It includes Etiology A Case Approach Management Algorithm ICU based Nursing Care

1. Care of Unconscious patient
PRESENTEDBY:ANJALIARORA
M.SC.NURSING-1ST YEAR
COLLEGEOFNURSING
INSTITUTEOFLIVERANDBILIARYSCIENCES

3. Terminologies
consciousness
Awareness
Semi-coma
And
Coma
Stupor
Lethargy
Vegetative state
And
Brain Death
Alertness
And fainting

4. Case You were called into
resuscitation, where a 55
year old man onto the ED
stretcher. You were called
after his family found him
unconscious at home. His
current GCS is 3…

5. Causes of unconsciousness

6. History

7. General Examination

8. Neuro Examination

9. Glasgow coma scale

10. Pupillary
Reaction

11. Pupillary Reaction

16. Non-Invasive Hemodynamic
monitoring

17. Invasive Hemodynamic
monitoring

18. Resuscitation trolley

19. List of Emergency Drugs

20. Drug Calculation

21. Nursing
Management
of
Unconscious
Patient

22. Nursing Management
 Ineffective airway clearance related to inability to clear respiratory secretions as evidenced
by unclear lung sounds, unequal lung expansion, noisy respiration, presence of stridor, cyanosis
or pallor
 Ineffective cerebral tissue perfusion related to effects of increased ICP as evidenced by
papilledema, vomiting.
 Imbalanced nutrition – less than body temperature, related to inability to eat and swallow
as evidenced by weight and other nutritional parameters less than normal.

23. Nursing Management
 Ineffective thermoregulation related to damage to hypothalamic centre as evidenced by
persistent elevation of body temperature, warm and dry skin, flushed appearance of skin.
 Altered oral mucous membrane related to ET insertion, absence of pharyngeal reflex,
inability to ingest fluid as evidenced by dryness, inflammation, crusting and halitosis.
 Self-care deficit-bathing, feeding, grooming, toileting related to unconscious state as
evidenced by unkempt and poorly nourished look, bed soiling.

24. Nursing Management
 Risk for complications – pressure sore, contractures, DVT, hypostatic pneumonia,
constipation – related to immobility.
 Risk of injury related to unconscious state.
 Risk for fluid volume deficit related to inability to ingest fluids, dehydration from osmotic
diuretics.
 Interrupted family process related to chronic illness of a family member as evidenced by
anger, grief, non-participation in client care.

25. Nursing Documentation

26. Points to remember
I. Put air way if Pt. is unconscious.
II. Tracheostomy – if air way obstruction.
III. Suction equipment available.
IV. Assess breath sound 1-2 hourly.
V. Never give fluid / food to shallow.
VI. Lateral position.
VII. Perineal care.
VIII. Examine abdomen for distention.
IX. Involve family in care.

27. Complications
 Skin: - Pressure sore, laceration.
 Respiratory: - pneumonia, pulmonary Embolism.
 C.V. system : - DVT, postural hypotension, thromboembolism.
 G.I. system: - Paralytic ileus, constipation, distention.
 Urological: - UTI
 Musculoskeletal: - Contracture, dystrophy, weakness.
 Neurological: - Foot drop.
 Psychological: - Anxiety, depression.

28. Research article
Continuous EEG Monitoring Predicts a Clinically Meaningful
Recovery Among Adult Inpatients.
Continuous EEG findings can be used to prognosticate survival and functional
recovery, and provide guidance in establishing goals of care.

29. Research articleHidden Brain Activity Revealed In People With Coma
Hospital patients who appear unresponsive after commands show evidence of brain
activity. Fifteen per cent of hospital patients with severe brain injuries exhibited
cognitive activity in response to commands — even though they did not react visibly.
Jan Claassen at Columbia University in New York and his colleagues studied 104
‘clinically unresponsive’ patients whose brains had been damaged by a stroke or other
trauma. None showed a visible response to verbal instructions; some were in a coma.
The researchers used a technique called electroencephalography (EEG) to study
electrical activity in the patients’ brains. When asked to move one hand, 15% of
patients showed brain patterns similar to those of healthy volunteers responding to the
same instructions. A year after their injury, 44% of patients whose brains responded to
commands could look after themselves for at least 8 hours, compared with only 14%
of those whose brains did not respond. Larger trials are needed to test the value of
EEG for prognosis, the authors say.

30. Summary

31. Conclusion
“Time is Brain”, an earliest intervention will
save the patient’s brain and life, to a great
extent.

32. Thankyou