The document discusses consciousness and unconsciousness. It defines consciousness as awareness of oneself and one's environment, while unconsciousness is a lack of response to stimuli and can range from confusion to deep coma. Unconsciousness can be caused by lesions in the brainstem, thalamus, or hemispheres. The Glasgow Coma Scale is used to assess level of consciousness. Nursing care for unconscious patients focuses on airway protection, circulation support, skin integrity, nutrition, and safety.
it includes the nursing care plan examples related to the respiratory system and their intervention in ideal format. check this for your reference. it help us to know the planning. its given according to NANDA nursing diagnosis.
it includes the nursing care plan examples related to the respiratory system and their intervention in ideal format. check this for your reference. it help us to know the planning. its given according to NANDA nursing diagnosis.
Precise guide for DGNM, B.Sc Nursing & M.Sc Nursing Students .. regarding Unconsciousness, and its management. Highly recommended for II B.Sc Nursing Students.
A physical examination is a routine test your primary care provider (PCP) performs to check your overall health. A PCP may be a doctor, a nurse practitioner, or a physician assistant. The exam is also known as a wellness check
This presentation includes the first aid measures one can provide in case of accidental as well as intentional poisoning in order to minimize the morbidity and mortality in victims with poisoning.
care of unconscious patient Med surg pptNehaNupur8
detailed information about care of unconscious patient in the hospital , neurological ward, contain introduction, definition, levels of unconsciousness , causes, clinical manifestations, pathophysiology diagnostic evaluation, assessment of patient, medical magement, nursing management, surgical care, emergency care ,complications, summary ,research.
Precise guide for DGNM, B.Sc Nursing & M.Sc Nursing Students .. regarding Unconsciousness, and its management. Highly recommended for II B.Sc Nursing Students.
A physical examination is a routine test your primary care provider (PCP) performs to check your overall health. A PCP may be a doctor, a nurse practitioner, or a physician assistant. The exam is also known as a wellness check
This presentation includes the first aid measures one can provide in case of accidental as well as intentional poisoning in order to minimize the morbidity and mortality in victims with poisoning.
care of unconscious patient Med surg pptNehaNupur8
detailed information about care of unconscious patient in the hospital , neurological ward, contain introduction, definition, levels of unconsciousness , causes, clinical manifestations, pathophysiology diagnostic evaluation, assessment of patient, medical magement, nursing management, surgical care, emergency care ,complications, summary ,research.
Pediatric Coma
Introduction
Disorders of Consciousness
Coma Mimics
Etiologies
Evaluation
Brainstem Reflexes
Pediatric Glasgow Coma Scale
Management
Coma Sequelae
Coma is defined and the anatomy of consciousness explained. The various levels of arousal, AVPU scale and Glasgow Coma Scale described. The differential diagnosis of coma discussed are coma with & without focal deficits and the meningitis syndrome.
The various aspects of history discussed in details. The examination part includes the general examination, Brainstem reflexes, motor functions with the signs of lateralisation and meningeal irritation signs.
The basic lab investigations, Imaging and special investigations like CSF examination, EEG discussed.
Elevated intracranial pressure and its management explained.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
3. It is defined as a state of awareness of oneself and of
one’s environment
Ability to perceive sensory stimuli and respond
appropriately to them
3
4. It comprises of two components:
1. Arousal
2. Awareness
Awareness of self: It means that the client can identify
himself or herself.
Awareness of environment: It indicates that the client can
identify his/ her present location and reason for being there.
Awareness of time: It indicates that a client knows the date,
month and year
4
5. A state of complete or partial unawareness or lack of
response to sensory stimuli. Various degrees of
unconsciousness are there: e.g. confusion, stupor, somnolent,
excitary and deep coma etc.
Abnormal state - client is unarousable and unresponsive.
Degrees of unconsciousness that vary in length and severity.
Unconsciousness is a symptom rather than a disease.
