Bed rest also increases urinary stasis in the renal pelvis and urinary bladder further exacerbating the risk of urinary tract infection (Hickey 2003a). Depending on the underlying condition, the unconscious patient may never fully recover or may die from complicating factors. Oxygen can be delivered using different types of equipment and humidification is advised, where possible, to warm and moisten its delivery and to prevent drying of secretions (Dougherty and Lister 2004). In Moore T, Woodrow P (Eds) High Dependency Nursing Care: Observation, Intervention and Support. You may need consider between hundred or thousand products from many store. It cannot be stressed enough that the nurse has a crucial responsibility to anticipate, where possible, deterioration in a patient’s condition (Nursing and Midwifery Council (NMC) 2004). The regularity with which observations should be undertaken is determined by the severity of the patient’s condition (Cree 2003). Blackwell Science, Oxford. In Hickey J (Ed) The Clinical Practice of Neurological and Neurosurgical Nursing. 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. Such skills will provide information that can allow for interventions to arrest a life-threatening deterioration and potentially avert a decline to unconsciousness. A shadow on the wall that takes the form of an animal, or a noise that is misinterpreted as a stranger coming to cause harm, are examples of illusional states (Pemberton 2000). Let’s find out which is your […] An IV insulin sliding-scale regimen may be required to maintain blood glucose levels within the normal range of 4-7mmol/l (Cowan 1997). Professional Nurse. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. You can change your ad preferences anytime. However, the patient may recover fully which can be a rewarding and uplifting experience. Hickey J (2003b) Neurological assessment. Nursing Standard. Professional Nurse. 15, 43, 33-36. George O. RRT 2,230 views. Unconscious patients usually breathe through the mouth, causing … Diarrhoea is caused when there is more fluid entering the bowel than the bowel can absorb during transit. Physiological changes that occur over short periods of immobility are less severe and potentially reversible. Webb P (1994) Communication. Casey G (2003) Haemostasis, anticoagulants and fibrinolysis. List the immediate nursing priorities. Nasoduodenal, nasojejunal, percutaneous endoscopie gastrostomy or jejunostomy tubes may be indicated if the patient’s condition contraindicates direct gastric feeding, for example, acute pancreatitis (Pearce and Duncan 2002). Consciousness demonstrates that the RAS is functioning and is capable of the screening and discrimination of information (Pemberton 2000). Choose from 500 different sets of introduction to patient care flashcards on Quizlet. Enterai feeding will not stimulate peristalsis (Hickey 2003a). Non-verbal cues are often the first elements of communication that help us to form immediate impressions about someone (Webb 1994). Elliott R, Wright L (1999) Verbal communication: what do critical care nurses say to their unconscious patients? The Waterlow Pressure Sore Prevention/Treatment Policy. Introduction • Trauma accounts for 10%-15% of all patients … Australian Critical Care. Thus, in addition to managing the underlying cause of unconsciousness, the nurse should also implement a framework of care that seeks to prevent further complications. Following any washing procedure, it is important to ensure that the skin is dry as this will minimise the risk of loss of skin integrity. Positioning the patient is important and will facilitate the drainage of secretions. 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. The administration of an anticoagulant will also reduce the risks of venous thromboembolism (Casey 2003). Non-verbal communication, such as facial expression, eye contact, posture, personal space and bodily contact, is important in social interaction. Communicating with relatives can aid and enhance the nurse-patient relationship by fostering understanding and empathy. Please consult an expert before taking any action. Fifth edition. Active listening is one of the most important communication skills in the healthcare setting (Bailey and Wilkinson 1998, McConnell 2001). It is important to remember that unconscious patients will not be able to communicate whether a feeding tube is in the wrong place. Alternatively, coma is a total absence of awareness of one’s self and the environment. Therefore, regular blood and urine tests to monitor electrolyte and metabolic changes are essential to promote accurate assessment of each individual patient. The reticular activating system (RAS) is a feature of the RF and is responsible for arousal from sleep and maintaining consciousness (Fitzgerald 1996). 