BSN Notes: Common Signs And Symptoms: Unconsciousness

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Unconsciousness 
Unconsciousness: Abnormal state of complete or partial unawareness of self and environment
Causes
·         Traumatic brain injury
·         Brain hypoxia (e.g., due to a brain infarction or cardiac arrest)
·         Severe poisoning with drugs that depress the activity of the central nervous system (e.g., alcohol and other hypnotic or sedative drugs).
Symptoms & Signs
·         Unresponsiveness (does not awaken when spoken to, touched, or otherwise stimulated)
·         Unconsciousness may be brief and temporary fainting or prolonged
·         Disorientation
·         Light-headedness
·         Palpitations
·         Headache
·         Drowsiness
·         Stupor
Assessment
·         Perform a complete assessment
·         Neurologic system - mental status, cranial nerve function, reflexes, and motor and sensory function, GIasgow Coma Scale
Complications of unconsciousness
·         Respiratory failure, pneumonia and aspiration.
·         Pressure ulcers, venous stasis, musculoskeletal deterioration, and disturbed gastrointestinal functioning due to immobility
Management
·         The goals of care are-
·         Maintenance of a clear airway
·         Protection from injury 
·         Attainment of fluid volume balance.
·         Achievement of intact oral mucous membranes  
·         Maintenance of normal skin integrity
·         Absence of corneal irritation,
·         Attainment of effective thermoregulation, and effective urinary and bowel elimination.  
·         Compensate for the absence of cough, swallowing, blink reflexes.

Nursing Interventions
1.       Maintaining the airway:
·         Establish an adequate airway and ensure ventilation.
·         Elevating the head of the bed to 30 degrees helps prevent aspiration.
·         Persistent suctioning
·         Oral care
2.        Protecting the patient
·         Padded side rails are provided and raised at all times.
·         Care should be taken to prevent injury from invasive lines and equipment, and other potential sources of injury should be identified
3.       Maintaining fluid balance and managing nutritional needs:
·         Assess hydration status, intake and output.
·         NG tube Feeding or IV fluids
4.       Providing mouth care
·         The mouth is inspected for dryness, inflammation, and crusting.
·         Frequent mouth wash
5.       Maintaining skin and joint integrity
·         Change position Q2H
·         Passive exercise of the extremities to prevent contractures.
·         Prevent foot drops by splits
6.       Preserving corneal integrity
·         Clean with cotton balls moistened with sterile normal saline to remove debris and discharge.
7.       Achieving thermoregulation
·         Assess for the body temperature
·         Cover the exposed parts
8.       Promoting bowel function
·         Monitors the number and consistency of bowel movements.
·         Fiber rich diet and stool softeners
9.       Preventing urinary retention 
·         Check for urinary retention
·         Indwelling urinary catheter
10.   Providing sensory stimulation
·         Sensory stimulation is provided at the appropriate time to help overcome the profound sensory  deprivation
11.   Monitoring and managing potential complications

12.   Meeting families' needs


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