5
6. State in which a patient is totally unaware of both self and
external surroundings
Coma is a state of sustained unconscious in which the patient:-
Totally unconscious, unresponsive, unaware and unarousable.
Do not respond to external stimuli, such as pain or light
Does not move voluntarily.
Altered respiratory patterns.
Does not blink
Coma is a deepest state of unconsciousness
6
7. Any abnormality of the following areas can cause
unconsciousness:
Bilateral hemispheric abnormality
Brainstem abnormality
Thalamic abnormality
7
10. Diseases of neurons
Metabolic encephalopathy
Diseases of other organs e.g.
liver, lungs and kidney etc.
Poisons, alcohol and drugs
Fluid and electrolyte
imbalance
Infections
Nutritional deficiency
Hypo/Hyperglycemia
Hypo/hypernatremia
Anoxia or ischemia
Temperature regulation
disorders
10
12. Consciousness is a complex function controlled by RAS
RAS begin in the medulla as reticular formation
Reticular formation connect to RAS located in the midbrain, connects to the
hypothalamus and thalamus
Integrated pathway connects to the cortex via thalamus and to the limbic system
via hypothalamus
Reticular formation produces wakefulness whereas RAS are responsible for
awareness of self and environment
Both cerebral hemisphere and the brain stem are affected
12
13. Damage to the brain and skull
Inflammation, edema and hemorrhage
Increased ICP
Diffused damage to the cerebral tissues
Blocks the signal to the RAS (Reticular activating system)
UNCONSCIOUSNESS
13
16. Disoriented to time, place and person
Increased motor activities.
Illusion, hallucinations
16
17. Reduced ability to be aroused & limited response to
environment.
Reduce level of alertness or consciousness
Sleeps unless stimulated with speech or touch
Verbally a grunt or nod
17
18. Deep sleep or unresponsiveness
Responds by withdrawing or grabbing at the source of pain
Can be aroused only with painful stimuli
18
20. Patient is awake but showing no sign of awareness
Opens eyes spontaneously
Does not follow commands
No purposeful movements
Show spontaneous roving eyes
Sleep awake cycles normal
Affect cognitive or affective function
20
21. Many patients emerge from a vegetative state within a
few weeks but those who do not recover within 30 days are
said to be in a persistent vegetative state (PVS).
Irregular circadian sleep–wake cycles
21
22. Caused by damage to specific portions of the lower brain
and brainstem with no damage to the upper brain.
Patient is aware but cannot move or communicate verbally
due to complete paralysis of nearly all voluntary muscles in
the body except for vertical eye movements and blinking
Mode of communication is eye movements or clinking of the
upper eyelid
22
23. Patients are immobile and usually lie with their eyes closed.
It is a state of unresponsiveness to the environment
Absence of body movement and speech but sometimes open
the eyes
Motor response to noxious stimuli is absent or minimal
23
24. Irreversible damage of the brain, including the brainstem and
cerebellum and cessation of functions.
Pulmonary and cardiac functions can be maintained by artificial means.
Untreated coma causes it.
24
26. As lesion expands, manifestation becomes more
pronounced
Unilateral sensory-motor deficit (e.g. Patient can’t raise
the right leg or arm)
Deficit in visual field (blind in one half of the visual field)
The person is unaware of his surroundings
Does not respond to sound or to touch
Inability to speak or move parts of his or her body
Loss of bowel or bladder control (incontinence)
If the lesion can’t be treated, coma develops.
26
27. Sudden loss of consciousness
Unusual respiratory pattern
Cranial nerve palsies, especially abnormal eye movements
and loss of pupillary reaction to light.
