This document provides guidance on caring for unconscious patients. It discusses assessing patients using the Glasgow Coma Scale and monitoring vital signs. Some key aspects of care include preventing secondary complications like pressure sores, pneumonia, and DVT through regular repositioning, skin care, oral hygiene, and early mobility when possible. Proper nutrition, bowel and bladder care, and sensory stimulation are also emphasized to support recovery and prevent further issues in unconscious patients who are fully dependent on others for their care.

1. Care Unconscious Patient
1
Presented By – Atul Yadav (RN,RM)

2. Care of unconscious patients.
(Unconscious, Bedridden, Critically ill, terminally ill)
• Person who has no control upon him self or his
environment.
• Is fully dependent upon others for monitoring
his/her vital functions.
Conditions of immobility: -
• Patient on traction, CVA, chronically ill,
terminally. ill, post –operative, unconscious
patients, #, accident, injury etc.
2

3. 3
impaired consciousness: -
• Clouding of consciousness.
• Delirium.
• Illusion. and hallucination
• Coma: Pt. totally unaware.

4. 4
Assessment: -
• G.C.S. (eye + verbal + moter).
• Vital signs: - TPR, BP,
• Pupil – size and reaction.
• Limb movement and tendon reflex. etc.

5. 5
• Complications of immobility: -
• Skin: - Pressure sore, laceration.
• Respiratory: - Hypostatic pneumonia, pull.
Embolism.
• C.V. complications: - DVT, postural
hypotension, thrombo embolsm.
• G.I. system: - Paralytic ilius, constipation,
distention.
• Urological: - UTI, stone.
• Muskulo skeleton: - Contracture, osteoporosis,
dystrophy, weakness.
• Neurological: - Foot drop.
• Psychological: - Anxiety, depression.

6. 6
Care of unconscious
Nsg. Aims: -
• Identify problems.
• Prevent secondry complications.
• Maximise functional recovery.
• Support patient and relatives.
• Care of psychological aspects,

7. 7
Care of unconscious Pt: -
• Emg. Management: - ABC.
• Air – way clearance: - suctioning / positioning.
• Prevention of risk of injury: -
– Altered cognitive status.
– Strain, padding and support.
– Side rails, foot splint / board.
• Maintanance of fluid volume: -
– I/O, IVF, N/G feeding, orally.
• Care of oral cavity – mouth care 4 hrly.
• Maintain tissue integrity of cornea: -
–  / abscent corneal reflex, eye care, pad.

8. 8
• Prevention from cold: -
– Damage of hypothalamic center.
– Warm clothing / protection.
• Catheter care / VS urinary care.
– Incontinence care,
– Catheterized.
– Retention care,
– Stimulation intemittat
– Catheterization, folly’s.
• Bowel care: -
• Constipation care – fluid / fiber / laxatives.
• Diarrhea – fluid / odours.
• Impaction – digital removal.

9. 9
• Prevention of pressure ulcer: -
• Back care, positioning, air / water matters etc.
• Skin care: - Positioning, bed bath, hair wash, nail.
• Nutritional care: - N/G, TPN, IVF, I/O.
• Pyrexia: - room cold, ventilation, TPR, cold.
• Promoting sensory stimulation: -
– To prevent from sensory deprivation.
Care: - Touching the Pt., communicating with Pt., avoid
negative comments near Pt., Orient Pt. about: time,
place, person ev.8 hrly. Divertional therapy: radio, music
etc.
• Monitoring and managing potential comp: -
e.g. Pneumonia, aspiration, respiratory failure.
Care: - TPR, BP, blood count, ABG, suctioning, chest
physio., C/S – blood and secretions.

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Specific needs and care: -
• Care of skin and prevention of bedsore.
• Bowel management.
• Prevention of physical detormities.
• Nutritional needs of patient.
• Care of urinary pladder.
• Different therapies to the bed-ridden Pt.
– Recreation  games, Phone, paper, pray, radio.
etc.
– Divertional  Relax. ex., meditation, touch. etc.
– Oceupational th.  Typing / phone/computer tee.
(esp. handicap).

11. 11
Management of patient with immobility:
Nursing aims: -
– Identify problems.
– Prevint secondry complications.
– Maximise functional recovery.
– Support patient and relatives.
– Care of psychological aspects and their
relatives.

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Specific needs and care: -
Care of skin and prevention of bed-sore: -
– Position change 2 hrly.
– Back care.
– Air/water mattress. (if need).
– Care of pressure points.
– Avoid friction.
– Nutrition diet.
– Family teaching.

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Points to remember: -
• Put air way if Pt. is unconscious.
• Tracheostomy – if air way obstruction.
• Suction equipment available.
• Assess breath sound 1-2 hrly.
• Never give fluid / food to shallow.
• Lateral position.
• Perineal care.
• Examine abdomen for distention.
• Involve family in care (general wards).

14. NEUROLIGICAL ASSESSMENT:
Level of consciousness: -
– Eye opening.
GCS Use.
score.
• Spontaneous 4
• To command 3
• To pain 2
• None 1
Verbal response
• Oriented
• Confused
• Inappropriate words
• Incomprehensive SUD.
• None
– Motor response:
5
4
3
2
1
• Obeys command
• Localizes to painful stimuli
• withdraws to painful stimuli
• Flexion to painful stimuli
• Extension to painful stimuli
• None to painful stimuli
6
5
4
3
2
1
Minimum score: 3 , Maximum score: 15 , Score less than 8: prognosis poor.
Score > 8: prognosis fair. Record every 12 hrly.

15. Communication Skills
required in Critical Care

16. Distance to be maintained in Communication:
Review
• Distance is proximity between people which gives
important signal.
 Intimate distance = 18 inches- Nurse and patient
 Personal distance =18 inches to 4ft between family
and friends
 Social distance = 4 to12ft – professional
 Public distance=12ft for public speaking

17. Thank You