fundamentals of nursing

1. COURSE: FUNDAMENTALS OF NURSING.
TUTOR: MRS LUBINDA.
GROUP THREE (3)
PRESENTATION ON
UNCONSCIOUSNESS
AND

2. GROUP THREE (3)
MEMBERS1. NYIRENDA ANTHONY
2. CHIPOYA NAOMI
3. MUBITANA MUBITANA
4. MUTEMBE KASHOLO
5. SILONGO JACKSON
6. MALUMANI INYAMO
7. LITIA ISITEKETO
8. MWANSA FLAVIA
9. KATUNGA KATUNGA CHARLES

3.  General Objective
 By the end of this presentation RPHN students should be
able to understand what unconsciousness and head injuries
are.

4.  Specific Objectives
 Define unconsciousness and head injury.
 What causes unconsciousness and head injuries.
 List the signs and symptoms of unconsciousness and head
injuries.
 Describe the clinical management of unconsciousness and
head injuries

5. UNCONCIOUSNESS AND
HEAD INJURIES.
Introduction:
 Fire-fighters, at times, are the first to arrive at incidents
involving casualties who have suffered major traumatic
injuries and in the first few moments of these incidents,
their expertise can make the difference between life and
death.
 The fire-fighter is often called
upon to fill the “vacuum” between the occurrence of injury
and the arrival of the paramedic or medical help.

6. Intro Cont’
 Therefore, emergency departments see a large number of
patients with minor or mild head injuries and need to
identify the very small number who will go on to have
serious acute intracranial complications.
 Because of the danger of compression it is very
important that you are able to accurately identify
potential brain injury and monitor changes in a casualty’s
level of consciousness. The method of measuring
conscious level is the Glasgow Coma Scale. Thus the
level of unconsciousness can be assessed using the
Glasgow Coma Scale.

7. DEFINITION OF TERMS.
UNCONCIOUSNESS:
 Unconsciousness is a state in which a patient is totally unaware
of both self and external surroundings, and unable to respond
meaningfully to external stimuli.
HEAD INJURY:
 head injury is defined as any trauma to the head other than
superficial injuries to the face.

8. CAUSES OF HEAD INJURIES.
 • in motor vehicle accidents
 • in falls
 • assaults & violence
 • in sports accidents
 • other (lightening strike, electric shock)
Sports involved (from more to less frequent)
 – Boxing
 – Football, soccer, rugby
 – Bicycling
 – Martial arts; auto

10. TYPES OF HEAD INJURIES.
 • Closed head injury (CHI)-skull relatively intact; brain injured
by excessive movement within skull
 • Concussion - transient neurologic dysfunction (altered
consciousness or loss of consciousness (LOC)), but no brain
damage visible on CT scan. BUT: re-injury before recovery is
particularly dangerous and may even be fatal!
 • Contusion - bruising of brain (surface blood vessels
broken, tissue swells)
 • Penetrating injury or laceration - brain tissue torn or
punctured (by bullet, bone fragment)

11. SIGNS AND SYMPTOMS OF HEAD INJURIES.
SIGNS
 Altered state of consciousness (Glasgow Coma Scale)
 bleeding and cerebro-spinal fluid from ears and/or nose
 blood under the sclera (white area) of the eye and bruising
around eyes obvious head injury
 loss of movement on one side of the body (Hemiplegia)
 loss of power on one side of the body (Hemiparesis)

12. SYMPTOMS
 headache
 nausea
 confusion
 speech disturbance
 loss of balance
 visual disturbance including a dislike of bright light

13. MANAGEMENT OF HEAD INJURIES.
On approach to an incident one can use the SAFE approach.
 S - SHOUT FOR HELP
 A - APPROACH WELL
 E - EVALUATE WITH CARE
 F - FREE FROM A.B.C.D.E.
 A- AIRWAY MAINTENANCE AND CONTROL OF THE
CERVICAL SPINE.
 B -BREATHING AND VENTILATION.
 C -CIRCULATION WITH HAEMORAGE CONTROL.
 D -DISABILITY I.E.: ASSESSMENT OF NEURLOGICAL
STATE.
 E -EXPOSURE AND ENVIRONMENTAL CONTROL.

14. 1. AIRWAY MAINTENCE AND CONTROL OF
THE CERVICAL SPINE.
 Anyone who approaches a casualty who is suspected of
head injuries should take measures to protect the cervical
spine at once. By addressing the casualty from the front one
hand should be placed on the patients forehead to steady it,
and a slight movement of the shoulders asking are you all
right. This should ascertain if the patient is conscious and
has a clear airway.

15. Airway - A
 Head tilt, chin lift
 Jaw trust

16. 2. BREATHING AND VENTILATION.
Serious head and chest injuries occurring together are
associated with a poor prognosis (outcome) and adequacy of
breathing must be assessed carefully.
THE IMMEDIATE PRIORITY IS TO :
 LOOK FOR THE CHEST RISING AND EQUAL.
 LISTEN FOR SOUNDS OF BREATHING.
 FEEL FOR ANY BREATH ON YOUR FACE.
 A good position for this is to put your face close to the
casualty's face and look down an exposed chest.

