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.
* Head injuries
* Meningitis, encephalitis
* Diabetes mellitus
* Renal failure
* Poisonous drugs (stomach wash, refer practicals)
* Assess the patient’s level of consciousness by Glasgow coma scale.
• Responses to command
• Eye opening
• Verbal responses
• Motor responses
* 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.