care of unconscious patient Med surg ppt

detailed information about care of unconscious patient in the hospital , neurological ward, contain introduction, definition, levels of unconsciousness , causes, clinical manifestations, pathophysiology diagnostic evaluation, assessment of patient, medical magement, nursing management, surgical care, emergency care ,complications, summary ,research.

1. Care of An unconscious patient Submitted to: Mrs. Mamta Toppo Associate professor, College of nursing RIMS, Ranchi Submitted by: Ambika Mehta Roll no- 01 Basic B.sc Nursing 3 rd year College of nursing RIMS, Ranchi 2017-21

2. Contents Introduction Definition of consciousness Definition of unconsciousness Levels of unconsciousness Cause of unconsciousness Clinical manifestation Pathophysiology Diagnostic evaluation Assessment of unconscious patient Medical management Surgical Management Emergency nursing care Nursing care of unconscious patient Complications of immobility Summary Evaluation Reference Bibliography

3. Introduction Unconsciousness is a state which occurs when the ability to maintain an awareness of self and environment is lost. It involves a complete lack of responsiveness to people and other environmental stimuli. Coma is a deepest state of unconsciousness . Unconsciousness is a symptom rather than a disease.

4. Definition Consciousness Consciousness is the awareness of environmental and cognitive events such as the sights and sounds of the world as well as of one’s memories, thoughts, feelings and bodily sensations. Unconsciousness Unconsciousness is a state in which a patient is totally unaware of both self and external surroundings, and unable to respond meaningfully to external stimuli.

5. Levels of unconsciousness Alertness, oriented: Opens eyes spontaneously, responds to stimuli appropriately. Lethargy, Sleepy: Slow to respond but appropriate response, opens eyes to stimuli Stupor: Never fully awake, confused, unclear conversations Semi-coma stage: Moves in response to painful stimuli, pupillary reflex present. Coma: Unresponsive except to severe pain, no protective reflexes, fixed pupils, no voluntary movement.

6. Cause of unconsciousness Structural or surgical unconsciousness: Trauma Epidural/ subdural hematoma Brain contusion Hydrocephalus Stroke Tumor Metabolic or medical unconsciousness: Infection Meningitis Encephalitis Hypo/Hyperglycaemia Hepatic encephalopathy Hyponatremia Drug/ Alcohol overdose Poisoning

7. Clinical Manifestation The person will be unresponsive ( does not respond to activity, touch, sound or other stimulation) Makes no purposeful movements Drowsiness Inability to speak or move parts of his or her body Loss of bowel or bladder control Respiratory changes ( cheyne stokes respiration, cluster breathing, ataxic breathing, hyperventilation) Abnormal pupil reactions

8. Pathophysiology Damage to the brain and skull Inflammation, edema and haemorrhage Increased intra cranial pressure Diffused damage to the cerebral tissues Blocks the signal to the reticular activating system Unconsciousness

9. Diagnostic evaluation X-ray Megnetic resonanance imaging (MRI): Tumors, Vascular abnormalities etc Computerized Tomography (CT): cerebral edema, infarctions, hydrocephalous. Lumbar puncture Positron emission tomography Electroencephalography Blood test like CBC, LFT, RFT etc

10. Assessment of unconscious patient History ( Medical, Surgical) Pattern of respiration Pupil ( size, reaction) Facial symmetry Swallowing reflex Limb movement and tendon reflex Level of consciousness ( Glasgow coma scale)

11. Glasgow coma scale

12. Interpretation of Glasgow coma scale Highest score is 15/15 – Good orientation Lowest score is 3/15 - Deep coma. Considered brain dead if client dependant on a ventilator. GCS ≤ 8 – Severe brain injury GCS – 9 to 12 – moderate brain injury GCS ≥ 13 – Mild brain injury

13. Medical Management The goal of medical management are to preserve brain function and prevent further damage. Ventilator support Oxygen Therapy Management of blood pressure Management of fluid balance Management of seizures: Antiepileptic , sedatives. Treating increased intracranial pressure: Mannitol, corticosteroids

14. Cont... Management of temprature regulation: Antipyretics, nonsteroidal anti- inglammatory drugs. Management of elimination: laxatives and high fibre diet Management of nutrition: Total parenteral nutrition

15. Surgical management The patients altered level of conscious is a space – occupying lesion, surgical removal of the mass may improve the patients condition. Craniotomy : A craniotomy may be performed to remove a tumor, abscess or intracerebral hematoma. Burr-hole: Created to drain a subdural hematoma. Ventricular catheter or shunt: May be place to reliive hydrocephalus.