Specific pattern of pupil size(pinpoint) and reactivity to
light occurs
27
28. Disorders affects entire brain
Before any physical symptoms are noticed confusion and
stupor occurs
Pupillary response is normal unless the condition is
related to drug overdose
Tremor
Asterixis
Seizure
28
32. 32
Provide high quality CPR
1. Start compression within 10 second of
recognition of cardiac arrest
2. Push hard and fast, compress at a rate of
100
beats per minute with depth of at least 2
inches for adult and 1 inch for children
3. Allow complete chest recoil after each
compression
4. Minimize interruption in compression
5. Give effective breaths that makes the chest
rise
6. Avoid excess ventilation
7. Begin cycle of 30:2 compression
33. Danger - Looking for Dangers to yourself and Casualty
Response - Checking Response (AVPU). Use the Glasgow
Coma Scale to ascertain level of consciousness
Airway - Examining the Airway for obstruction
Breathing - Look, Listen and Feel for adequate respiratory
effort. Supplement with Oxygen to correct hypoxia if
saturation is below 95%
Circulation - Checking the Circulation. If a carotid pulse is
not palpable then resuscitation should be commenced.
33
34. Monitor vital signs, blood glucose levels.
Obtain history from relatives, family or witnesses.
Collect as much information as possible about the patient.
Allergies
Medication
Previous medical history (Epilepsy, Diabetes)
Last meal
Event - What has happened
34
35. Pharmacological treatment
Treating Increased ICP: mannitol, corticosteroids
Mannitol 0.5 mg/kg over 15 min and repeat after 4 hrs.
Steroids
Dexamethasone
Management of fever: ice packs, tepid sponging, Antipyretics, NSAIDS
Management of elimination: laxatives and high fiber diet
Loop diuretics: inj. Lasix 40 mg stat
Surgical interventions: ventriculostomy
for draining CSF
35
36. Hypoglycemia: 50 ml of 50% D IV push
Wernicke's encephalopathy :thiamine
Drug overdose :naloxone
Seizures: antiepileptic, sedatives and paralytic
agents
Infection: antibiotics
Hyperglycemia: insulin
Poison ingestion: gastric lavage
Management of nutrition: TPN and Ryle’s Tube feeds
36
37. GOALS OF NURSING CARE
Maintain adequate cerebral perfusion
Remain normothermic
Be free from pain, discomfort, and infection
Attain maximal cognitive, motor and sensory function
37
38. LOC
RR, rhythm
Pupils
Eye movements
Doll's eye reflex
Vital signs
Skin
Bowel and Bladder function
Intake and output
Pulmonary functions
38
40. Highest score is 15/15 - Good orientation
Lowest score is 3/15 - Deep coma. Considered brain dead
if client dependent on a ventilator
GCS≤8- Severe brain injury
GCS 9-12- Moderate brain injury
GCS 13 Mild brain injury
40
41. Ineffective airway clearance related to altered level of
consciousness.
Fluid volume deficit related to inability to take in fluids by
mouth
Disturbed sensory perception related to neurological
impairment
Self-care deficit related to loss of consciousness.
Interrupted family process related to uncertain future and
impending death of a family member.
41
42. Bowel incontinence related to impairment in neurological control.
Impaired urinary elimination related to impairment in neurological
control.
Risk for aspiration related to lack of effective airway clearance and loss
of gag reflex.
Risk for impaired skin integrity related to immobility.
Risk for increased ICP related to Brain Swelling, Blood accumulation
and Obstruction of Cerebrospinal Fluid Flow
Risk for injury related to decreased level of consciousness.
42
43. The breath sounds must be assessed every 2 hourly.
ABG results must be interpreted to determine the degree of
oxygenation provided by the ventilators or oxygen.
Assess for cough and swallow reflexes
Use an oral artificial airway to maintain patency
Tracheostomy or endotracheal intubation and mechanical
ventilation maybe necessary
PREVENTING AIRWAY OBSTRUCTION
Position on alternate sides 2-4 hours to prevent secretions
accumulating in the airways on one side.
Maintain the neck in a neutral position
43
44. Assess the hydration status by examining the tissue turgor,
mucous membrane, I/O chart monitoring, CVP
measurement.
Maintain I/O chart strictly.
Provide intravenous fluid as prescribed.
