UNCONSCIOUSNESS

DEFINITION:
An unconscious person is usually completely unresponsive to their environment or people
around them.
ETIOLOGY:

 Structural: Brain lesions that destroy tissue or occupy space that is normally occupied
by the brain. (Epilepsy, Tumors, Trauma)
 Cardiovascular: Temporary or permanent interruption to the blood supply to the brain
(Vasovagal response, CVA , Transient Ischemic Attack, Hypertensive encephalopathy,     
Shock, Dysrhythmias)
 Metabolic: Abnormally high or low levels of circulating metabolites. (Hypoxia,
Hypoglycemia, Hyperglycemia, Renal failure (uremia), Liver failure, Infection (sepsis)
 Environmental: External factors that cause deterioration of central nervous system
function. (Overdose, Toxins)
 Behavioral: Abnormal mental status that results from internal factors (Psychiatric
disorders)

SIGNS AND SYMPTOMS:

 Unresponsiveness
 Lack of consciousness
 Lack of awareness of self
 Lack of awareness of surroundings
INVESTIGATIONS:

Non- invasive method:

Medical history from family members/relatives/ care takers

Physical examination

Glasgow coma scale:

 Eye Opening
4. Spontaneous
3. Verbal
2. Painful
1. None
 Motor Response
6. Obedient
 5. Purposeful
4. Withdraws
3. Flexion
2. Extension
1. None
 Verbal Response
5. Oriented
4. Disoriented
3. Inappropriate
2. Incomprehensible
1. None
Invasive method:

Blood test (Glucose, Electrolytes, etc)

MANAGEMENT:

MEDICAL MANAGEMENT:

Drugs:

 BLS procedures
 Maintain airway: the unconscious patient may need assistance to maintain and
protect their airway.
 They cannot control their tongue which can easily block the airway.
 Frequent suctioning may be needed to clear away secretions and vomitus.
 High flow O2 by mask: to reduce damage to the brain from hypoxia
 Left Lateral Position: if there is no trauma present this position will help the patient
to maintain their airway by allowing secretions to flow out of the mouth and away
from the airways.

 ALS procedures
 Advanced airway : If the patient is deeply comatose and endotracheal tube will
maintain an open airway and allow secretions to be suctioned efficiently.
 Venous access: There are many causes of unconsciousness which can be treated with
medications given intravenously.
 Glucometer: All patients should have a Glucometer done to rule out hypoglycemia or
hyperglycemia.
 Monitor: Dysrhythmias can cause altered level of consciousness.
 Valium for active seizures: Give to stop the seizure activity. Only given in the field for
active tonic-clonic seizures. Respirations and blood pressure must be closely monitored
following Valium administration.
 Dopamine drip - May be ordered for hypotension if rales are present or if there is no
response to a fluid challenge.
  Adenosine, Atropine, and Lidocaine may be given to treat cardiac dysrhythmias.
 Electrical cardioversion may be needed to treat poorly perfusing cardiac dysrhythmias.
Diet:

 Enteral feeding can be administered (Nasogastric feeding is the most commonly used
method)

 Administer adequate fluid to prevent fluid or electrolyte imbalances

General Management:

 Dentures should be removed and note made of any loose teeth or crowns that may
become dislodged and compromise the airway

 Insert oropharyngeal airways to prevent the tongue from obstructing the airway

 To maintain a patent airway the lateral recumbent position is advised with the head of the
bed slightly tilted upwards, about 10-30 degrees.

 Obtaining a 24-hour urine collection is an important means of assessing the protein needs
of the unconscious patient. Nitrogen is lost from the body when protein is broken down.
If nitrogen loss exceeds supply then catabolism (muscle breakdown) occurs.

 Introduction of rectal preparations such as suppositories and enemas may be necessary in

case of constipation

 Insert urinary catheter

 Meet the patient personal hygienic needs

 Care should be taken to examine the skin properly, noting any areas which are red, dry or
broken to prevent bedsore

 Clean the eye with gauze and 0.9% sodium chloride to prevent eye infection
SURGICAL MANAGEMENT:

If unconsciousness is prolonged and an artificial airway is still required then a tracheostomy

should be considered.

NURSING MANAGEMENT:

S.no Nursing Goal Nursing Interventions

diagnosis
 1.

Other possible nursing diagnoses:

 Always take a rectal temperature.

 Report changes in vital signs to the charge nurse
 Note changes in response to stimuli.
 Note the return of protective reflexes such as blinking the eyelids or swallowing saliva.
 Keep the patient's room at a comfortable temperature. Check the patient's skin
temperature by feeling the extremities for warmth or coolness. Adjust the room
temperature if the patient's skin is too warm or too cool.
 Maintain a patent airway by proper positioning of the patient. Position the patient on his
side with the chin extended. This prevents the tongue from obstructing the airway.
 Administer oxygen as ordered.
 Always have suction available to prevent aspiration of vomitus.
 A patient who is unconscious is normally fed and medicated by gavage. (G-Tube)
 Keep accurate records of IV intake and urine output.
 Observe the patient for signs of dehydration or fluid overload
 Provide oral hygiene at least twice per shift. Include the tongue, all tooth surfaces, and all
soft tissue areas. The unconscious patient is often a mouth breather. This causes saliva to
dry and adhere to the mouth and tooth surfaces.
 Always have suction apparatus immediately available when giving mouth care to the
unconscious patient.
 Apply petrolatum to the lips to prevent drying.
 Change the bed linen if damp or soiled.
 Observe the skin for evidence of skin breakdown.
 The bowel should be evacuated regularly to prevent impaction of stool.
 Provide catheter care at least once per shift to prevent infection in catheterized patients
 When positioning the unconscious patient, pay particular attention to maintaining proper
body alignment. The unconscious patient cannot tell you that he/she is uncomfortable or
is experiencing pressure on a body part.
 It is a nursing care responsibility to maintain the patient's range of motion.
 Precautions must be taken to prevent the development of pressure sores.
 Change the patient's position at least every two hours.
PREVENTION:

 Avoid situations where blood sugar level gets too low.

 Avoid standing in one place too long without moving, especially if you are prone to
fainting.
 Get enough fluid, particularly in warm weather.
 If you feel like you are about to faint, lie down or sit with your head bent forward
between your knees.

COMPLICATIONS:

 Falls

 Respiratory failure

 Bed sore

 Gastric content aspiration

 Atelectasis and pneumonia

 Venous thromboembolism and Pulmonary emboli