unconsciousness & syncope

1. 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

2. MEANING OF CONSCIOUSNESS
• It is a state of that has three important aspects-
wakefulness;
Awareness of self,
Awareness of Environment and time.

3. Unconsciousness
• Unconsciousness is when a person suddenly
becomes unable to respond to stimuli and
appears to be asleep. A person may be
unconscious for a few seconds — as in fainting
— or for longer periods of time.

4. causes unconsciousness
• Unconsciousness can be brought on by a major
illness or injury, or complications from drug
use or alcohol misuse.
• Common causes of unconsciousness include:
• a car accident
• severe blood loss
• a blow to the chest or head
• a drug overdose
• Alcohol, poisoning
• Shock• Seizures

5. Common causes of temporary unconsciousness
include:
• low blood sugar
• low blood pressure
• syncope, or the loss of consciousness due to lack
of blood flow to the brain
• neurologic syncope, or the loss of consciousness
caused by a seizure, stroke, or transient ischemic
attack (TIA)
• dehydration
• problems with the heart’s rhythm
• straining
• hyperventilating

6. LEVELS OF UNCONSCIOUSNESS
• Excitatory unconsciousness
• Stuporous
• Fainting
• Somnolent
• Coma
• Vegetative stage

7. • Exicitatory unconsciousness
• Does not respond coherently but is
disturbed by sensory stimuli such as bright
light, noise.
• Stupor
• In stupor, patient responds to external
stimuli and shows the symptoms of
annoyance when stimulated by pinprick or
loud noise such as clapping of hands.

8. • Fainting
• In fainting, there is a momentary
loss of consciousness and the patient usually
recovers spontaneously
• Somnolent
• a state when patient feels drowsy or
sleepy or we can say it is a state between
sleeping and awakning.

9. • Coma
• Coma is a clinical state of unconsciousness in
which the patient is unaware of himself and
his environment. The patient may respond to
deep painful stimuli. In deep coma, there is no
arousal

10. • Vegetative state
• Clinical condition of complete unawareness of
self & environment with damage to CNS.
• No chance to recover back.

11. PATHOPHYSIOLOGY

12. Symptoms
• Symptoms that may indicate that
unconsciousness is about to occur include:
• sudden inability to respond
• slurred speech
• a rapid heartbeat
• Confusion, Very pale skin
• dizziness or lightheadedness

13. Diagnostic test
• complete medical history and physical examination,
which includes a detailed neurological evaluation
• Complete blood count (CBC). This blood test reveals
whether you have a low hemoglobin level, which
indicates anemia. An elevated white blood cell (WBC)
count indicates infections, such
as meningitis or pneumonia.
• Toxicology screen. This test uses a blood or urine sample
to detect the presence and levels of medications, illegal
drugs, and poisons in your system.
• Electrolyte panel. These blood tests measures levels
of sodium, potassium, chloride, and bicarbonate.

14. • Liver function tests These tests determine the health of your liver
by measuring levels of proteins, liver enzymes, or bilirubin in your
blood.
• Electroencephalogram (EEG) This exam uses scalp electrodes to
evaluate brain activity.
• Electrocardiogram (EKG)This exam measures your heart’s
electrical activity (such as heart rate and rhythm).
• Chest X-ray Doctors use this imaging test to evaluate the heart and
lungs.
• CT scan of the head A CT scan uses computers and rotating X-ray
to make high-resolution images of the brain. Doctors use these
images to find abnormalities.
• MRI of the head An MRI uses nuclear magnetic resonance imaging
to make high-resolution images of the brain.

15. Management
• Obtain And Maintain Airway.
• Insert oral airway
• Monitor Circulatory Status To Ensure Adequate
Perfusion To The Body And Brain(CPR)
• Central Line Catheterization
• Foley’s Catheterization
• Ryle’s Tube Insertion
• Prevention Of Complication

16. EMERGENCY NURSING CARE
• Check clues and causes of unconsciousness
• Loosen clothes
• Ease breathing by turning head to side keeping
neck straight, chin forward drain and clean mouth
secretion
• remove artificial teeth if any.

17. • Keep warm and comfortable
• Observe LOC
• Keep his extremities and joints in
functional position
• It is important to remember that hearing
sense is the last one to go and first one to
come back, so avoid unnecessary talk.

18. DO NOT
• DO NOT give an unconscious person any food
or drink.
• DO NOT leave the person alone.
• DO NOT place a pillow under the head of an
unconscious person.
• DO NOT slap an unconscious person's face or
splash water on their face to try to revive them.

19. Prevention
To prevent becoming unconscious or fainting:
• Avoid situations where your blood sugar level gets too
low.
• Avoid standing in one place too long without moving,
especially if you are prone to fainting.
• Get enough fluid, particularly in warm weather.
• If you feel like you are about to faint, lie down or sit
with your head bent forward between your knees.
• If you have a medical condition, such as diabetes,
always wear a medical alert necklace or bracelet.

20. Complication
Potential complications of being unconscious for a
long period of time include:
• Coma
• Brain damage
• Broken or fractured ribs from the chest
compression during CPR
• Choking can also occur during unconsciousness.
Food or liquid may have blocked your airway.
This is particularly dangerous and could lead to
death if it isn’t remedied.