Daily weight should be taken.
Assess and document symptoms that may indicate fluid
volume overload or deficit.
Diuretics may be prescribed to correct fluid overload and
reduce edema.
44
45. Assess the neurological status of the patient.
Communicate with the patient as hearing often remains intact in
the unconscious patient.
Avoid making any negative comments about the patient’s status or
explaining prognosis to the family members.
Call the patient by preferred name, tell patient date, time.
Touch the patient gently and describe the boundaries and
environment
Tell family members to remain with the patient to communicate.
45
46. Attending to the hygiene needs of the unconscious patient should
never become ritualistic, and despite the patient's perceived lack of
awareness, dignity should not be compromised.
Involving the family in self care needs.
Incontinence, perspiration, poor nutrition, obesity and old age also
contribute to the formation of pressure ulcers.
Care should be taken to examine the skin properly, noting any areas
which are red, dry or broken.
46
47. Observe the skin for evidence of skin breakdown.
Change the patient's position at least every two hours and provide
back care.
Provide complete bath every other day. Patient's perineal area
should be bathed daily.
The skin should be lubricated with moisturizing lotion after bathing.
The nails should be kept short, as many patients will scratch
themselves.
Change the bed linen if damp or soiled.
47
48. Unconscious patient is often a mouth breather. This causes
saliva to dry and adhere to the mouth and tooth surfaces.
Provide oral hygiene at least twice per shift. Include the
tongue; all tooth surfaces, and all soft tissue areas.
Apply lubricant to the lips to prevent drying.
Keep the nostrils free of crusted secretions
A chlorhexidine based solution is used.
48
49. In assessing the eyes, observe for signs of irritation, corneal drying,
abrasions and edema.
Gentle cleaning with gauze and 0.9% sodium chloride should be
sufficient to prevent infection.
Artificial tears can also be applied as drops to help moisten the eyes.
Corneal damage can result if the eyes remain open for a longer time.
49
50. Diet prescribed nutrition based on individuals requirements
specifically to meet energy needs, tissue repair, replace fluid loss to
maintain basic life functions
TPN is considered for prolonged unconsciousness.
Intravenous fluids are administered for comatose patients. As fluid
intake is restricted and glucose is avoided to control cerebral edema
and intravenous infusion cannot be considered as a nutritional
support.
Enteral feeding via Nasogastric, nasojejunal OR PEG tube. 50
51. Side rails must be kept whenever the patient is not receiving direct
care.
Seizure precautions must be taken.
Adequate support to limbs and head must be given when moving or
turning an unconscious patient. Protect from external sources of heat.
Over sedation should be avoided - as it impedes the assessment of the
level of consciousness and impairs respiration.
Assess the Need for restrain
51
52. Assess for constipation and bladder distention.
Auscultate bowel sounds.
Stool softeners or laxatives may be given. Bladder catheterization may
be done.
Meticulous catheter care must be provided under aseptic techniques.
Monitor the urine output and color.
Initiate bladder training as soon as consciousness has regained.
52
53. Impaired Skin Integrity
The nurse should provide intervention for all self-care
needs including bathing, hair care, skin and nail care.
Frequent back care should be given.
Comfort devices should be used.
Positions should be changed.
Special mattresses or airbeds to be used.
Adequate nutritional and hydration status should be
maintained.
Patient's nails should be kept trimmed.
Cornea should be kept moist by instilling methyl cellulose
53
54. Lateral position on a pillow to maintain head in a neutral position
Upper arm positioned on a pillow to maintain shoulder alignment
Upper leg supported on a pillow to maintain alignment of the hip
Change position to lie on alternate sides every 2-4hrs
For hemiplegia - position on the affected side for brief periods,
taking care to prevent injury to soft tissue and nerves, edema or
disruption of the blood supply
54
55. Assess the GCS score, assess signs of increased ICP.
Head elevation of 30 degrees, neutral position maintained to
facilitate venous drainage and prevent aspiration.
