Transcript PPT

Adult Medical-Surgical
Nursing
Neurology Module:
Care of the Unconscious Patient
The Unconscious Patient:
Definitions
The unconscious patient is unresponsive
to and unaware of environmental stimuli
(short duration → several hours)
Coma: the condition of unconsciousness
lasts for a prolonged period
Persistent vegetative state: the patient is
wakeful but devoid of conscious cognitive
or affective mental function
Brain death: irreversible loss brain function
Causes of Unconsciousness
Neurological/ structural: head injury,
stroke, epileptic seizure
Vaso-vagal attack (faint): inadequate
cerebral perfusion
Toxicological: alcohol or drug abuse
Metabolic: hepatic or renal coma, diabetic
ketoacidosis, hypoglycaemia
Diagnosis of Cause of
Unconsciousness
Patient history from family
Clinical picture/ neurological assessment
Skull Xray, CT scan, MRI
Cerebral angiography, carotid doppler
ABGs, CBC, blood coagulation studies,
electrolytes, urea and KFT, blood glucose,
serum ammonia, LFT, toxicology, (relevant
blood profile)
Electro-encephalogram
Potential Complications Associated
with Unconsciousness
Respiratory failure: depressed resp centre,
atelectasis, pneumonia, aspiration
pneumonia
Pressure ulcers, may become infected
Contractures of muscles/ joints, foot drop
Corneal abrasions, dryness
Mouth ulcers, oral candida (thrush)
↓GI function: swallowing, gastric emptying,
absorption, motility(constipation/diarrhoea)
Care of the Unconscious Patient
Care of the person and his family
Maintaining a good airway/ respirations
Monitoring progress
General nursing care
The Unconscious Patient:
Care of the Person
Although the patient may be unresponsive:
Level of consciousness varies
Awareness may be deceptive
Sense of hearing persists after others lost
Therefore communication with the
patient is very important →
Communication with the
Unconscious Patient
Loving, caring handling
Kind words
The importance of touch, holding the hand
Stimulation: Speak to patient as if he
understands
Regular orientation to time and place
Avoid private conversations: include your
patient in the conversation
Communication with the
Unconscious Patient (cont)
Explain actions beforehand
Take time: avoid hasty movements which
shock
Always treat with dignity and respect.
Maintain privacy
The Unconscious Patient:
Care of the Family
Relatives face possible loss of loved one
Treat with kindness, understanding,
listening, support
Always explain his condition and any
procedures
Let them work with you. They need to feel
they are helping their loved one
Relatives can help stimulate him through
talking, reading, radio
The Unconscious Patient:
Care of the Person and Family
Always think that this unconscious
patient and his family could have
been your relatives and treat them all
accordingly
Care of the Unconscious Patient
Care of the person and his family √
Maintaining a good airway/ respirations
Monitoring progress
General nursing care
Care of the Unconscious Patient:
Maintaining the Airway
Optimal position to assist respiration
Care of:
Endotracheal tube (nasal or oral)
Tracheostomy
Mechanical ventilation
Includes humidified O2, frequent
physiotherapy and suction, oral hygiene,
aseptic technique for suction and
dressings, frequent ABGs
Care of the Unconscious Patient:
Monitoring Progress
Conscious level (Glasgow Coma Scale):
Sensory and motor function/ reflexes:
“best responses”
Pupils: size, equal or not, reaction to light
Vital signs, CVP or arterial MAP
Patency of IV lines
Strict fluid balance: IV, NG, gastrostomy or
TPN, Foley, drains
Care of the Unconscious Patient:
Nursing Care
Air mattress, elevate head 30o / tilt 45o
May change position 2-hourly if possible,
avoid dragging (friction), creases in sheets
Natural position; bolster prevents footdrop
Passive exercise of all limbs, full range of
movement (to improve circulation and to
prevent DVT, muscle atrophy, stiff joints)
Chest physio/ suction/ care of airways
Care of the Unconscious Patient:
Nursing Care (cont)
Hygiene: clean, dry but moisturised skin
Mouthcare: moist, clean mouth to prevent
thrush, lubricate lips
Cleanse and instill drops like artificial tears
to moisten cornea as eyes may be open; it
is good to close the eyes sometimes
Care of Foley catheter; bowel care
Temperature regulation (fan, tepid
sponging, extra cover as required)
Medications Commonly Used
Dexamethasone (↓ cerebral oedema) by
anti-inflammatory and diuretic effect
Epanutin (anti-convulsive: ↓ risk of
seizure)
Norvasc, Cerebrolysin: ↑ cerebral
perfusion
Vitamin B Complex, vitamin B12: improves
myelination to assist recovery of impulse
conductivity and nervous function
Prodofalgan: antipyretic