care of ill patinet

2. Care of unconscious patient:
Consciousness is a state of being wakeful and aware of self,
environment and time.
Loss of consciousness is apparent in a patient who is not
oriented, does not follow commands, or needs persistent stimuli
to achieve a state of alertness.
Level of consciouness
Alert:
• Normal consciouness
• Sound and clear mind, responding normally and answering
questions quickly.
Automatism
• Aware of surrounding
• May be unable to remember action later.
• Possible abnormal mood may show defects of memory and
judgement.

3. Confusion
• Loss of ability to speak and think in a logical coherent fashion.
• Responds to simple orders.
• May be disorineted for time and space.
Delirium/acute confusion with agitation
• Characterized by restlessness and possible violence.
• Not capable to rational thought.
• May be troublesomeand not comply with simple orders.
Stupor
• Quite and uncommunicative
• Remains conscious but sits or lies with a galzed expression.
• Does not respond to orders.
• Bladder and rectal incontinenece occur
• More serious than the previous wild stage.

4. Semi coma
• A twilight stage
• Patients often pass fit fully into unconsciouness
• May be aroused to the stuporosed state by vigorous
stimulation.
Coma
• Patient deeply unconscious
• Cannot be roused and does not wake up with vigorous
stimulation.

5. CAUSE ON UNCONSCIOUS PATIENT
• Head injury
• Skull fracture
• Asphyxia
• Fainting
• Extreme body temperature
• Cardiac arrest
• Blood loss
• Cerebro vascular accident
• Epilepsy
• Infantile convulsion
• Hypogylcemia etc.

6. ASSESMENT OF UNCONSIOUS PATIENT
• History
• Physical assessment
• Glassgow coma scale( The glassgow coma scale (GCS)
(Jennett and Teasdale 1977) is the most common scoring
system used to describe the level of consciouness in a
patinet. The GCS gives practitioners an internationally
accepted format that assists communication, minimizes use
practioners an internationally accepted format that assists
communication, minimizes user interpretation, and rapidly
detects change in the patient’s condition.

7. COMPONENTS OF GLASSGOW COMA
SCALE
• Eye opening
Spontaneous :4
To speech: 3
To pain: 2
No response: 1
• Verbal response:
Oriented: 5
Confused :4
Inappropriate words: 3
Incomprehensive sounds: 2
No response: 1

8. • Motor response
Obeys commands: 6
Localizes : 5
Withdraws: 4
Flexes : 3
Extends : 2
No response: 1
Total score : 3-15
Management
First of all, make sure quickly that they are unconscious,
and not just asleep. A patient who is unconscious is at a
very high risk of compounding the problems by adding to
them by asphyxia.

9. ASSESSMENT OF LOC
Evaluation of mental status
Cranial nerve functioning
Reflexes
Motor and sensory functioning
Scanning , imaging, tomography, EEG
Glassgow coma scale
Care given to the patient
Maintaining patent airway
• Elevating the head end of the bed to 30 degree prevents
aspiration.
• Positioning the patinet in lateral or semi prone position.
• Suctinong
• Chest physiotherapy
• Auscultate in every every 8 hours
• Endo tracheal tube or tracheostomy.

10. PROTECTING THE CLIENT
• Padded side rails
• Restrains
• Take care to avoid any imjury.
• Talk with the clinet in between the
procedures.
• Speak positively to enhance the self-esteem
and confidience of the patient.

11. MAINTAINING FLUID BALANCE AND
MANAGING NUTRITIONAL NEEDS
Assess the hydration status.
Start IV line if needed.
Give plenty of liquid diet.
NG tube feeding.
Maintaining skin integrity by:
• Regular changing in position two hourly.
• Performing passive exercise.
• Doing back massage.
• Using splints or foam boots to prevent foot drop.
• Using special beds to prevent pressure on bony prominences.

12. PREVENTING FROM URINARY
RETENTION
• Palpate for a full bladder.
• Insert an indwelling catheter
• Condom catheter for male and absorbent pads for
females in case of incontinence.
• Including stimulation to urinate.
PROVIDING HYGIENE NEEDS AND SKIN CARE
• personal hygiene is considered part of the essence of
care and needs to be carried out to an uncompromising
standard.
• Maintain the patient’s physical appearance.

13. POSITIONING THE UNCONSCIOUS
PATIENT
• Attention is given to good body alignment to help prevent
contractures, foot and wrist drop, muscle strain, joint
injury and interference with circulation and chest
expansion.
• Care needs to be taken to ensure that the head and
neck are aligned with the spine.
PREVENTING FROM INJURY
• Keep a call bell within reach of patient.
• Apply restraint only as last resort as physicians.

14. PROVIDING SENSORY SENSATION
• Provided at proper time to avoid sensory deprivation.
• Efforts are made to maintain the sense of daily rhythm by
keeping the usual day and night patterns for activity and
sleep.
• Maintain the same schedule each day.
• Orient the client to the day, date an dtime accordingly.
• Touch and talk.
• Proper communication.
• Always address the client by name , and explain the
procedure each time.

