UNCONSCIOUSNESS

UNCONSCIOUSNESS
 CONSCIOUSNESS
It is a state of being that has
two important aspects:-
• Wakefulness
• Awareness
self
environment
time
 DEFINITION :-
“Unconsciousness is defined as when a
person is unable to respond to people and
activities often this is called as coma or
being in a comatosed state”
OR
“Unconsciousness is defined as the state in
which a patient is totally unaware of both
self and external surroundings and unable
to respond meaningfully to an external
stimuli”
 ETIOLOGY

METABOLIC DISORDERS
STRUCTURAL LESIONS OR
OR DIFFUSE BRAIN DYSFUNCTIONS
FOCAL BRAIN DYSFUNCTIONS
 STRUCTURAL
LESIONS:-
This is caused when a pressure is placed on
the brain stem or on the structures within
the posterior cranial fossa including the
cerebellum,midbrain,pons and the
medulla.This may be caused when there is:-
• Brain tumors
• Head trauma
• Stroke
• Assault,falls or accident
 METABOLIC
DISORDERS:-
This is caused when there is impairement in
wakefulness and awareness by
reducing the supply of oxygen and glucose

and further altering other cerebral and

metabolic processes

and can occur in:-

CONDITIONS:-

1. Hypoxia
2. Blood loss
3. High altitudes
4. Carbon monoxide poisoning
5. Seizures
6. Fluid and electrolyte imbalances
7. Infections
PATHOPHYSIOLOGY:-
Etiological factors
(neurogenic,metabolic,toxins)

Disruption in the cells of the nervous

system and the neurotransmitters

Disruption of the basic functional unit

that is neurons

Faulty impulse transmission

Impending communication within the
brain and to different parts of the
body

Cerebral edema

Increase or decrease in the supply of

blood or CSF circulation

Various sign and symptoms

 SIGN AND SYMPTOMS;-
 Weakness
 Pale and moist skin
 Shallow breathing
 Double vision
 Apathy and irritability
 Drooling
 Tingling and numbness in fingers and
feet's
 Headache and sweating
 CLINICAL
MANIFESTAIONS
The clinical manifestations are divided into:-

• Incase of focal brain dysfunctions

• Incase of metabolic dysfunction

 INCASE OF FOCAL BRAIN
DYSFUNCTION:-
1. Abnormal pupillary response
2. History of progressive onset of
headache
3. Bizzare respiratory patterns
4. Cranial nerve palsy
5. Unresponsiveness
6. Confusion and abnormal eye movements
7. Rapid heart beat
8. Drowsiness,stupor
 METABOLIC
DYSFUNCTION
• Confusion

• Pupillary reactions are

preserved

• Seizures

• Acid base imbalances

DIAGNOSTIC TESTS:-
• Computed tomography
• Magnetic resonance
imaging
• Lumbar puncture
• Electroencephalography
• Laboratory tests
• Test for ocular reflexes
• GCS
GLASGOW COMA SCALE:-
 COMPLICATIONS:-
• Respiratory failure

• Pneumonia

• Pressure ulcers

• Aspiration

• Deep vein thrombosis

 MANAGEMENT:-
The management is divided
into further:-
1. First aid
2. Medical management
3. Pharmacological
management
4. Nursing management
 FIRST AID
MANAGEMENT
• Check ABC and pulse

• Side lying position

• Loosen clothes

• Keep patient warm

• Call for help

CPR:-
 MEDICAL
MANAGEMENT
GOALS:-
• To preserve brain functions
and additional
Brain injury

• To restore the present

functioning of the brain
 INTERVENTIONS:-
• ABC

• Nasal or oral airway must be inserted

• Observe airway for obstruction

• Insert ETtube if the patient is

unresponsive

• Ventilation and oxygenation

 CONT….
• Proper BP maintainance
• Check level of
consciousness
• Observe improvement in
GCS scale
• Pupil charting
• Fluid and electrolyte
balance
• Investigations
 PHARMACOLOGICAL
MANAGEMENT
• Vasoactive drugs;-
These are the drugs to maintain BP
eg;-dopamine
,dobutamine,phenylephrine
• Anticonvulsants;-
These enhance the GABA reception
in brain eg;-
diazepam,lorazepam,phenytoin and
phenobarbitone
• Diuretics:-
These promote shifting of extra
cellular fluid back to plasma eg:-
Mannitol and glyvin
 Contd……
• Antihypertensive;-
These act by decreasing the peripheral
resistance and BP eg:-
amlodipine,nifedipine,losartan
• Antibiotics:-
These act to inhibit the bacterial cell wall
Syntheses eg:- amoxycillin,ciprofloxacin,
Amikacin
• antipyretics
• IV fluids
 NURSING
MANAGEMENT
GOAL:-
The main goal of nursing management
is to prevent complications
ASSESSMENT:-
• Airway
• Neurological status
• Vital signs
• ICP
• Pupils
 NURSING DIAGNOSIS:-
1. Ineffective airway clearance
related to loss of gag reflex:

 Head end elevated

 Proper chest physiotherapy
followed by suctioning
 Monitoring of the breath
sounds
 Oral airway insertion
 Contd……
2. Fluid volume deficit related to
unconscious state;-
 Assessment of the fluid status

 Daily weight

 Accurate documentation

 Lab investigations
 Contd…..
3.Altered nutrition less than body
requirement related to inability to
eat and swallow;-
 Assessment of the nutritional status
 Proper enteral feedings
 Daily weight and intake/output
 Auscultation of the bowel sounds
 High protein and high calorie feeding
 NURSING DIAGNOSIS:-
4.Impaired skin integrity related to immobility

• Provide care for all the self care needs

• Provide back care every 4hrly
• Nails should be cut short
• Positioning every 2hrly
• Air mattress should be provided to the
patient
 RECAPTULISATION
TRUE/FALSE:-
1. Unconsciousness is a symptom and not
a disease?
2. It is caused by structural lesions and
metabolic disorders?
3. There is no change in the pupillary
reactions?
4. Respiratory failure is not associated
complication of unconsciousness?