Unconscious Patients

Subject: Medical and Surgical Nursing I (Theory)

Overview

When a patient is completely oblivious of themselves or their surroundings and unable to meaningfully react to outside stimuli, they are said to be unconscious. It may be brief, lasting from a few seconds to an hour, or it may linger longer. COMA: A coma is a persistent condition of unconsciousness. Its causes include cerebral infractions, cerebral hemorrhage, brain tumors, brain abscesses, etc. Quickly check your breathing rate, heart rate, blood pressure, temperature, and oxygen saturation. The patient should always be lying on his side with his chin extended. As a result, the airway is kept clear of the tongue. The patient must receive complete care, including eye, dental, and skin care. Keep the patient safe from harm. It is recommended to sit down and support the patient with pillows when feeding an unconscious patient. This enables the feeding or medication to be moved by gravity.
  • When a patient is completely oblivious of themselves or their surroundings and unable to meaningfully react to outside stimuli, they are said to be unconscious.
  • It may be brief, lasting from a few seconds to an hour, or it may linger longer.
  • The fundamental idea to keep in mind is that the unconscious patient is totally reliant on other people to provide all of his requirements.

Coma

 A coma is a persistently unconscious state. In a coma, a person's awareness and the necessary reaction for comfort and self-preservation are no longer active.

Causes of Coma

  • Supratentorial lesions
    • Cerebral edema
    • Brain tumor
    • Brain abscess
    • Cerebral infractions
    • Cerebral hemorrhage
    • Epidural hematoma
  • Infra tentorial lesion
    • Cerebellar abscess
    • Brain stem or cerebellar hemorrhage
    • Brain stem or cerebellar infarction
    • Cerebellar tumor
  • Metabolic disorder and toxin
    • Poison, alcohol, and drug
    • Fluid and electrolyte imbalance
    • Seizure
    • Infection
    • Hypoglycemia
    • Syncope

General Nursing Consideration

  • Address the patient by name and explain what you are about to do.
  • Always presume that the patient can hear even if he doesn't respond.
  • Do not discuss the patient's situation with anyone while the patient is present.

History

Collect as much information as possible about a patient.

  • Allergies
  • Medication
  • Previous medical history
  • Last meal
  • Onset of coma
  • Recent injury
  • Access to drugs.

Monitor

  • Oxygen saturation, heart rate, blood pressure, temperature, and respiratory rate.
  • Management of airway and breathing
    • By placing a patient correctly, you can maintain a patent airway.
    • The patient should always be lying on his side with his chin extended. As a result, the airway is kept clear of the tongue.
    • To stop secretions from being aspirated, suction the mouth, pharynx, and trachea as often as necessary.
    • As directed, administer oxygen.
    • To avoid aspirating vomit, always have suction on hand.
  • Assessment of GCS
    • This scale provides a quick way to gauge the level of unconsciousness. This measures verbal, motor, and ocular activity, and the scores range from 3 to 15.
    • 4 is the best eye reaction.
    • 5 is the best spoken response.
    • 6 is the best motor response.
  • Meeting Nutritional needs
    A patient who is unconscious is normally fed and medicated bu gavage.
    • It is recommended to sit down and support the patient with pillows when feeding an unconscious patient. This enables the feeding or medication to be moved by gravity.
    • Always keep a close eye on the patient while giving anything through gavage.
    • Gavage feeding should not be done when the patient is unattended,
    • All intakes should be accurately recorded.
  • Skincare
    • Check the skin for signs of skin deterioration.
    • Every two hours or more, shift the patient's position and provide them back treatment.
    • After taking a bath, moisturizer should be applied to the skin.
    • If the bedding is wet or dirty, replace it.
  • Oral care
    • The unconscious patient frequently breathes via their mouth. Saliva dries out as a result and sticks to the surfaces of the mouth and teeth.
    • At least twice during each shift, provide oral care.
    • Lubricant can be used to keep lips from drying out.
    • Keep crushed secretions out of the nostrils.
  • Eye care
    • Take care of your eyes because when you're unconscious, you can't blink.
    • Regularly check the eyes for symptoms of irritation or infection.
  • Care for bowel and bladder
    • Regular bowel evacuations are necessary to avoid stool impaction.
    • To avoid constipation, a doctor could prescribe liquid stool softeners or an enema.
    • In order to prevent infection, catheter care should be given at least once per shift.
  • Safety and security needs
    • Guard the sufferer against harm.
    • Maintain the side railings.
    • Use drawing sheets to make turning easier.
    • When applying hot or cold treatment, use caution.
    • Keep suction at your bedside in case of an emergency.

