Consciousness refers to the normal level of wakefulness which is dependent upon the interaction of a functioning cerebral cortex and an intact reticular activating system.
CONSCIOUSNESS
1) Orientation to time, place, and person
2) Alert and awake 3) Awareness to the environment 4) Ability to answer questions appropriately
5) Intact recent and remote memory
Characteristics of consciousness
Confusion: • Loss of the means to think clearly and quickly.• Impaired judgement and decision making. Disorientation: • Disorientation to time or place.• Impaired memory.• Lack of recognition of self.• Lethargy• Restricted unprompted speech or movement.• Easy to arouse by normal speech or touch.• Potential disorientation to time, place or
person.
ALTERED LEVELS OF CONSCIOUSNESS
Obtundation: Mild to modest reduction in arousal Clouding of consciousness. Constrained responsiveness to surroundings. Ability to fall asleep easily. Ability to reply to questions with minimum
response. Stupor: An excessively long sleep-like state. A state of deep sleep or unresponsiveness. Arousable to verbal response only and to
vigorous and repeated stimulation, for example, shouting or shaking.
Withdrawal or grabbing response to stimulation.
Coma : A state of complete unresponsiveness. Lack of motor or verbal responses to
external surroundings or to any stimuli. No response to noxious stimuli for example,
deep pain. The person cannot be aroused at all by any
stimulus.
Seizure Cerebrovascular causes Tumour Cardiac arrest Heart or lung disease Asphyxiation Alcohol Carbon monoxide Drugs Infections
CAUSES OF ALTERED CONSCIOUSNESS
Normal conscious behaviour is dependent on an intact and fully functioning brain
RAS is responsible for arousal from sleep and maintaining consciousness.
RAS includes the mesencephalon (upper pons and mid-brain) and the thalamus
The RAS receives input signals from the senses
Disorders that affect any part of the RAS can produce coma.
PATHOPHYSIOLOGY
Direct compression or destruction of the structures
Decrease in availability of oxygen or glucose
Toxic effects of substances on the structures of the RAS
UNCONSCIOUSNESS
Assessment identification of major etiological factors history, neurologic examination, identification of related signs and symptoms
and significant diagnostic tests
NURSING CARE OF UNCONSCIOUS CLIENT
Eye response 1.No eye opening
2.Eye opening in response to pain
3.Eye opening to speech
4.Eyes opening spontaneously
Glassgow Coma Scale
Motor response
1.No motor response
2.Extension to pain
3.Abnormal flexion to pain
4.Flexion/Withdrawal to pain
5.Localizes to pain.
6.Obeys commands
Verbal response
1.No verbal response
2.Incomprehensible sounds
3.Inappropriate words
4.Confused
5.Oriented
Alert: this refers to spontaneous eye-opening, speaking and intact motor functions, for example, able to move limbs
Voice: responds when spoken to. The response may be the spoken word (speech) or a grunt
Pain: responds to pain, for example, the sternal rub
Unresponsive: if no response to pain, such as no eye, voice or motor movement
AVPU Scale
Ineffective airway clearance Impaired gas exchange Alteration in tissue perfusion, cerebral Sensory perceptual alterations Alteration in nutrition less than body
requirements Alteration in bowel elimination Alteration in patterns of urinary elimination Self care deficit: feeding, bathing, dressing,
toileting Impaired physical mobility Potential for impaired skin integrity
Nursing Diagnoses
Assess respiratory status, oral cavity, and oxygen saturation
Oropharyngeal airways Oxygen therapy Chest PT Lateral recumbent position Suctioning ET tube insertion and mechanical
ventilation
Respiratory function
Monitor pulse, B.P Passive limb movements I/O chart Antiembolic stockings Anticoagulants as ordered
Cardiovascular function
Monitor S. electrolytes Maintain I/O chart Monitor urine protein Sliding scale insulin Enteral feeding Parenteral feeding and IVF
Nutrition and hydration
Maintain adequate hydration Monitor bowel pattern, bowel sounds Maintain I/O chart Administer laxatives as ordered
GI function
Assess skin colour, turgor, and integrity Change position frequently Use pressure relieving matresses Ensure that skin is dry after bed bath Cut nails short Oral hygiene Eye care
Hygiene and skin care
Positioning Maintain body alignment Lateral recumbent position Position feet at 90° to the leg
Communication Reassure the patient Explain all the procedures Talk to the patient