This document discusses the care of unconscious patients. It defines key terms like consciousness, sleep, unconsciousness, and coma. It describes various causes of unconsciousness including oxygenation problems, circulation disorders, metabolic disorders, and central nervous system disorders. It outlines different levels of consciousness from conscious to comatose. The Glasgow Coma Scale is introduced as a standardized tool for assessing impaired consciousness based on eye opening, verbal, and motor responses.

1. CARE OF UNCONSCIOUS
PATIENT
Hillary Lubuto
BSc NRS 4th
Year ,RN
DNS-SOM-UNZA
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2. INTRODUCTION
 Managing of the critically ill/ unconscious
patient can be a challenging experience and
it requires a collaborative approach. However
one of the key members of the team is the
critical care nurse because the patient needs
the services of the nurse at all times.
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3. INTRO…
 Unconscious patients have no control over
themselves or their environment and thus are
dependent on the nurse
 Therefore a nurse in critical care
unit/Intensive care unit needs to be abreast
with appropriate knowledge and right attitude
on how to care for the unconscious patient.

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4. DEFINITION OF TERMS
Consciousness
 Consciousness is the state of general
wakefulness and responsiveness to the
environment.(Stedman`s Medical Dictionary
28th
edition)
Sleep
 Sleep is the state of altered consciousness or
partial unconsciousness from which an
individual can be aroused
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5.  Unconsciousness
 Unconsciousness is the state of
unresponsiveness, where the patient is
unaware of the environment and no
purposeful response can be obtained.
 Unconsciousness is the condition in which
cerebral function is depressed ranging from
stupor to coma (Baughman and Hackley
1996).
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6. Coma
 Coma is a clinical state of unconsciousness
in which the patient unaware of self and
environment and an individual cannot be
awakened.
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7. CAUSES
Blood oxygenation problems:
 Carbon Monoxide( CO) poisoning
The haemoglobin(Hb) has 200 fold greater˗ ˗
affinity for CO than oxygen
 Respiratory acidosis –
resulting from respiratory failure leading to
inadequate oxygen supply to the vital center
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8. Blood circulation disorders
 Hypovolaemic shock, Cardiac Arrest
Hypovolaemia resulting from excessive˗
haemorrhage and fluid loss due to severe
burns causes cerebral hypoperfusion and
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9. CAUSES CONT…
 Metabolic disorders
 Renal failure, drug overdose, alcohol
intoxication
 Due to the failure of the kidneys to˗
effectively eliminate nitrogenous waste
 Alcohol affects the reticular activating˗
system (RAS)
 An appx 200mg/dl
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10. Central nervous system disorders
 Head injury, Cardiovascular
Accident(stroke)
 These conditions may result in the˗
disruption of blood supply to the brain tissue
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11. Causes cont..
 Space occupying brain tumour, Meningitis
These conditions increases intracranial˗
pressure
An increased pressure in an enclosed cranial
cavity result in the compression of brain
tissue and vital centers
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12. LEVEL OF CONSCIOUSNESS
 1.Conscious - Consciousness is a state of
wakefulness, alertness & awareness of self &
environment.
 2. Lethargy - This is the level of
consciousness in which a individual is sleepy
but arousable, can be aroused with little
difficulty.
 3. Obtunded - The patient have more
depressed level of consciousness and cannot
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13.  4. Stupor - A state of impaired
consciousness characterized by marked
diminution in the capacity to react to
environmental stimuli. An individual is almost
totally immobile and unresponsive, even to
painful stimuli.
 5. Coma – Coma is the state of profound
state of unconsciousness and the patient
cannot be wakened with outside physical or
auditory stimulation.

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14. GLASGOW COMA SCALE
 Glasgow coma scale is a quick, practical and
standardized system for assessing the
degree of impaired consciousness.
 GCS was developed and introduced in 1974
by Graham Teasdale and Bryan J. Jennett,
1974 at University of Glasgow. It is mainly
used in adults and in children Blantyre coma
scale is used.
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15.  In GCS three indicators of response are
evaluated: 1.Opening of the eyes 2. Best
verbal response and 3. Best motor response.
 A score of 15 is the highest GCS Score for
the fully alert individual and a score of 3 is
indicative of deep coma state. A score of ≤8
is generally indicative of coma
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16. GCS
Eye opening
 Spontaneous eye opening 4
 Opening of eyes to name or command 3
 response to pain 2
 No response to any stimuli 1
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17. GCS
BEST VERBAL RESPONSE
 Appropriated oriented 5
 Confused conversation 4
 Inappropriate conversation 3
 Incomprehensible sounds 2
 Lack of sound 1
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18. BEST MOTOR RESPONSE
 Obeys command 6
 Localization of pain 5
 Normal flexion(withdrawal) 4
 Abnormal flexion 3
 Abnormal extension 2
 Lack of response 1
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19. REFERENCES
 S.L . Lewis et al, Medical Surgical Nursing: Assessment
and management of clinical problems,8th
edition,2011
 G. A . Hacknes and J. Dincher, Medical Surgical
Nursing: Total Patient Care, 10th edition,1999
 Mosby`s Medical Dictionary 7th
edition
 P. A. Potter and A. G. Perry, Fundamentals of
Nursing,7th
edition,2009
 V. Kumar et al,Robbin`s basic pathology,8th
edition,2007
ISBN:978 0 8089 2366 4
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