References

  •  A Textbook of Adult Health Nursing (2nd ed.). Mandal, G. (August 2013). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013
  • healthline.com/health/unconsciousness-first-aid
  • medlineplus.gov › Medical Encyclopedia
  • patient.info/health/dealing-with-an-adult-who-is-unresponsive
Things to remember
  • When a patient is completely oblivious of themselves or their surroundings and unable to meaningfully react to outside stimuli, they are said to be unconscious. COMA: A coma is a persistent condition of unconsciousness.
  • Always presume that the patient is hearing even if he doesn't speak back.
  • By placing a patient correctly, you can maintain a patent airway.
  • To avoid aspirating vomit, always keep suction on hand.
  • Every two hours or more, shift the patient's position and provide them back treatment.
  • Due to the absence of the blink reflex when unconscious, take care of your eyes.
  • When applying hot or cold applications, be careful.
Questions and Answers

Unconscious Patients

  • When a patient is completely oblivious of themselves or their surroundings and unable to effectively react to outside stimuli, they are said to be unconscious.
  • It may be short, lasting from a few seconds to an hour, or it may linger longer.
  • The fundamental idea to keep in mind is that the unconscious patient is totally reliant on other people to meet all of his needs.

Coma: Coma is state of constant unconsciousness.

  • In coma an individual awareness, as well as that response essential to comfort and self-preservation , no longer operate.

 

Causes of Coma

  • Supratentorial Lesions
    • Cerebral edema,
    • Brain tumor,
    • Brain abscess,
    • Cerebral infractions,
    • Cerebral hemorrhage,
    • Epidural hematoma.
       
  • Infra Tentorial Lesion
    • Cerebellar abscess,
    • Brain stem or cerebellar hemorrhage,
    • Brain stem or cerebellar infraction,
    • Cerebellar tumor.
       
  • Metabolic Disorder and Toxin
    • Poison, alcohol, and drug,
    • Fluid and electrolyte imbalance,
    • Seizure,
    • Infection,
    • Hypoglycemia,
    • Syncope.

General Nursing Consideration

  • Always assume that the patient can hear, even though he makes no response.
  • Always address the patient by name and tell him what you are going to do.
  • Avoid doing any conversation about the patients condition while in the patients presence.

History

Collect as much information as possible about a patient.

  • Allergies,
  • Medication,
  • Previous medical history,
  • Last meal,
  • Onset of coma,
  • Recent injury,
  • Access to drugs.

Monitor

  • Respiratory rate, pulse rate, blood pressure, temperature, oxygen saturation.

Management of Airway and Breathing

  • Maintain a patent airway by proper positioning of a patient.
  • Whenever possible, position the patient on his side with chin extended. This prevents the tongue from obstructing the airway.
  • Suction mouth, pharynx and trachea as often as necessary to prevent aspirations of secretion.
  • Administer oxygen as ordered.
  • Always have suction available to prevent aspiration of vomitus.

Assessment of GCS

  • This scale gives a simple measure of a degree of unconsciousness. This looks at eye activity, verbal and motor response and score range from 3 being to 15.
  • best eye response=4
  • best verbal response=5
  • best motor response=6

Meeting Nutritional Needs

A patient who is unconscious is normally fed and medicated bu gavage.

  • When feeding an unconscious patient, it is best to place the patient in a sitting position and support with pillows. This permits gravity to help move the feeding or medication.
  • Always observe the patient carefully when administering anything by gavage.
  • Do not leave the patient unattended while gavage feeding.
  • Keep an accurate record of all intakes.

Skin Care

  • Observe the skin for evidence of skin breakdown.
  • Change patient's position at least every two hours and provide back care.
  • The skin should be lubricated with moisturizing lotion after bathing.
  • Change the bed linen if damp or soiled .

Oral Care

  • The unconscious patient is often a mouth breather. This causes saliva to dry and adhere to mouth and tooth surfaces.
  • Provide oral care at least twice per shift.
  • Apply lubricant to lips to prevent drying.
  • Keep nostrils free of crushed secretion.

Eye Care

  • Carry out eye care because the blink reflex is absent during unconsciousness.
  • Check the eyes frequently for signs of irritation or infection.

Care for Bowel and Bladder

  • The bowel should be evacuated regularly to prevent impaction of stool.
  • A liquid stool softeners or enema may be ordered to prevent constipation.
  • Catheterization: provide catheter care at least once per shift to prevent infection.

Safety and Security Needs

  • Protect the patient from injury.
  • Keep side rails up.
  • Use draw sheets for easier Turning.
  • Take precautions while applying hot and cold application.
  • Keep suction available at the bedside for an emergency.

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