78, 918, 198-204. Year ,RN This can cause unusual behaviour, ranging from irritability and confusion, to poor concentration and drowsiness (Pemberton 2000). In Moore T1 Woodrow P (Eds) High Dependency Nursing Care: Observation, Intervention and Support. Nursing Standard. The lower limb that is uppermost is flexed at the hip and knee, and supported by a pillow with the other lower limb slightly flexed. WB Saunders, London. PNU Nursing Students 21,193 views. Ensuring that the skin is dry between the toes will help to minimise fungal infection. A mid-sagittal view of the reticular activating system and related structures. Noisy snoring or harsh breathing sounds may be a sign that the airway is being compromised. The insertion of a nasogastric tube in the early stages of unconsciousness will allow removal of gastric contents, thus reducing the risk of aspiration. The literature associated with the care of the unconscious patient tends to concentrate on aspects of care relevant to the maintenance of the patient's equilibrium, within a medical or surgical context (Atkinson 1970, Roper 1973, Ayres 1974, Burrell & Burrell 1977, Rhodes 1977). 10, 34, 40-43. Bailey K, Wilkinson S (1998) Patients’ views on nurses’ communication skills: a pilot study. 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. Lippincott Williams & Wilkins, Philadelphia PA, 277-293. However, reported experiences describe threatening and frightening hallucinations. Fitzgerald M (1996) Neuroanatomy: Basic and Clinical. … Cardiovascular function Monitoring the cardiovascular function in unconscious patients is of high importance. What did you find challenging about nursing this patient? Genitourinary function An unconscious patient will be incontinent of urine. Enterai laxatives on their own may not be sufficient and the introduction of rectal preparations such as suppositories and enemas may be necessary. Waterlow J (1998) The treatment and use of the Waterlow card. However, terms such as semi-coma and deep coma are still used in clinical practice. Colquhoun M, Hadley A, Evans T (2004) ABC of Resuscitation. Medsurgical Nursing. Constipation not only causes discomfort, but also increases intra-abdominal pressure which will result in an unwanted rise in intracranial pressure and the potential of further neurological impairment (Cree 2003). Care of unconscious patient Unconsciousness is a condition in which there is depression of cerebral function ranging from stupor to coma. Sustained pressure from immobilisation remains the most important cause of skin breakdown (Hickey 2003a). Third edition. 12. 11, 4, 163-167. However, a loud noise or noxious stimulus will wake us. We are second year nursing students from princess Nora University. If the patient remains stable on hourly GCS assessment for four hours, the observations can be reduced to every two hours (NICE 2003). Reflect on your experience of the Glasgow Coma Scale. Do they meet the NICE (2003) guidelines? Care needs to be taken to ensure that the head and neck are aligned with the spine. Gobbi M, Torrance C (2000) Fluid and electrolyte balance. Nutritional requirements may be affected by underlying conditions that increase normal metabolic demand or require further supplements, for example, sepsis, loss of fluids and electrolytes from diarrhoea or drainage, or tissue repair following trauma ( Woodrow 2004). In Dolman M, Getliffe K (Eds) Promoting Continence. Hourly interventions will help to moisten the membranes of patients who mouth breathe or require oxygen therapy (Krishnasamy 1995). Within this context of intensive care, the nursing contribution involves meticulous observation and skilled intervention, the provision of basic hygiene, nutrition and prevention of harm, as well as the provision of emotional and psychological support to both the patient and their families. The GCS meas\ures the degree of consciousness under three distinct categories, and each category is further subdivided and given a score as shown in Box 1 (see also the version adapted by NICE 2003). The causes of unconsciousness may dictate the length of the coma and the prognosis (Mallett and Dougherty 2000). This process of selection prevents the cerebral cortex from receiving too much information at once, thus possibly playing a part in directing an individual’s attention to specific mental activities (Hickey2003b). Our emotional response and reasoning to such a stimulus will ‘modify’ the RAS positively or negatively as the RAS is also stimulated by the cerebral cortex (Pemberton 2000). DNS-SOM-UNZA second edition. The use of antiembolic stockings should be considered once the risk of venous thromboembolism has been identified (Bryne 2002). Fingernails and toenails also need to be assessed for length and cleanliness, and ongoing care may require consultation by