Unconscious Status, Neurological disorder,Unconsciousness problems, Causes of unconsciousness,

Nursing

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

* Head injuries

* Meningitis, encephalitis

* Diabetes mellitus

* Renal failure

* Poisonous drugs (stomach wash, refer practicals)

* Asphaxia

* Epilepsy

Diagnosis

* Assess the patient’s level of consciousness by Glasgow coma scale.

• Responses to command

• Eye opening

• Verbal responses

• Motor responses

Nursing Management

* 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.

• If necessary insert oral airway for easy breathing.

* 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 f luids with electrolytes and vitamins (refer practicals).

• Maintain Intake and output chart accurately.

• 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 4th hourly and 2nd hourly position changing to relieve pressure on pressure areas.

• Clip the nails

• Range of motion exercises atleast 4 times a day.

• Cleanse the mouth with the prescribed solution every two hours 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 angles to the legs with 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 bedpan 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 (refer practicals).

• Palpate the abdomen for distension.

• Auscultate 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.

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