16. Emergency nursing care ABCDE Management A- Airway: Assess patency of airway and imminent threats. Check for upper airway obstruction. Look for facial fractures and injuries to the neck. Remove foreign body by direct vision and suction secretion. An airway adjunct may be required to maintain patency. Administer high concentrations of inspired oxygen.

17. Cont.... B- Breathing: Look for symmetrical expansion and respiratory rate. Administer supplemental oxygen. C-Circulation: Identify pulses and assess rate, rhythum and check blood pressure. Intravenous access with administration IV crystalloid solution.

18. Cont... D-Disability: Check the patients pupillary response. Assess the posture Assess the Glasgow coma scale Check for any sign of raised intracranial pressure. E- Exposure/Environmental control: The aim is to expose the patient so that an adequate complete examination can be performed.

19. Nursing Management Nursing Diagnosis: Ineffective airway clearence related to upper airway obstruction. Ineffective cerebral tissue perfusion related to effects of increased intracranial pressure. Risk for impaired tissue integrity related to absence of corneal blink reflex, dryness of eyes. Risk for injury related to unconscious state. Imbalanced nutrition less than body requirement related to inability to eat and swallow.

20. Interventions Goal: Maintaining a patent airway. Assess respiratory rate pattern, lung sound, lung expansion, sign of tissue hypoxia, cyanosis. Elevate head of bed to 30° or place client in lateral position. Suction the mouth, pharynx and trachea as often as necessary to prevent aspiration of secretions. Administer humidified oxygen.

21. Cont... 2. Goal: Maintains optimum Cerebral perfusion Assess sign of increased intracranial pressure, cerebral edema. Monitor ABG values Administer osmotic diuretics e.g mannitol Maintain Paco2 through hyperventilation. Administer stool softness as prescribed.

22. Cont... 3. Goal : Maintains intact corneal tissue integrity. Assess signs of impaired corneal integrity look for presence of corneal blink response. Protect eyes with an eye shield. Inspect the condition of eyes with a flash light at regular intervals. Instill artificial tears as prescribed. Apply eye patches when indicated.

23. Cont... 4. Goal: prevent from injury Assess risk factors for injury. Keep side rails up and bed in lowest position whenever the client is not recieving direct care. Administer prescribed Antiseizure drugs. Give adequate support to the limbs and head when moving or turning the unconscious client.

24. Cont... 5. Goal: Maintains optimum nutrition. Always observe the patient carefully when administering anything by gavage. Do not leave the patient carefully when administering anything by gavage. Keep accurate records of all intake. Fluids are maintainef by IV therapy. Keep accurate records of IV intake and urine output. Observd the patient for sign of dehydration or fluid overload.

25. Complications of immobility Pressure sore Hypostatic pneumonia, pulmonary embolism Deep vein thrombosis, postural hypotension, thrombo embolism Paralytic ilius, constipation Urinary tract infection Contracture, osteoporosis, dystrophy Foot drop Anxiety, depression

26. Summary 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. Unconsciousness may occur as the result of traumatic brain injury, brain hypoxia, severe poisoning with drug that depress the activity of the central nervous system, severe fatigue, anaesthesia and other causes. Nurse play and important role in the care of unconscious patient to prevent potential complications respiratory ,distress, pneumonia, aspiration, pressure ulcer, this is achived by: Maintaining patent airway,protecting the client,maintaining fluid balance and managing nutritional needs etc.

27. Evaluation Is coma is a last stage of unconsciousness? What is the initial step in evaluation of an unconscious patient? Is nystagmus is commonly seen in unconscious patient ? Is communication is important in care of unconscious patient? Is catatonia can cause unconsciousness? Is trauma is only cause of unconsciousness? What is the emergency nursing care of unconscious patient? How to assess the unconscious patient? Enlist the levels of unconsciousness? Discuss the pathophysiology of unconsciousness?

28. Reference Books Internet Discussion with teacher

29. Bibliography Ansari Javed, textbook of medical surgical nursing, volume – 2, PV publications, page no- 411to414. Brunner and Suddarth’s,`Textbook of Medical Surgical Nursing’,South Asia edition, volume-2, Wolters kluwer publications, page no-1676 to 1682. www.wikipedia.org nursingassignments.blogspot.com www.ncbi.nlm.nih.gov