15. SUPPORTING FAMILY NEEDS
• Assess family for usual copying skills.
• Introduce family to new resources available and provided
needed information.
• Teach patient care skills needed for home care to family.
Potential complications:
• Respiratory distress
• Pneumonia
• Aspiration
• Pressure ulcer

16. CARING BEDRIDDEN PATIENT
A person who is bedridden need full-time care and
attention. There are some conditions like stroke, paralysis
of limbs and head injury when a patient might remain bed
ridden for days to weeks. Such patients require constant
care to avoid formation of bed sores, pneumonia, infection
of urine tract, constipation, etc. caring for a bedridden
patient requires a special set of skills.
Following list includes some useful suggestions to improve
case of bedridden patinets:

17. Maintaining skin integrity
• Regular changing in position two hourly.
• Performing passive exercise.
• Doing back massage.
• Using splints or foam boots to prevent foot drop.
• Using air or water filled mattress to prevent pressure
on bony prominences.
Maintaining nutritional needs
• Assess the hydration status.
• Assist for oral feeding.
• Prepare the patient’s meals according to her physical
abilities. You may need to cut food in smaller size or
find sources of supplemental nutrition.

18. • Give plenty of liquid diet.
• Start IV line if needed.
• NG tube feeding.
Care of bowel and bladder/preventing
urinary retention
• Palpate for a full bladder frequently.
• Offer bed pan frequently.
• Prevent from constipation.
• In case of constipation, laxatives like
syrup cremaffin or duphalac can be given.
• Insert an indwelling catheter if needed.

19. Positioning the patient
• Attention is given to good body alignment, to
help prevent contractures, foot and wrist drop,
muscle strain, joint injury and interfernece with
circulation and chest expansion.
• Care needs to be taken to ensure that the head
and neck are aligned with the spine.
General care:
• Maintain the patinet’s physical appearance.
• Physiotherapy should be done two times daily to
protect muscles and joints by a trained
physitherapist.
• Daily mouth cleaning with saline water, and if
possible teeth brushing should be done.

20. • Change bed linens and fluff pillows at least
once a day to improve comfort and decrease
the chances of bedsores or blood clots.
• Communicate and provide emotional comfort
to the patinet.
• Report any changes in physical condition,
change in mental conditions and additional
obseravtions.
• Provide emotional support: the people who are
caring for and other family members may also
benefit from counselling.
• Physitherapy to protect muscles and joints.

21. CARE OF CHRONIC ILLNESS
• Chronic illness means the illness that persists for a long
time. A chronic or long-term illness means having to
adjust to the demands of the illness and the therapy
used to treat condition.
The term chronic is usually applied when the
course of the disease lasts for more than three months. It
can be stressful and may change the way person lives and
how they relate others.

22. CHARACTERISTICS OF CHRONIC
ILLNESS
• Complex causes
• Many risk factors
• Long latency periods
• A long illness
• Functional impairment or disability
Most common chronic conditions :
• Type II diabetes
• Arthritis
• Osteoporosis
• Parkinson’s disease
• Asthma
• COPD

23. • Lung cancer
• Glaucoma
• Cataracts
• Enlarged prostate
• Chronic kidney disease
• Macular degeneration
• Dementia
• Depression
• Alzheimer’s disease
• Coronary hear disease
• Stroke
• Colorectal cancer
• Oral disease

24. PREVENTION
• Practicing a healthy lifestyle that includes healthy eating,
regular exercise and avoiding tobacco use.
• Regular use of early detection and testing such as
breast, prostate and cervical cancer screenings,
diabetes and cholestrol screenings, and bone destiny
scans etc.
• Make kitchen implements easier like opening jars and
bottles, peeling and cutting vegetables.
• Use claw-like devices for people with arthritis or other
muscle or joint problmes

25. • Shower chairs and bath benches and hand-held shower
heads for bathing.
• Elevate toilet seats. Lift stairwells, beds and chairs
automatically.
• Use talking clocks, wristwatches, and calculators for
people with poor vision.

26. CARE OF TERMINALLY ILL PATIENT/
• In medical terminology, a terminal illness is a disease
that will result in the death of the patient regardless of
any treatment intervention.
A patient who has such illness may be reffered to as
a terminal patient, terminally ill or simply terminal.
Often, a patient is considered terminally ill when their
estimated life expectancy is six months or less, under the
assumption that the disease will run its normal course.

27. STAGES OF TERMINAL ILNESSS
Disbelief : in the stage of disbelief, most people are
shocked that it could happen to them. There is extreme
anxiety especially about the unknown. Shock , despair
and anger are common.
There is also guilt that perhaps the person has done
something wrong to receive such a diagnosis. Some
individuals use humor as a psychological defense
mechanism: others become helpless and often start to
bargain. This first stage usually lasts from a few days to
many months.

28. Depression : the second stage is usually a reaction to
the diagnosis. The depression is mild to moderate in
intensity and needs family support. Only in rare cases,
any type of medical therapy is required. Duration of
depression often can last several weeks to throughout
the illness. The goal is to help the person go into the final
stage of acceptance.

29. MANAGEMENT
• By definition there is no cure or adequate treatment for
terminal illness. However, some kind of medical treatments
may be appropriate anyway, such as treatment to reduce pain
or ease breathing.
• Some terminally ill patients stop all debilitating treatments to
reduce unwanted success.
• Still others reject conventional medical treatmnet and pursue.
Patient’s choices about different treatments may change over
time.
• Palliative care is normally offered to terminally ill patinets,
regardless of their overall disease management style. It helps
to manage symptoms such as pain and improve quality of life.

30. • Hospice care can be provided at home or in a long-term care
facility. It additionally provides emotional and spiritual support
for the patient and loved ones.
• Some complementary medicine approaches, such as
relaxation therapy, massage and acupuncture relieve some
symptoms and other causes of suffering.