21. NURSING CARE OF
UNCONSCIOUS PATIENT
• Nsg diagnosis-
• Ineffective airway clearance R/t inability to swallowing
• Intervention
• Airway management, an oral airway can be inserted
• Care of ETT/ tracheostomy
• Suctioning
• Positioning
• Chest physiotherapy
• Nebulization

22. • Risk for aspiration R/T altered LOC
• Intervention—
• Monitor ABG
• Keep suctioning equipment available
• Observe cardiac monitoring for
dysrhythmias
• Positioning

23. Impaired oral mucus membrane
R/T mouth breathing absence of pharyngeal
reflex, & altered fluid intake
• Intervention
• Inspect pt’s mouth every 8 hours
• Apply water-soluble lubricant to prevent cracking, drying.
• Oral hygiene( to avoid parotities, aspiration and
RTI)

24. • Deficient fluid volume r/t inability to
take fluids by mouth
INTERVENTION-
• Accurate documentation of intake and
output
• Assessment and documentation of conditions
that might increase fluid volume deficit
(diaphoresis, polyuria, diarrhea, vomiting)
• Avoid overhydration in a patient receiving
IV fluids because of risk of cerebral edema

25. • Risk for injury R/T decreasedLOC
• Intervention-
• Side rails
• Seizure precautions ( use padded side rails,
keep the patient’s nail short)
• Protect patient’s head
• Use caution when moving
• Always turn an unconscious patient toward
you or someone else to prevent fall.

26. • Do not restrain the patient unless absolutely
necessary, if restraints are used, they must be
released at least every 2hours for skin check.
• Avoid oversedation (which increases ICP)
• Do not leave unattended.

27. • Risk of skin integrity R/T immobility
Intervention
• Personal hygiene
• Skin care, care of pressure points
• Keep nails trimmed
• Repositioned every 2 hours
• Put on special mattress or bed

28. SYNCOPE

29. SYNCOPE
• Syncope (pronounced “sin ko pea”) is the medical
term for fainting or passing out. It is caused by a
temporary drop in the amount of blood that flows
to the brain
• syncope can happen if you have a sudden drop in
blood pressure, a drop in heart rate, or changes in
the amount of blood in areas of your body. If you
pass out, you will likely become conscious and
alert right away, but you may be feel confused for
a bit.

30. causes syncope
• Syncope can be caused by many things. Many
patients have a medical condition they may or
may not know about that affects the nervous
system or heart.
• You may also have a condition that affects
blood flow through your body and causes your
blood pressure to drop when you change
positions (for example, going from lying down
to standing).

31. Types of Syncope
• Vasovagal syncope
• Situational syncope
• Postural syncope
• Neurologic syncope
• Postural Orthostatic Tachycardia Syndrome
• Unknown Causes of Syncope

32. Vasovagal syncope
• Vasovagal syncope is the most common type of
syncope. It is caused by a sudden drop in blood
pressure, which causes a drop in blood flow to the
brain.
• When you stand up, gravity causes blood to settle
in the lower part of your body, below your
diaphragm.
• When that happens, the heart and autonomic
nervous system (ANS) work to keep your blood
pressure stable.

33. Situational syncope
• Situational syncope is a type of vasovagal
syncope.
• It happens only during certain situations that
affect the nervous system and lead to syncope.
Some of these situations are:
• Dehydration
• Intense emotional stress
• Anxiety
• Fear
• Pain
• Hunger
• Use of alcohol or drugs

34. Postural syncope
• Postural syncope is caused by a sudden drop in
blood pressure due to a quick change in
position, such as from lying down to standing.
Certain medications and dehydration can lead
to this condition.
• Patients with this type of syncope usually have
changes in their blood pressure that cause it to
drop by at least 20 mmHg (systolic/top
number) and at least 10 mmHg
(diastolic/bottom number) when they stand

35. Neurologic syncope
• Neurologic syncope is caused by a
neurological condition such as seizure, stroke
or transient ischemic attack (TIA).
• Other less common conditions that lead to
neurologic syncope include migraines and
normal pressure hydrocephalus

36. Postural Orthostatic Tachycardia
Syndrome
• Postural-Orthostatic Tachycardia Syndrome is
caused by a very fast heart rate (tachycardia) that
happens when a person stands after sitting or
lying down.
• The heart rate can speed up by 30 beats per
minute or more.
• The increase usually happens within 10 minutes
of standing. The condition is most common in
women, but it can also occur in men.

37. Unknown Causes of Syncope
• The cause of syncope is unknown In about
one-third of patients. However, an increased
risk of syncope is a side effect for some
medications.

38. symptoms of syncope
• Blacking out
• Feeling lightheaded
• Falling for no reason
• Feeling dizzy
• Feeling drowsy or groggy
• Fainting, especially after eating or exercising
• Feeling unsteady or weak when standing
• Changes in vision, such as seeing spots or having
tunnel vision
• Headaches

39. Diagnostic test
• Laboratory testing
• Electrocardiogram (EKG or ECG)
• Exercise stress test
• Echocardiogram
• Hemodynamic testing

40. Management
• Taking medications or making changes to medications
you already take.
• Wearing support garments or compression stockings to
improve blood circulation.
• Making changes to your diet. Your doctor may suggest
that you eat small, frequent meals; eat more salt
(sodium); drink more fluids, increase the amount of
potassium in your diet; and avoid caffeine and alcohol.
• Being extra cautious when you stand up.
• Elevating the head of your bed while sleeping. You can
do this by using extra pillows or by placing risers under
the legs of the head of the bed.

41. • Avoiding or changing the situations or “triggers”
that cause a syncope episode.
• Biofeedback training to control a fast heartbeat.
• Treatment for structural heart disease.
• Implanting a pacemaker to keep your heart rate
regular (only needed for patients with certain
medical conditions).
• An implantable cardiac defibrillator (ICD). This
device constantly monitors your heart rate and
rhythm and corrects a fast, abnormal rhythm (only
needed for patients with certain medical conditions).