Unconsciousness implies that is a stage of depressed cerebral function that result impairment in response to sensory stimuli; abnormal loss of awareness of self & surroundings.

1. UNCONSCIOUSNESS
PRESENTED BY,
MS. SILLA ELSA SOJI
MSC NURSING

2. DEFINITION
Unconsciousness is a state of complete or
partial unawareness or lack of response to
sensory stimuli. Period of unconsciousness
may be momentary (faint or syncope) or may
last for month.

3. DEGREES OR LEVEL OF
UNCONSCIOUNESS
• Excitatory unconsciousness
• Fainting
• Somnolent
• Stupor
• Coma
• Vegetative state

4. ETIOLOGY
1.Structural lesions:
• Supratentorial lesions: EDH/SDH, Brain
abscess, Cerebral infarction, brain
tumour, haemorrhage
• Subtentorial lesions
compressing/destroying the reticular
formation E.g.. Cerebellar abscess,
infarction, haemorrhage/tumour.

5. 2.Metabolic disorders and diffuse lesions:
Diabetic coma, Hepatic coma, Fluid and
electrolyte imbalance , Nutritional
deficiency, Anoxia or ischemia, Disease of
neuron e.g.. Lesions of motor neuron;
Concussion and postictal states, Drug
overdose e.g. Sedatives, analgesic, alcohol.
3. Psychogenic causes :hysteria or
catatonia

6. PATHOPHYSIOLOGY

8. CLINICAL MANIFESTATIONS
• Respiratory system: Stridor, Rales,
Rhonchi, Progressive Cyanosis, Cheyne
Stokes Respiration, Asymmetrical
chest wall movements, Decreased
respiratory rate, Decreased depth of
respiration.
• Cardiovascular system: Bradycardia,
Hypotension, Ventricular tachycardia,
Atrial fibrillation, Hyperkalaemia,
Arrhythmias,

9. • Neurological system: Asterixis,
Myoclonus seizures, Cranial nerve palsies,
Lethargy, Unequal pupillary dilation,
Absent deep tendon reflexes
• Gastrointestinal System: Due to the
disruption of CN -10th (vagus) function,
Abdominal distension, Decreased bowel
sounds, Constipation, Ascites,
• Urinary System: Urinary Incontinence,
High Creatinine Index, Oliguria,
Ketonuria, Urinary tract infection, Pyuria

10. DIAGNOSTIC FINDING
• History collection and physical
examination
• CT scan/ MRI scan
• Lumbar puncture
• Electroencephalography
• Laboratory Test: CBC, Urinalysis,
Electrolytes[includes glucose, blood
urea nitrogen, creatinine], LFT, Cardiac
enzymes ,Arterial blood gas, Toxicology
screens for drugs of abuse

11. MEDICAL MANAGEMENT
• Ventilatory support
• Oxygen therapy
• Management of blood pressure
• Management of fluid balance:
Administering IV fluids or plasma
volume expanders
• Management of seizures : Anti epileptic
sedatives, paralytic agents

12. • Treating Increased ICP : Mannitol,
corticosteroids
• Management of temperature regulation
(fever): ice packs, tepid sponging,
Antipyretics, NSAIDS
• Management of elimination : laxatives
• Management of nutrition: TPN and RT
feeds
• DVT prophylaxis (Administration of
LMWH, Sequential compression device)

13. SURGICAL MANAGEMENT

14. NURSING MANAGEMENT
 Ineffective airway clearance related to inability to
swallowing
 Risk for aspiration related to altered LOC
 Impaired oral mucus membrane, related to mouth
breathing absence of pharyngeal reflex, & altered
 Deficient fluid volume related to inability to take
fluids by mouth
 Imbalanced nutrition less than body requirements
related to inability to feed
 Risk for injury related to decreased LOC
 Impaired urinary elimination related to impairment
in neurologic sensing and control
 Bowel incontinence related to changes in nutritional
delivery methods.
 Risk of Impaired skin integrity related to
immobility