Pre-oxygenation before suctioning should be mandatory, and each
pass of the catheter limited to 10 seconds, with appropriate sedation
to limit the rise in ICP.
Insertion of an oral airway to suction the secretions.
The breath sounds must be assessed every 2 hourly
55
56. Restlessness
Headache
Pupillary changes: ASSESS every hourly
Respiratory irregularity
Widening pulse pressure, hypertension and bradycardia.
(CUSHING'S TRIAD)
NORMAL ICP: 5 TO 15 mm of Hg
56
57. A retrospective analysis of the unaccompanied, unconscious patients attending the
emergency department of Bir hospital during 14 April 2009 to 13 April 2010 was
carried out. The aim of this study to analyze the morbidity & mortality as well as
the types of illness, causes of unconsciousness and the source of unconsciousness in
these patients without any identity.
Results: Two-thirds of these patients were brought to hospital by the police. The
next category (20%) were brought by unknown person and left without any
information. In the span of one year, a total of 64,240 patients received care in the
emergency department of Bir Hospital and out of them, 248(0.4%) were
unaccompanied unconscious patients.
57
58. Unaccompanied, unconscious patients are priority patients for
emergency medical service. Alcohol intoxication, infections in
beggars and ingestion of unknown substance are major causes
and quite a big amount of resources has been utilized for them.
58
59. 1. Mandal G.N. "Textbook of Medical Surgical Nursing". 6th ed. Baneshwor,
Kathmandu: Safal Publication House Pvt. Ltd; 2019.
2. Sharma M., Kalpana P., Gautam R. "Essential Textbook of Medical Surgical
Nursing". 2nd ed. Ghattekulo Rautahadevi Marga, Kathmandu: Samiksha
Publication Pvt. Ltd; 2017.
3. Chugh S N. "Textbook of Medical Surgical Nursing". 1st ed. New Delhi: Avichal
Publishing Company; 2013.
4. Singh D, Acharya R, Singh S. Profile of unaccompanied, unconscious patients in
the emergency department. J Inst Med. 2011;32(2):2009–11.
5. Bhatta S, Magnus D, Mytton J, Joshi E, Bhatta S, Adhikari D, Manandhar SR,
Joshi SK. The Epidemiology of Injuries in Adults in Nepal: Findings from a
Hospital-Based Injury Surveillance Study. Int J Environ Res Public Health.
2021 Dec 2;18(23):12701. doi: 10.3390/ijerph182312701. PMID: 34886427;
PMCID: PMC8656929.
59
All of your senses are wired directly to this bundle of neurons. RAS has a very important role : it’s the gatekeeper of information. Play big role in the sensory information you perceive daily. To produce unconsciousness, a disorder must-
• Disrupt ascending RAS extends length of brain stem and up in to the thalamus .
Disrupt the function of both cerebral hemisphere.
Unconsciousness is generally caused by a temporary or permanent impairment of RAS in the brainstem , both cerebral hemispheres or bilateral thalamus
Decreasing the blood supply of oxygen and accumulation of waste product
Hypoglycemia blood glucose level low then brain does not receive enough glucose and then can not function properly
Hyperglycemia blood glucose level high - dehydration- brain does not receive proper nutrition- uncnsciousness
That refer to a decline in cognitive ability
A mental state in which a person is confused and has reduced awareness of their surroundings.
The have no chance of recovery because their body is unable to survive without artificial life support
Pupils shrink to small size
causes: Opioids/heroin , organophosphate and glaucoma eye drop
flapping tremor or hand , is a tremor of the hand when the wrist is extended
It is a condition In which neither eye move fully upward or downward
PET scan studies have shown metabolic activity in the cerebral cortex and cerebellum
Cerebrospinal fluid analysis should include opening pressure, cell count, gram stain, glucose, protein, culture, and viral testing
Mannitol : osmotic diuretics corticosteroids anti- inflammatory drug and paralytic agents for muscle relaxation