Nursing the unconscious patient can be a challenging experience.

Unconscious patients have no control over themselves or their environment and thus are highly dependent on the nurse. The skills required to care for unconscious patients are not specific to critical care and theatres as unconscious patients are nursed in a variety of clinical settings. Nursing such patients can be a source of anxiety for nurses. However, with a good knowledge base to initiate the assessment, planning and implementation of quality care, nursing patients who are unconscious can prove highly rewarding, and the skills acquired can promote confidence in the care of all patients. Unconsciousness spans a broad spectrum (Hickey 2003a), from momentary loss of consciousness as seen with fainting, to prolonged coma that may last weeks, months or even years. The causes of unconsciousness will dictate the length of the coma and the prognosis.

CONSCIOUSNESS:Implies awareness and attention to one's surroundings and to oneself.Consciousness is maintained by impulses mediated via Grey Matter in the Reticular Activating System (R.A.S.) Sleep is a physiological process which is usually accompanied by reduction of impulses in the R.A.S. The individual is easily arousable from sleep and basic protective reflexes are also intact.
Consciousness can be defined as a state of awareness of one's self and the environment (Barker 2002). A conscious person is capable of responding to sensory stimuli. Alternatively, coma is a total absence of awareness of one's self and the environment. A person in a coma is unrousable and unresponsive to external stimuli. For example, when a person is asleep he or she can be aroused by external stimuli, but this does not occur when a person is in a coma. Assessment of consciousness

UNCONSCIOUSNESS: Unconsciousness is different from normal sleep in that unconscious subjects are not usually arousable and quite often, there is loss of or interference with basic protective reflexes such as: • • Maintenance of free airway Coughing and swallowing

• Withdrawal from noxious stimuli etc.

Unconsciousness may be: a) Partial (semi-coma or stupor) b) Complete (coma) Accurate diagnosis of the cause of Unconsciousness is important for SPECIFIC TREATMENT but for the GENERAL CARE of the patient, level of consciousness is more important. CAUSES OF UNCONSCIOUSNESS INCLUDE: 1) SHOCK

Remove the casualty from any obvious hazard and call for help. food particles. Check the breathing and remove any airway obstruction caused by flaccid tongue.2) ASPHYXIA 3) POISONING 4) HEAD INJURY 5) CEREBROVASCULAR ACCIDENTS (STROKE) 6) EPILEPSY 7) HYSTERIA 8) INFANTILE CONVULSIONS 9) HYPOTHERMIA OR HYPERTHERMIA 10) DIABETES MELLITUS – HYPO/HYPER 11) FAINTING/SYNCOPE. . commence .EG. 3. If subject is not breathing or breathing is inadequate.Be aware that injury to the spine may be present 2. VASOVAGAL ATTACKS 12) HEART ATTACKS 13) OTHERS E.MENINGO ENCEPHALITIS FLUIDS AND ELECTROLYTE DISORDERS CARE 1) Emergency care or first aid 2) Long term care-usually as inpatient EMERGENCY CARE General rules 1. denture etc. blood clots.

General care is however necessary. Do not leave the patient unattended unless absolutely necessary and constantly watch the breathing and check the pulse.artificial respiration immediately. This is easier with the patient in supine position. Keep warm with blanket if necessary but do not apply heat. Do not administer any oral fluids or food to an unconscious subject. In the absence of both pulse and breathing. check the pulse and out external chest compression if there is no pulse. 4. no matter the cause of consciousness is important in determining the extent of care required and may involve doctors. physiotherapists. 6. However. 1. 5. examination. 3. The GCS has been used as a prognostic device during immediate . nutritionists etc. This will involve the usual steps of history taking. Remove the subject to medical aid (hospital) as soon as possible and preferable on a stretcher. It may also require an intensive care unit. which decreases the subjectivity and confusion associated with assessing levels of consciousness (Hickey 2003b). If both breathing and pulse are present. Next. and treat any obvious life threatening injury such as profuse bleeding. the Glasgow Coma Scale (GCS) (Jennett and Teasdale 1977) is the most universally accepted tool. it will be helpful to know the cause of the unconsciousness. loosen all tight clothing. carry out the sequence of one-rescuer CPR until help arrives. A variety of scales have been devised to describe patients' level of consciousness (Barker 2002). investigations etc. Place and support the casualty in the semi-prone or "tonsil" position. b) LONG TERM CARE: In order to optimize the care of the unconscious patient in a hospital. Give oxygen by mask if available and elevate the legs if the pulse is feeble or fast. nurses. 7. 2. 4.

injured patients (National Institute for Clinical Excellence (NICE) 2003). minimises user interpretation.assessment following a head injury. The lower the score the poorer the prognosis. avoiding subjective terminology. such as 'stupor' and 'semi-coma' . National guidelines indicate that the GCS should be used to assess all brain. objective and easily interpreted mode of neurological assessment. The GCS forms a quick. The GCS gives practitioners an internationally accepted format that assists communication. and rapidly detects change in the patient's condition (Howarth 2004).

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