unconsciousness

1. UNCONSCIOUSNESS

2. CONSCIOUSNESS
It is a state of being that has
two important aspects:-
• Wakefulness
• Awareness
self
environment
time

3. “Unconsciousness is defined as when a
person is unable to respond to people
and activities often this is called as
coma or being in a comatosed state”
OR
“Unconsciousness is defined as the state
in which a patient is totally unaware of
both self and external surroundings and
unable to respond meaningfully to an
external stimuli”
DEFINITION :-

4. ETIOLOGY
STRUCTURAL LESIONS
OR
FOCAL BRAIN DYSFUNCTIONS
METABOLIC DISORDERS
OR
DIFFUSE BRAIN DYSFUNCTIONS

5. STRUCTURAL
LESIONS:-
This is caused when a pressure is placed on
the brain stem or on the structures within
the posterior cranial fossa including the
cerebellum,midbrain,pons and the
medulla.This may be caused when there is:-
• Brain tumors
• Head trauma
• Stroke
• Assault,falls or accident

6. METABOLIC
DISORDERS:-
This is caused when there is impairement in
wakefulness and awareness by
reducing the supply of oxygen and glucose
and further altering other cerebral and
metabolic processes
and can occur in:-

7. CONDITIONS:-
1. Hypoxia
2. Blood loss
3. High altitudes
4. Carbon monoxide poisoning
5. Seizures
6. Fluid and electrolyte imbalances
7. Infections

8. PATHOPHYSIOLOGY:-
Etiological factors
(neurogenic,metabolic,toxins)
Disruption in the cells of the nervous
system and the neurotransmitters
Disruption of the basic functional unit
that is neurons
Faulty impulse transmission

9. Impending communication within the
brain and to different parts of the
body
Cerebral edema
Increase or decrease in the supply of
blood or CSF circulation
Various sign and symptoms

10. SIGN AND SYMPTOMS;-
Weakness
Pale and moist skin
Shallow breathing
Double vision
Apathy and irritability
Drooling
Tingling and numbness in fingers and
feet's
Headache and sweating

11. CLINICAL
MANIFESTAIONS
The clinical manifestations are divided into:-
• Incase of focal brain dysfunctions
• Incase of metabolic dysfunction

12. INCASE OF FOCAL BRAIN
DYSFUNCTION:-
1. Abnormal pupillary response
2. History of progressive onset of
headache
3. Bizzare respiratory patterns
4. Cranial nerve palsy
5. Unresponsiveness
6. Confusion and abnormal eye movements
7. Rapid heart beat
8. Drowsiness,stupor

13. METABOLIC
DYSFUNCTION
• Confusion
• Pupillary reactions are
preserved
• Seizures
• Acid base imbalances

14. DIAGNOSTIC TESTS:-
• Computed tomography
• Magnetic resonance
imaging
• Lumbar puncture
• Electroencephalography
• Laboratory tests
• Test for ocular reflexes
• GCS

15. GLASGOW COMA SCALE:-

16. COMPLICATIONS:-
• Respiratory failure
• Pneumonia
• Pressure ulcers
• Aspiration
• Deep vein thrombosis

17. MANAGEMENT:-
The management is divided
into further:-
1. First aid
2. Medical management
3. Pharmacological
management
4. Nursing management

18. FIRST AID
MANAGEMENT
• Check ABC and pulse
• Side lying position
• Loosen clothes
• Keep patient warm
• Call for help

19. CPR:-

20. MEDICAL
MANAGEMENT
GOALS:-
• To preserve brain functions
and additional
Brain injury
• To restore the present
functioning of the brain

21. INTERVENTIONS:-
• ABC
• Nasal or oral airway must be inserted
• Observe airway for obstruction
• Insert ETtube if the patient is
unresponsive
• Ventilation and oxygenation

22. CONT….
• Proper BP maintainance
• Check level of
consciousness
• Observe improvement in
GCS scale
• Pupil charting
• Fluid and electrolyte
balance
• Investigations

23. PHARMACOLOGICAL
MANAGEMENT
• Vasoactive drugs;-
These are the drugs to maintain BP
eg;-dopamine
,dobutamine,phenylephrine
• Anticonvulsants;-
These enhance the GABA reception
in brain eg;-
diazepam,lorazepam,phenytoin and
phenobarbitone
• Diuretics:-
These promote shifting of extra
cellular fluid back to plasma eg:-
Mannitol and glyvin

24. Contd……
• Antihypertensive;-
These act by decreasing the peripheral
resistance and BP eg:-
amlodipine,nifedipine,losartan
• Antibiotics:-
These act to inhibit the bacterial cell wall
Syntheses eg:- amoxycillin,ciprofloxacin,
Amikacin
• antipyretics
• IV fluids

25. NURSING
MANAGEMENT
GOAL:-
The main goal of nursing management
is to prevent complications
ASSESSMENT:-
• Airway
• Neurological status
• Vital signs
• ICP
• Pupils

26. NURSING DIAGNOSIS:-
1. Ineffective airway clearance
related to loss of gag reflex:
 Head end elevated
 Proper chest physiotherapy
followed by suctioning
 Monitoring of the breath
sounds
 Oral airway insertion

27. Contd……
2. Fluid volume deficit related to
unconscious state;-
 Assessment of the fluid status
 Daily weight
 Accurate documentation
 Lab investigations

28. Contd…..
3.Altered nutrition less than body
requirement related to inability to
eat and swallow;-
Assessment of the nutritional status
Proper enteral feedings
Daily weight and intake/output
Auscultation of the bowel sounds
High protein and high calorie feeding

29. NURSING DIAGNOSIS:-
4.Impaired skin integrity related to immobility
• Provide care for all the self care needs
• Provide back care every 4hrly
• Nails should be cut short
• Positioning every 2hrly
• Air mattress should be provided to the
patient

31. RECAPTULISATION
TRUE/FALSE:-
1. Unconsciousness is a symptom and not
a disease?
2. It is caused by structural lesions and
metabolic disorders?
3. There is no change in the pupillary
reactions?
4. Respiratory failure is not associated
complication of unconsciousness?