17.  Look, listen and feel for
NORMAL breathing.

18. 3. CIRCULATION AND HAEMORRHAGE CONTROL
 Bleeding scalp vessels are easily compressed by gentle, continuous
pressure. If there is obvious deformation or instability of the structure
the bleeding can be controlled by compressing the area around the
wound, taking care to press on an area which is stable.
 The patient may be bleeding from the nose or ears.
 Although excessive blood loss needs to be stemmed there is a
possibility that if the patients intercrannial pressure (pressure between
the brain and inside of the skull) can increase and cause further brain
damage. These areas should be covered with a light dressing and
allowed to leak slightly.

19. 4. DISABILITY THE ASSESSMENT OF
NEURLOGICAL STATE.
LEVEL OF CONCIOUSSNESS OF THE PATIENT IN THE HEAD TRAUMA
PATIENT SHOULD BE MEASURED BY THE PNEUMONIC AVPU.
 A- IS THE PATIENT ALERT.
 V -DOES THE PATIENT RESPOND TO VOICE.
 P -DOES THE PATIENT RESPOND TO PAIN (PINCHING OF THE EYELID).
 U -THE PATIENT IS UNRESPONSIVE TO THE ABOVE.
 PUPIL SIZE MUST ALSO BE CONSIDERED
 THIS IS DONE BY THE PNEUMONIC PEARL.
 PUPILS EQUALAND REACTIVE TO LIGHT.
 If they are not equal and don't react when a beam of light is shone into them will
indicate a possibility of a build build-in intercranial pressure. Rapid extrication
from their environment and removal to hospital is the desired outcome
 NOTE USE OF PEARL CAN BE CLOUDED IF THE CASUALTY IS
UNDER THE INFLUANCE OF ALCOHOL OR DRUGS

20. 5. EXPOSURE TO THE ENVIRONMENT
As with any trauma it is important to protect the patient from
the extremities of the
 weather.
 It is possible that following a head injury the onset of
hyperthermia may manifest itself.
 HYPERTHERMIA -The rise in the core body temperature,
 In the case of the head injury patient, this is brought on by
the disturbance of the
 temperature control center.

21. CAUSES OF UNCONSCIOUSNESS.
The causes of unconsciousness can be classified into four broad groups.
 Blood oxygenation problems.
 Blood circulation problems.
 Metabolic problems (e.g. diabetes, overdose).
 Central Nervous System problems (e.g. head injury, stroke, tumour,
epilepsy) etc.
NOTE:
 Fainting is a common cause of unconsciousness and may occur when
the victim’s heart rate is too slow to maintain sufficient blood pressure
for the brain.
 Combination of different cause may be present in an unconscious
victim e.g. head injury victim under the influence of alcohol.

22. SIGNS AND SYMPTOMS OF UNCONSCIOUSNESS.
 minimal headache and slight neck stiffness 70%
 Moderate to severe headache; neck stiffness; no neurologic
deficit except cranial nerve palsy 60%
 Drowsy; minimal neurologic deficit 50%
 Stuporous; moderate to severe hemiparesis; possibly early
decerebrate rigidity and vegetative disturbances 20%
 Deep coma; decerebrate rigidity; moribund 10%

23. FIRST AID MANAGEMENT.
 Call for help
 Check the person's airway, breathing, and pulse frequently. If
necessary, begin rescue breathing and cardio pulmonary
resuscitation
 If the person is breathing and lying on the back, and you do not
think there is a spinal injury, carefully roll the person toward you
onto the side. Bend the top leg so both hip and knee are at right
angles. Gently tilt the head back to keep the airway open. If
breathing or pulse stops at any time, roll the person on to his back.
 If you think there is a spinal injury, leave the person where you
found them (as long as breathing continues). If the person vomits,
roll the entire body at one time to the side. Support the neck and
back to keep the head and body in the same position while you roll.
 Keep the person warm until medical help starts.
 If you see a person fainting, try to prevent a fall. Lay the person flat

24. MANAGEMENT OF UNCONSCIOUSNESS.
 • Care of pressure area
 • Care of the mouth, eyes and skin
 • Nutrition and fluid balance
 • Care of bowel and bladder
 • Monitoring of the CVS
 • Control of infection
 • Physiotherapy to protect muscles and joints
 • Prevention of deep vein thrombosis
 • Maintenance of adequate oxygenation, if feasible

25. REFERENCES.
 EBIC Guidelines for Management of severe Head Injury in
Adults. Acta Neurochir (wine) 1997.
 Hannay HJ et al . (2004). “Neuropathological for
neuropsychologist”. Neuropsychological Assessment. Oxford:
Oxford University Press.
 Marshal LF .(2000). Head Injury: Recent Past, Present and Future
Neurosurgery.

26. THANK YOU FOR YOUR
ATTENTION.