a chiropodist. Mosby, Missouri MO, 51-97. In Alexander M, Fawcett J, Runciman P (Eds) Nursing Practice, Hospital and Home. Dimensions of Critical Care Nursing. Menu. The supine position compromises the mechanics of breathing and lung volumes (Hickey 2003a). Nursing and Midwifery Council (2004) The NMC Code of Professional Conduct: Standards for Conduct, Performance and Ethics. Nursing management of the unconscious patient. The risk of venous thromboembolism and pulmonary emboli from the effects of immobility is well recognised (Dougherty and Lister 2004). Acute states are generally caused by metabolic upsets, such as hypoglycaemia or drug intoxication, which alter brain function. Churchill Livingstone, London, 757-774. Unconscious patients are nursed in a variety of clinical settings and therefore it is necessary for all nurses to assess, plan and implement the nursing care of this vulnerable patient group. This suggests that consciousness depends on whether the individual can be aroused to wakefulness. Liaison with the physiotherapist will also be of benefit, as the introduction of passive limb movements will encourage blood flow back to the heart as well as having positive musculoskeletal effects. Nurses are accountable for their practice and a\ppropriate training should be undertaken before this procedure is carried out. Another example of this is in critical care units, such as intensive care, where an anaesthetist will intervene and induce unconsciousness pharmacologically to allow for emergency intervention to stop a decline in a patient’s condition. Immobility also alters glucose-insulin intolerance. Howarth V (2004) Neurological assessment. The arm that is uppermost is flexed at the elbow and rested on a pillow to prevent drag on the shoulder and wrist drop. In Sheppard M, Wright M (Eds) Principles and Practice of High Dependency Nursing. Self care deficit Attending to the hygiene needs of the unconscious patient should never become ritualistic, and despite the patient's perceived lack of awareness, dignity should not be compromised. Baillire Tindall, London, 665-745. Witnessing the events leading to someone losing consciousness can be very distressing. NS309 Geraghty M (2005) Nursing the unconscious patient. Evans G (2001) A rationale for oral care. Max Geraghty is senior staff nurse, Intensive Care Unit, North Middlesex University Hospital, London. In this article, we make a short list of the best readers for oral care of unconscious patient including detail information and customer reviews. Head injuries; Nursing: role; Patient assessment; Unconsciousness. See our Privacy Policy and User Agreement for details. Mouth Care for Unconscious Resident - Duration: ... Providing Special Oral Care for Unconscious Patient - Duration: 4:06. Using a nursing model familiar to your clinical area write a care plan that addresses Beatrice’s needs. The RAS serves as a point of convergence for signals from our external environment and our internal thoughts and feelings. Suctioning should be undertaken with care, following appropriate patient assessment to establish the need for intervention. Greenwich Medical Media, London. Antiembolic stockings increase the velocity of flow not only in the legs but also in the pelvic veins and inferior vena cava, particularly when thigh-length stockings are used (Hayes et al 2002). The patient is unconscious, oral care will be needed more frequently. It also provides some cushioning to bony prominences. Clipping is a handy way to collect important slides you want to go back to later. However, the effects of immobility can cause changes in cardiovascular function with increased cardiac workload and central fluid shifts from the legs to the thorax and head (Dougherty and Lister 2004). Pulse oximetry assists in monitoring the effectiveness of oxygen therapy (Dougherty and Lister 2004 ). Hygiene needs and skin care Attending to the hygiene needs of the unconscious patient should never become ritualistic, and despite the patient’s perceived lack of awareness, dignity should not be compromised. Reflect on what you have learnt about the nursing management of unconscious patients. Cree C (2003) Acquired brain injury: acute management. care of unconsciousness patient Loss of Consciousness is apparent in patient who is not oriented, does not follow commands, or needs persistent stimuli to achieve a state of alertness. Enterai feeding can be administered in a variety of ways and the most appropriate means needs to be decided following assessment of the unconscious patient. Increased water in the gut or a decreased ability to absorb fluid can result in diarrhoea. If you continue browsing the site, you agree to the use of cookies on this website. Hillary Lubuto Anaesthetic Care of the Unconscious, Multiple Trauma and Burns Patient 1. If uncorrected this will compromise breathing by wasting respiratory and skeletal muscles (Woodrow 2004). Think of a patient with impaired consciousness you have nursed. However, these recommendations cannot be generalised and each patient needs to be individually assessed. Unconsciousness occurs when the RAS is damaged or inhibited, thus affecting the normal arousal mechanism (Pemberton 2000). Changes in the pattern of breathing may indicate a developing respiratory failure, or a disorder of the respiratory control centre in the brain (Dawson 2000). 