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469770849-UNCONSCIOUSNESS-ppt.unconcsiousnessppt
- 1.
- 2. CONSCIOUSNESS It is astate of being that has two important aspects:- • Wakefulness • Awareness self environment time
- 3. “Unconsciousness is definedas 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” DEFINITION :-
- 4. ETIOLOGY STRUCTURAL LESIONS OR FOCAL BRAINDYSFUNCTIONS METABOLIC DISORDERS OR DIFFUSE BRAIN DYSFUNCTIONS
- 5. STRUCTURAL LESIONS:- This is causedwhen 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
- 6. METABOLIC DISORDERS:- This is causedwhen 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:-
- 7. CONDITIONS:- 1. Hypoxia 2. Bloodloss 3. High altitudes 4. Carbon monoxide poisoning 5. Seizures 6. Fluid and electrolyte imbalances 7. Infections
- 8. PATHOPHYSIOLOGY:- Etiological factors (neurogenic,metabolic,toxins) Disruption inthe cells of the nervous system and the neurotransmitters Disruption of the basic functional unit that is neurons Faulty impulse transmission
- 9. Impending communication withinthe 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
- 10. SIGN AND SYMPTOMS;- Weakness Paleand moist skin Shallow breathing Double vision Apathy and irritability Drooling Tingling and numbness in fingers and feet's Headache and sweating
- 11. CLINICAL MANIFESTAIONS The clinical manifestationsare divided into:- • Incase of focal brain dysfunctions • Incase of metabolic dysfunction
- 12. INCASE OF FOCALBRAIN 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
- 13. METABOLIC DYSFUNCTION • Confusion • Pupillaryreactions are preserved • Seizures • Acid base imbalances
- 14. DIAGNOSTIC TESTS:- • Computedtomography • Magnetic resonance imaging • Lumbar puncture • Electroencephalography • Laboratory tests • Test for ocular reflexes • GCS
- 15.
- 16. COMPLICATIONS:- • Respiratory failure •Pneumonia • Pressure ulcers • Aspiration • Deep vein thrombosis
- 17. MANAGEMENT:- The management isdivided into further:- 1. First aid 2. Medical management 3. Pharmacological management 4. Nursing management
- 18. FIRST AID MANAGEMENT • CheckABC and pulse • Side lying position • Loosen clothes • Keep patient warm • Call for help
- 19.
- 20. MEDICAL MANAGEMENT GOALS:- • To preservebrain functions and additional Brain injury • To restore the present functioning of the brain
- 21. INTERVENTIONS:- • ABC • Nasalor oral airway must be inserted • Observe airway for obstruction • Insert ETtube if the patient is unresponsive • Ventilation and oxygenation
- 22. CONT…. • Proper BPmaintainance • Check level of consciousness • Observe improvement in GCS scale • Pupil charting • Fluid and electrolyte balance • Investigations
- 23. PHARMACOLOGICAL MANAGEMENT • Vasoactive drugs;- Theseare 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
- 24. Contd…… • Antihypertensive;- These actby 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
- 25. NURSING MANAGEMENT GOAL:- The main goalof nursing management is to prevent complications ASSESSMENT:- • Airway • Neurological status • Vital signs • ICP • Pupils
- 26. NURSING DIAGNOSIS:- 1. Ineffectiveairway clearance related to loss of gag reflex: Head end elevated Proper chest physiotherapy followed by suctioning Monitoring of the breath sounds Oral airway insertion
- 27. Contd…… 2. Fluid volumedeficit related to unconscious state;- Assessment of the fluid status Daily weight Accurate documentation Lab investigations
- 28. Contd….. 3.Altered nutrition lessthan 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
- 29. NURSING DIAGNOSIS:- 4.Impaired skinintegrity 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
- 31. RECAPTULISATION TRUE/FALSE:- 1. Unconsciousness isa 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?