Care of unconscious patient: Causes, Diagnosis, Management

Care of unconscious patient

Unconsciousness is a condition in which there is depression of cerebral function ranging from stupor to coma.

Coma may be defined as no eye opening on stimulation, absence of comprehensible speech, a failure to obey commands.

Unconsciousness is a lack of awareness of one' s environment and the inability to respond to external stimuli.

Therefore, observe the patient' s condition and prevent any complications.

Causes:

1.     Head injuries

2.     Meningitis, encephalitis

3.     Diabetes mellitus

4.     Renal failure

5.     Poisonous drugs (stomach wash, refer practicals)

6.     Asphaxia

7.     Epilepsy.

Diagnosis:

Asses the patient' s level of consciousness by Glasgow coma scale.

1.     Responds to command

2.     Eye opening

3.     Verbal responses

4.     Motor responses

Interpretation :

1.     Best score

2.     Worst Score

3.     7 or less generally indicates coma (Changes from baseline are most important)

 Nursing Management :

a.Maintenance of effective airway : -

An adequate airway must be maintained at all times.

It must be necessary to hold the patients jaw forward or place the patient in the lateral position to prevent the tongue obstructing airway by falling back.

Loosen the garments to allow free movements of the chest and abdomen.

Frequent suction is required to prevent the pooling of secretion in the patients pharynx

It necessary insert oral airway for easy breathing.

b. maintenance of fluid & electrolyte balance and nutrition :

The diet must contain an adequate supply of all nutrients required for life. Nutrition may be supplied by intravenous fluids or gastric tube feeding. (refer practicals)

Administer prescribed intravenous fluids with Electrolytes and vitamins.(refer practicals)

Monitor Intake and output chart accurately and record.

Monitor vital signs and record.

Maintenance of personal hygiene and care of pressure areas including prevention of foot drop:

Sponging is performed as frequently as necessary

Keep the skin dry, clean and free of moisture to prevent bed sore.

Apply back care every 4^th hourly and 2^nd hourly position changing to relieve pressure on pressure areas

Clip the nails

Range of motion exercises at least 4 times daily.

Cleanse the mouth with the prescribed solution every 2^nd hourly and apply emollients to prevent parotitis.

Irrigate the eye with sterile prescribed solution to remove discharge and debris.

Clean the ear with swab and dry carefully especially behind the ears.

The bed linen must be kept wrinkle free and dry.

Side railing on both sides are helpful to protect the patient

The feet should be kept at right ankles to the legs with a help of pillow or sand bags to prevent foot drop.

Promoting elimination

If the patient is observed for any sign of urinary incontinency retention and constipation, report to the physician.

If the patient has incontinence of urine - provide bedpans or catheterization can be done according to Doctor' s order to record the accurate output.(refer practicals)

If the patient has retention of urine, apply gentle pressure over the bladder region. It will help in partially emptying the bladder.

If the patient is constipated, a glycerine suppository or enema is advised according to doctor' s prescription.

Perineal care, vaginal douch, catheter care to be provided

Palpate the abdomen for distension   Ascultate bowel sounds.

Family education:

Develop an interpersonal relationship with the family.

Provide frequent update information on patient condition

Involve the relatives in routine care

Provide comfortable physical environment

Teach family to report any unusual symptoms.