20, 1, 54-64. We are excited to announce that FibromyalgiaTreating.com is now part of RedOrbit.com. Gentle cleaning of the nasal mucosa with gauze and water will help remove the build up of debris and maintain a moist environment. Unconscious Patient Care & Communication Skills required in Critical Care 1Prof. Nursing Standard. Care should be taken to examine the skin properly, noting any areas which are red, dry or broken. Lippincott Williams & Wilkins, Philadelphia PA, 133-162. After reading this article you should be able to: * Define consciousness and have an understanding of the related anatomy and physiology. Reflect on your experience and the underlying causes that led to impairment in that patient’s consciousness. Unconscious patients are extremely vulnerable. For patients with impaired consciousness touch, combined with kind and comforting words, can be a valuable means of providing reassurance. For example, a low blood pressure in the presence of a tachycardia with a pulse that feels weak on palpation may indicate hypovolaemia. There is minimal information on this invasive procedure in the nursing literature. A clouding of consciousness suggests interference with the integrity of the RAS, with a resultant effect on the arousal response. The GCS has been used as a prognostic device during immediate assessment following a head injury. the new Fibromyalgia Treating by RedOrbit! Break . Fifth edition. BSc NRS 4th Delusions are more persistent misperceptions that are held to be real, however illogical they may seem (Hickey 2003b). Baillire Tindall, London, 145-182. However, Fader ( 1997) suggests that manual evacuation should only be undertaken when other methods of bowel evacuation have failed. Now customize the name of a clipboard to store your clips. In Perry A, Potter P (Eds) Clinical Nursing Skills and Techniques. The reader should refer to the article by Moore (2004) to gain a better understanding of this skill. Studies exploring the recollection of the unconscious patient following a return to consciousness are predominantly concerned with sedated critical care patients, for example, Green (1996). Whenever these areas become excited impulses are transmitted to the RAS, further increasing the level of activity, and in turn the RAS stimulates the cerebral cortex, thus increasing the excitation of both regions. Therefore, care must be taken to ensure that it has been inserted correctly. Many people who have life-threatening conditions that can precipitate unconsciousness, such as epilepsy or allergies to penicillin, may be wearing bracelets that inform medical practitioners (Fuller 2004). Payne-James J, Grimble G, Silk D (2001) Enterai nutrition. Incontinence, perspiration, poor nutrition, obesity and old age also contribute to … European Journal of Cancer Care. Gastrointestinal function Bowel action is likely to become irregular in the unconscious patient, thus monitoring and observation are important. The collapse of lung tissue and the effects of secretions will impair gaseous exchange. T he patient who is unconscious from cerebral catastrophe must depend upon others to detect or anticipate his needs and to institute the appropriate measures to assure his recovery if the pathological insult can be overcome. For example, stimulation of the vagus nerve in the rectal wall can slow the patient’s heart (Powell and Rigby 2000). What policies are available in your workplace to assist and guide its application? They encourage healthcare practitioners to maintain verbal communication with the unconscious patient. National Institute for Clinical Excellence (2003) Head Injury, Triage, Assessment, Investigation and Early Management of Head Injury in Infants, Children and Adults. The RAS receives input signals from a wide range of sources, including the senses (Pemberton 2000). Introduction: The human body is designated to physical activity and movement thus, physiological changes will occur in the unconscious patient which will be exacerbated by the length of immobility, cause of unconscious the quality of care. As a patient starts to become unconscious he or she loses control of his or her ability to maintain a safe environment. Sixth edition. Gauging appropriate communication requirements demands an understanding of the patient, hence the patient’s family can be a valuable resource in helping the nurse to become more informed about the patient’s life, his or her personality, and his or her wishes and desires. In Alexander M, Fawcett J, Runciman P (Eds) Nursing Practice, Hospital and Home. Barker E (2002) The adult neurological assessment. Nitrogen is lost from the body when protein is broken down. The unconscious patient is challenging, in terms of immediate care, diagnosis, specific treatment and predicting prognosis. