Unconsciousness

Precise guide for DGNM, B.Sc Nursing & M.Sc Nursing Students .. regarding Unconsciousness, and its management. Highly recommended for II B.Sc Nursing Students.

1. UNCONSCIOUSNESS

2. UNCONSCIOUSNESS IT 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. PERIOD MAY BE MOMENTARY OR MAY LAST FOR MONTH.

3. LEVELS OF UNCONSCIOUNESS EXCITATORY UNCONSCIOUSNESS: PATIENT DOES NOT RESPOND COHERENTLY BUT IS EASILY DISTURBED BY SENSORY STIMULI. COMMONLY SEEN IN PATIENTS WHO ARE GOING UNDER ANESTHESIA.

4. SOMNOLENT: PATIENT IS EXTREMELY DROWSY AND WILL RESPOND ONLY OF SPOKEN TO DIRECTLY AND PERHAPS TOUCHED.

5. STUPOROUS PATIENT RESPONDS ONLY TO PAINFUL STIMULI SUCH AS PRICKING OR PINCHING OF THE SKIN. IN DEEP STUPOR PATIENT MAY RESPOND ONLY TO SUPRAORBITAL OR SUBSTERNAL PRESSURE.

6. ETIOLOGY STRUCTURAL LESIONS IN BRAIN. eg; Brain tumor,Cerebral haemorrage. METABOLIC DISORDERS. eg;Infections,Hypoglycemia,Nutritional deficency. PSYCHOGENIC CAUSES. eg;Hysteria, Catatonia.

7. a car accident severe blood loss a blow to the chest or head a drug overdose alcohol poisoning

8. low blood sugar low blood pressure syncope, or the loss of consciousness due to lack of blood flow to the brain neurologic syncope, or the loss of consciousness caused by a  seizure,   stroke , or transient ischemic attack (TIA) dehydration problems with the heart’s rhythm straining hyperventilating Common causes of temporary unconsciousness include:

9. PATHOPHYSIOLOGY HYPOXIA ISCHEMIA CHEMICALS NEEDED TO CARRYOUT FUNCTION NOT FORMED COMA DIRECT COMPRESSION IN BRAIN STEM TOXIC WASTE FROM LIVER/KIDNEY ECT..

10. CLINICAL MANIFESTATIONS Symptoms that may indicate that unconsciousness is about to occur include: sudden inability to respond slurred speech a rapid heartbeat confusion dizziness or lightheadedness

11. DIAGNOSTIC ASSESSMENT GLASGOW COMA SCALE. COMPUTED TOMOGRAPHY. MAGNETIC RESONANCE IMAGING. LUMBAR PUNCTURE. EEG. VENTRICULOGRAPHY. ANGIOGRAPHY. DRUG LEVEL. LFT/RFT BLOOD GASES & PH SERUM GLUCOSE,CALCIUM,SODIUM ect .

12. MANAGEMENT ABC Immediate management Examination History Investigations

13. ABC C-CIRCULATION B- A-AIRWAY BREATHING

14. Immediate management Maintain i.v line, oxygen inhalation Blood sample for RBS Control seizures Consider i.v glucose, thiamine, naloxone, flumazenil

15. Nursing Management Maintenance of an adequate airway. Maintenance of circulatoin. Moving and position. Mouth care. Eye care. Food and fluids. Prevention of accidents.

16. SUMMA R Y ABC of life support Oxygen and I.V access Stabilize cervical spine

17. Blood glucose Control seizures Consider I.V glucose, thiamine, naloxone, flumazenil

18. Brief examination and obtain history Investigate Reassess the situation and plan further

19. Potential complications of being unconscious for a long period of time include coma and brain damage. A person who received CPR while unconscious may have broken or fractured ribs from the chest compressions. The doctor will X-ray the chest and treat any fractures or broken ribs before the person leaves the hospital. Choking can also occur during unconsciousness. Food or liquid may have blocked the airway. complications of unconsciousness