for culture and sensitivity test to assess presence of pathogenic organisms Provide adequate fluid intake

29. 11. To maintain normal bowel elimination Assess bowel for incontinence or constipation For constipation: Give fruit juice, Vegetable soup through NG for stool softening Insert suppository as ordered For incontinence: Wear incontinence pad or diapers Provide perineal care as soon the bowel opened Keep the perineal area clean and dry.

30. 11. To maintain normal Physical activity Assess all joint for deformity or muscle wasting Provide passive exercise to all joints Turn patient every 2 hourly. Use supportive device to prevent any deformity Teach and educate family members about exercise Refer to physiotherapy for proper exercise.

31. 13. To improve self care Provide bed bath daily Provide pressure point care Provide oral care every 2-4 hourly Comb hair as needed Provide perineal care twice a day Change clothes and linen daily Shave beared if male patient Provide nail and foot care Educate family memvers to maintain good hygiene of patient.

32. 13. To prevent complications Bedsores Keep skin clean and dry Turn patient 2 hourly Provide pressure point care Use supportive device like air mattress,air cushion ,rings to prevent pressure points

33. Contd.... Joint contractures,foot drop wrist drop Provide exercise to all joints Provide supportive devices like sand bags,Foot board, splints. Give high protein diet to Promote tissue growth .

34. Contd... Deep vein thrombosis Elevate lower limb over heart level intermittently Provide passive ROM exercise every 4 hourly. Use elastic stockings for lower limbs Monitor and compare temperature of both legs Check posterior tibial and dorsal pedis pulse regularly Monitor for pain, swelling, redness of lower legs Give subcutaneous heparin if prescribed

35. Contd... Pneumonia Suction out the secretion at regular intervals Give chest physiotherapy and postural drainage to drain secretion from lungs Keep head in elevated position while feeding Keep head turned to a side to facilitate drainage .