The brain requires a constant supply of oxygenated blood and glucose to function. Interruption of this supply will cause loss of consciousness within a few seconds and permanent brain damage in minutes. Unconsciousness: A state of unarousable responsiveness, where the client is unaware of the self or the surroundings and no purposeful response can be obtained to external stimuli. May be – Brief – lasting for few seconds to an hour Sustained – lasting for a few hours or longer Etiology: Blood oxygenation problems Blood circulation problems Metabolic problems (Diabetes mellitus, over dosage) CNS problems (head injury, stroke, tumor , epilepsy)

1. Name: Miss Vedanti Patel
Designation: Assi. Professor
1

2. INTRODUCTION
The brain requires a constant supply of
oxygenated blood and glucose to
function. Interruption of this supply
will cause loss of consciousness within a
few seconds and permanent brain
damage in minutes.
2

3.  A state of wakefulness & awareness of self and the
environment.
3

4. UNCONSCIOUSNESS….:
A state of unarousable responsiveness,
where the client is unaware of the self or the
surroundings and no purposeful response
can be obtained to external stimuli. May be
–
 Brief – lasting for few seconds to an hour
 Sustained – lasting for a few hours or longer
4

5. ETIOLOGY OF
UNCONSCIOUSNESS:
 Blood oxygenation problems
 Blood circulation problems
 Metabolic problems (Diabetes mellitus, over dosage) CNS
problems (head injury, stroke, tumor , epilepsy)
5

6. ETIOLOGY (CAUSES)
Brain
Dysfunction
• Brain tumour
• Vascular events
(CVA)
• Head injury
Diffuse brain
dysfunction
Infection –
• Meningitis/
Encephalitis
• Epilepsy
• Hypoxia,
• Poisoning And
Overdoses (
Including Alcohol)
6

7. Metabolic/Endocrine Causes –
•Hepatic Or Renal Failure,
•Hypothyroidism,
•Severe Electrolyte Disturbances
•Hypotension, Or Hypertensive
Crisis
•Diffuse Head Injury
•Subarachnoid Haemorrhage
•Hypothermia, Hyperthermia
7

8. CLINICAL
MANIFESTATIONS
RESPIRATORY
SYSTEM
•Stridor
•Progressive cyanosis
•Assymetrical chest wall movements
•Decreased respiratory rate,
decreased depth
8

9. CARDIOVASCULAR
SYMPTOMS
•Bradycardia
•Hypotension
•Ventricular
tachycardia
•Hyperkalemic
•Decreased cardiac
output
9

10. NEUROLOGICAL
SYSTEM
•• Asterexis
•• Seizures
•• Cranial nerve palsies
•• Lethargy
•• Unequal pupillary dilation
•• Absent deep tendon
reflexes
10

11. GASTROINTESTINAL
SYSTEM
•Abdominal distension
•Decreased bowel
sounds
•Constipation
•Ascites
•Hyperlipidemia
11

12. URINARY
SYSTEM
•Urinary incontinence
•High creatinine
•Oliguria
•Ketonuria
•UTI
•Pyuria
12

13. ASSESSMENT
 Glasgow Coma Scale (GCS)
• Assess neurological function by using Glasgow Coma Scale
(GCS)
Score range - 3 to 15
Abnormal - <10 •
Normal - >10
13

14. PHYSICAL
ASSESSMENT
 • Voluntary movement- strength and asymmetry in the upper
extremities
 • Deep tendon reflexes- biceps, triceps & patella.
 Posture:- –
 Decerebrate
 Decorticate
14

15. 15

16. 16

17. DIAGNOSTIC TESTS
 CT Scan
 Lumbar puncture
 MRI
 HAEMATOLOGICAL – complete blood count – BSL – level of drugs
in blood e.g.. Aspirin, paracetamol
 EEG:- electrical activity of cerebral cortex layer
 Intra cranial pressure(ICP normal - 5-15mmhg)
17

18. MEDICAL MANAGEMENT
 Obtain And Maintain Airway.
 Insert oral airway
 Monitor Circulatory Status To Ensure Adequate Perfusion To
The Body And Brain.
 Central Line Catheterization• Foley’s Catheterization
 Ryle’s Tube Insertion
 Prevention Of Complication
18

19. EMERGENCY NURSING
CARE
 Check causes of unconsciousness
 NBM
 Loosen clothes
 Ease breathing by turning head to side
 drain and clean mouth secretion
 remove artificial teeth if any.
 Keep warm and comfortable
 Observe LOC
 It is important to remember that hearing sense is the last one
to go and first one to come back, so avoid unnecessary talk.
19

20. NURSING MANAGEMENT
 Ineffective airway clearance R/t inability to swallowing
Intervention
 Airway management, an oral airway can be inserted
 Care of ETT/ tracheostomy
 Suctioning
 Positioning
 Chest physiotherapy
 Nebulization
20

21. Risk for aspiration R/T altered LOC
 Intervention—
 Monitor ABG
 Keep suctioning equipment available
 Observe cardiac monitoring for dysrhythmias
 Positioning
21

22. Impaired oral mucus membrane, R/T mouth breathing absence
of pharyngeal reflex, & altered fluid intake
Intervention----
 Inspect pt’s mouth every 8 hours
 Apply water-soluble lubricant to prevent cracking, drying.
 Oral hygiene( to avoid parotities, aspiration and RTI)
22

23. Deficient fluid volume r/t inability to take fluids by mouth
INTERVENTION-
 Accurate documentation of intake and output
 Assessment and documentation of conditions that might
increase fluid volume deficit (diaphoresis, polyuria, diarrhea,
vomiting)
 Avoid over hydration in a patient receiving IV fluids because
of risk of cerebral edema
23

24. Imbalanced nutrition less than body requirements R/T inability
to feed
Intervention—
 • IV fluids
 • NG Tube feeding
 • Maintain intake output chart
24

25. Risk for injury R/T decreased LOC
Intervention-
 Side rails
 Seizure precautions ( use padded side rails, keep the patient’s
nail short)
 Protect patient’s head
 Use caution when moving
 Always turn an unconscious patient toward you or someone
else to prevent fall.
 Do not restrain the patient unless absolutely necessary, if
restraints are used, they must be released at least every
2hours for skin check.
 Avoid over sedation (which increases ICP)
 Do not leave unattended.
25

26. Impaired urinary elimination R/T impairment in neurologic
sensing and control
Intervention—
 Catheterization
 Catheter care
 Maintain aseptic technique
 Monitor urine color
 Initiate bladder training as soon as consciousness regained.
26

27. Bowel incontinence R/T changes in nutritional delivery methods.
Intervention—
 Monitor
 Auscultate for bowel sounds;
 palpate lower abdomen for distention
 Maintain food hygiene.
27

28. Risk of skin integrity R/T immobility
Intervention—
 Personal hygiene
 Skin care, care of pressure points
 Keep nails trimmed
 Repositioned every 2 hours
 Put on special mattress or bed
28

29. 29