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. care for the unconscious patient can be used to enhance practice in other areas of nursing. Pulse oximetry will aid the ongoing monitoring of respiratory function. To maintain a patent airway the lateral recumbent position is advised (Allan 2002) with the head of the bed slightly tilted upwards, about 10-30 degrees (Pemberton 2000) (Figure 2). Nursing Standard. Research focusing on oral problems associated with cancer suggests a minimum of four-hourly interventions to reduce the potential of infection from micro- organisms. * Discuss the various levels of impaired consciousness. The A (airway), B (breathing), C (circulation), D (disability) approach to resuscitation should be adopted, and the maintenance of a clear airway is the first priority (Colquhoun et al 2004). Department of Health (2001a) Essence of Care: Patient-focused Benchmarks for Clinical Governance. Attention is given to good body alignment, to help prevent contractures, foot and wrist drop, muscle strain, joint injury and interference with circulation and chest expansion. The patient may require the administration of oxygen therapy. It is important to recognise that such positioning is the ideal and may be contraindicated by an underlying condition, for example, a spinal or an underlying brain injury. second edition. Personal hygiene is considered part of The Essence of Care (Department of Health (DH) 2001a) and needs to be carried out to an uncompromising standard. Acute states are potentially reversible, whereas chronic states indicate underlying brain damage and hence are irreversible (Pemberton 2000). from doctors and scientists. To avoid foot drop the feet are positioned at a 90 degree angle to the leg with caretaken to avoid any unnecessary pressure. Wunderlich R (2002b) Body mechanics, transfer and position. Yet the immediate and ongoing needs of the unconscious patient are similar, whatever the underlying cause. CARE OF UNCONSCIOUS Intrinsic factors that affect the nervous system directly can be seen as primary causes. Bryne B (2002) Deep vein thrombosis prophylaxis: the effectiveness and implications of using below-knee or thigh-length graduated compression stockings. Physical examination can give many clues as to the cause of unconsciousness. Nursing Standard. Medical management will vary according to the original cause of the patient’s condition, but nursing care will be constant. Tidal volumes -the volume of air that passes in and out of the lungs during normal quiet breathing- may not be compromised, depending on any underlying respiratory pathology, but generally lying flat causes a reduction in the residual volume and functional residual capacity of the lungs (Hickey 2003a). Hayes JM, Lehman CA, Castonguay P (2002) Graduated compression stockings: updating practice, improving compliance. The arm that is down is drawn slightly forward from under the body, bent at the elbow to lie on the bed parallel with the neck and head, or across the chest. The delivery of nutritional requirements is best achieved enterally as the parenteral route has the disadvantages of expense, increased risk of infection from IV cannulation, and gut atrophy and translocation of gut bacteria from non-use of the digestive tract (Woodrow 2004). Unconsciousness is the condition in which cerebral function is depressed ranging from stupor to coma (Baughman and Hackley 1996). Pemberton L (2000) The unconscious patient. Prolonged periods result in increased pathophysiological changes associated with increased morbidity and permanent disabilities (Hickey 2003a). Date of acceptance: July 18 2005. Introduction Nursing the unconscious patient can be a challenging experience. For example, a bitten tongue may indicate an epileptic seizure, or needle marks on the lower limbs or abdomen could be because the patient has insulin-dependent diabetes (Fuller 2004). See our User Agreement and Privacy Policy. Gentle cleaning with gauze and 0.9% sodium chloride should be sufficient to prevent infection. They are easy to insert, prevent the tongue from obstructing the airway, provide a passage that allows the patient to breathe, and allows the nurse to remove secretions from the trachea through suctioning.

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