Unconsciousness refers to a lack of awareness of one's environment and inability to respond to external stimuli. It can range from stupor to a coma. The exact mechanisms in the brain are unknown but it involves areas regulating consciousness like the cerebral cortex and reticular formation. Causes include head injuries, strokes, seizures, cardiac issues, hypoxia, infections, and substance abuse. Clinically, it presents as confusion, altered mental status, abnormal vital signs, and seizures. The Glasgow Coma Scale is used to assess the level of consciousness. Nursing management focuses on airway maintenance, fluid/nutrition support, personal hygiene, mobility, and family education to optimize the patient's condition.

1. Unconsciousness
BY
BHUVANESWARI V B.SC. NURSING
PADMAVATHY COLLEGE OF NURSING
BAHOUR

2.  Unconsciousness is a condition in which there is depression
of cerebral function ranging from stupor to coma
 Coma may be defined as no eye opening on stimulation,
absence of comprehensible speech, a failure to obey
commands.
 Unconsciousness is a lack of awareness of one’s environment
and the inability to responds to external stimuli
 Unconsciousness is when a person is unable to respond to
people and activities often called coma/ comatose state.

3. Mechanism in brain
 Exact mechanism is unknown
 Number of critical areas in the brains that are deeply involved
in maintaining consciousness
 Cerebral cortex receives sensory inputs from the main
sensory nerves and also from the reticular formation
 Nerve routes from around the body branch out to the
reticular formation and feed it a constant stream of electrical
signals

4.  In turn, causes reticular formation to fire off signals to targets
all around brain.
 If the driving force is slows down or prevented from
occurring. The cerebral cortex becomes sleepy and
unconscious.
 Brain stem is important in maintaining heartbeat, blood
pressure, breathing

5. Causes
 Head injury
 CVA
 SAH
 Skull fracture
 Epileptic fits
 Cardiac arrest
 Asphyxia Infantile convulsion Blood loss
 Fainting Hysteria Substance abuse
 Concussion

6.  Hypogylcemia
 Drug overdose
 Compression
 Alcohol abuse
 Hypothermia
 Extreme body temperature
 CNS infection
 Poisoning substances
 Metabolic / endocrine causes
 Hypertensive crisis
 Hypoxia and hypercabnia

7. Clinical manifestations
 Confusion
 Drowsiness
 Disorientation
 Chyne – stroke respiration
 Altered ocular movements and dilated pupils
 Inability to speak or move parts of his or her body
 Light headedness
 Loss of bowel or bladder control (incontinence)

8. Clinical manifestations (cont..)
 Rapid heartbeat (palpitations )
 Rigidity of extremities
 Increased intracranial and cerebrospinal pressure
 Convulsion or seizures
 Stupor

9. Assessment of level of consciousness
 Glasgow coma scale is used to assess the level of
consciousness in unconscious patients.
 Based on 15 points scale for estimating and categorizing the
outcomes of brain injury
 Measures the motor response, verbal response, eye opening.
 Helps to measure the wide variety of conditions such as acute
brain damage due to traumatic/ vascular injuries or infection,
metabolic disorders

10.  Score ranges from 3 to 15
 3- 8 coma
 3 deep coma
 15 normal

11. Glasgow coma scale
 Eye opening
Spontaneous 4
To voice 3
To pain 2
None 1

12.  Best verbal response
Oriented 5
Confused 4
Inappropriate words 3
Incomprehensible sounds 2
None 1

13.  Best motor response
Obeys commands 6
Localizes pain 5
Withdraws 4
Flexion 3
Extension 2
None 1
Total 3 - 15

14. Medical management
 Patent airway – tracheostomy, oral/ nasal intubation
 Adequate oxygenation – oxygen therapy, mechanical
ventilation
 Fluid balance – IV catheter
 Nutritional support – feeding tube, gastrostomy tube
 Circulatory status – to ensure the adequate perfusion to
body and brain

15. Nursing management
 Maintaining effective airway:
 position patient in lateral recumbent position
 Elevate head to 30 degrees
 Suctioning whenever necessary
 Changing position side to side every 2nd hourly
 Maintaining patency of airway
 If needed insert airway

16. Maintaining patient airway (cont…)
 Administer oxygen therapy when necessary
 Physiotherapy to improve lung expansion

17. Nursing management (cont..)
 Maintenance of fluid and electrolyte balance and nutrition
 Supplied by IV fluids, gastric tube feeding
 Monitor I/O
 24 hours urine collection to assess the protein need of the
patient.
 Monitor heart rate, respiratory rate, rhythm, blood
pressure, temperature.

18. Maintenance of fluid and electrolyte
balance and nutrition (cont..)
 Assess neurologic status
 Assess for pallor or cyanosis, pyrexia, infection, tachycardia,
hypotension
 Administer fluids, electrolytes, vitamins
 Signs of dehydration
 Give 200 to 250ml of fluids every 3 hours

19. Nursing management (cont..)
 Maintenance of personal hygiene and care of pressure areas
 Sponging every day
 2nd hourly position change
 Side railing to protect and prevent fall
 Keep skin dry, clean, free of moisture and prevent bed
sore.
 Back care every 4th hourly.

20. Maintenance of personal hygiene and
care of pressure areas (cont..)
 Protective mattress
 Oral hygiene at least twice per shift
 Clean ear with swabs
 Check eyes frequently for signs of infection, irritation
 Gentle cleaning of the nasal mucosa with gauze and water.

21. Nursing management ( cont..)
 Promoting elimination
 Bowel evacuation, auscultate bowel sounds
 Assess for urinary incontinence, retension
 Foley catheterization
 Stool softeners to relieve constipation

22. Nursing management (cont..)
 Maintaining mobility
 Provide foot rest (pillow or sand bag)
 Passive exercises 4 times daily
 Check for thrombophlebitis

23. Nursing management (cont..)
 Family education
 IPR with family
 Update of information and patient condition
 Involve relatives with routine care
 Comfortable physical environment
 Report any unusual findings
 Ensure all procedures are informed to patient