coma

2. INTRODUCTION
 The Brain requires a constant supply of oxygenated
blood and glucose to function. Interruption of this
supply will cause loss of consciousness within a few
seconds and permanent brain damage in minutes.

3. MEANING OF CONSCIOUSNESS
 Consciousness is a state of being wakeful and aware of
self, environment and time

4. MEANING OF UNCONSCIOUSNESS
 Unconsciousness is an abnormal state resulting from
disturbance of sensory perception to the extent that
the patient is not aware of what is happening around
him or her.

5. LEVELS OF UNCONSCIOUSNESS
Excitatory Unconsciousness
Stupor
Fainting
Somnolent
Coma
Vegetative Stage

6. COMA
‘Coma’- Greek word - Koma –deep sleep
A coma is a deep state of prolonged unconsciousness in
which a person can not be awakened, fails to respond
normally to painful stimuli, light or sound; lacks a
normal wake sleep cycle and does not initiate
voluntary action.

7. CAUSES
 Traumatic Brain injuries
 Stroke
 Tumors
 Diabetes
 Lack of Oxygen
 Infections
 Seizures
 Drugs and Alcohol
 Medically induced Coma

8. SIGNS AND SYMPTOMS
 Unresponsive
 Unaware of surroundings
 Unable to open the eyes
 Pupils not responding to light
 Irregular breathing
 Inability to speak or move parts
 Incontinence
 GCS score 3-8

9. ASSESSMENT
G.C.S. (eye + verbal +motor).
Vital signs
Pupil – size and reaction.
Limb movement and tendon reflex. etc

11. PUPIL REACTION

13. DIAGNOSIS

14. MEDICAL MANAGEMENT

15. MEDICAL MANAGEMENT
 The goal of medical managementare to preserve
brain function and prevent further damage.
Ventilatory support
Oxygen therapy
Management of blood pressure
Management of fluid balance
Management of seizures : anti epileptic sedatives,
paralytic agents

16. Contd…
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

17. COMPLICATIONS OF IMMOBILITY
Skin: - Pressure sore, laceration.
Respiratory: - Hypostatic pneumonia, pulmonary.
Embolism.
C.V. complications: - DVT, postural hypotension,
thromboembolism.
G.I. system: - Paralytic ilius, constipation, distention.
Urological: - UTI, stone.
Musculoskeletal: - Contracture, osteoporosis,
dystrophy, weakness.
Neurological: - Foot drop.
Psychological: - Anxiety, depression

18. NURSING MANAGEMENT

19. MAINTAINING PATENT AIRWAY
 Elevating head end of
the bed
 Positioning the
patient
 Endotracheal tube or
tracheostomy
 Chest physiotherapy
 Suctioning

20. SUCTIONING

21. TRACHEOSTOMY CARE

22. PROTECTING THE CLIENT
 Side rails
 Take care to avoid any
injury
 Protect from external
sources of heat
 Avoid over sedation
 Assess for need of restrain

23. SKIN INTEGRITY
 Assessing the skin
 Hygiene
 Back care
 Prevention of Bed sores
Positioning
Comfort devices
 Nutrition

24. Contd…

25. NUTRITION
TPN (Total Parenteral nutrition)
Enteral feeding via Nasogastric, nasojejunal or PEG
tube
Intravenous fluids (Max 72 hrs)

26. EYE CARE
 Observe
 Cleaning
 Eye drops
 Eye Pad

27. ORAL CARE
 Chlorhexidine based
solution
 Airway should be
removed
 Minimum of four-hourly
 Protect Gingiva

28. CARE OF BOWEL
 Assess for constipation
 Auscultate bowel sounds
 Stool softeners or
laxatives
 Fiber Diet

29. CARE OF BLADDER
 Assess for bladder
distention
 Bladder catheterization
 Catheter Care

30. FOOT CARE
Prevention of DVT
Prevention of Contractures
Prevention of Foot drop

31. PSYCHOLOGICAL SUPPORT
1. Patient : Encourage Sensory stimulation
Playing music/radio/CD/TV
Reading a book
Bring perfumed flowers
2. Family

32. PREVENTION OF HAI

33. FAST HUG MNEMONIC
 F – Feeding
 A – Analgesia
 S – Sedation (scale??)
 T – Thromboembolic prophylaxis
 H – Head of bed elevation
 U – Stress ulcer prevention
 G – Glucose control