unconsciousness

2. R. PUSHPAKALAMBIGA,
M.SC (NURSING) 1 YEAR,
DEPT OF CHN.

3. The brain requires a constant supply
of oxygenated blood and glucose to
function. Interruption of this supply
will cause loss of consciousness
within a few seconds and permanent
brain damage in minutes.

5. It is an abnormal state results from
disturbance of sensory perception
to the patient is not aware of both
self and external surroundings.

7.  Supratentorial lesions
 Brain tumors
 Brain abscess
 Cerebral hemorrhage
 Cerebral infarction
 Epidural hematoma
 Subtentorial lesions
 Cerebellar abscess
 Potine / cerebellar hemorrhage

8.  Disease of neurons.
 Metabolic encephalopathy
 Disease of other organs
 Poisons ,alcohol and drugs
 Fluid and electrolyte imbalance
 Infections

9.  Nutritional deficiency
 Hypoglycemia
 Anoxia or ischemia: po2 < 25 mm hg
 Temperature regulating disorders.
 Common fainting.

13.  It is a state of semi consciousness in which
person to external stimuli, loud noise, painful
stimuli.
(e.g) pricking or pinching of skin.

14.  Patient is extremely drowsy and will respond
only of spoken to directly and perhaps touch.
 (e.g) jirky body movement

15.  Patient does not respond coherently but is easily
disturbed by sensory stimuli.
 (e.g) bright lights, noise, sudden movement.

16.  Coma is a state of sustained unconscious in
which the patient,
 Doesn’t respond to verbal stimuli.
 May have varying painful stimuli.
 Doesn’t move voluntarily.
 Doesn’t blink.
 Altered respiratory pattern.

17.  LIGHT COMA: spontaneous and evoked
movement.
 DEEP COMA: heart rate is slow and respiratory
rate is fast and depth is increased.
 PREMORIBUND: rhythm is periodic, pulse is
irregular and blood pressure rises.
 MORIBUND: apnoeic respiration, pupil dilated
and fixed pulse beates faster and blood
pressure falls.

18.  Consciousness is a complex function controlled
by RAS.
 RAS begin in the medulla as reticular formation
 Reticular formation connects to RAS located in
the midbrain, connects to hypothalamus and
thalamus.
 Integrated pathway connects to the cortex via
thalamus and to the limbic system via
hypothalamus.

19. hypoxia
ischemia
Chemicals needed to
carryout functions not
formed
coma
Toxic waste
from organs
Direct
compression,
destruction
of structures
of brain stem

20.  Neurological examination
 Laboratory investigations
 Others investigations

21. RESPONSE SCORE
EYE OPENING:
spontaneous 4
To loud voice 3
To pain 2
none 1
VERBAL RESPONSE:
oriented 5
Confused, disoriented 4
Inappropriate words 3
Incomprehensive sounds 2
none 1

22. RESPONSE SCORE
MOTOR RESPONSE:
obeys 6
localizes 5
withdraws 4
Abnormal flexion 3
extension 2
none 1
TOTAL 15

23.  TEMPERATURE:
pyrexia
hypothermia
 NECK MOVEMENTS: neck stiffness
 FUNDUS:
papilloedema
subhyaloid hemorrhages
diabetic retinopathy
hypertensive retinopathy.

29. Computer topographic (CT) scan
Magnetic resonance(MRI) scan
Lumbar puncture
Electroencephalogram(EEG).

30. EPIDURAL
HEMATOMA
INTRACRANIAL
HEMARRHAGES

31.  It indicates whether the cause of coma is
structural, tumors, area of bleeding.
 Sometimes the patient will require
emergency surgery to remove the mass or
drain the fluid.

34.  Serum glucose,
 Serum calcium, sodium,potassium,
magnesium
 Blood gases and ph level
 Liver function test
 Renal function test etc..

35. Medical management
Surgical management
Nursing management

36. FIRST AID:
Call or tell someone to call ambulance.
Check ABC’s and do CPR.
If person is breathing and lying on the
back ,you do not think there is a spinal
injury, carefully roll the person towards you
onto the side.
Keep the person warm until medical help
arrives.

37.  Support airway by tilting the head and lifting the
chin.
 Breathing can be monitor by
LOOK,LISTEN,FEEL.
 Provide supplemental oxygen therapy
 Provide IV line
 Care of pressure areas.
 Care of MBBS( mouth, bladder, back, skin)
 Maintain nutrition and fluid balance

38.  Cardio pulmonary resuscitation.

39. Don’t ;
Don’t leave the person alone.
Don’t place a pillow under the head of an
unconscious person.
Don’t slap an unconscious person’s face
and splash water on the face to try to
revive him.

40. CRANIOTOMY BURR HOLE SURGERY

41. 1) Environment and family.
2) Physical care of patient.
 Maintenance of an adequate airway
 Maintenance of circulation
 Moving and position
 Mouth care
 Eye care
 Food and fluids
 hyperthermia

42. Hypothermia
Problems of elimination
Prevention of accidents
3) Observation
4) Death of patients

43.  Ineffective airway clearance related to upper
airway obstruction by tongue and soft tissue.
 Ineffective cerebral tissue perfusion related to
effects of increased ICP as evidenced by
papilledema, vomiting.
 Risk for fluid volume deficient related to inability
to ingest fluids, dehydration from osmotic
diuretics
 Self care deficient related to unconscious state