 Care of unconscious patient-

 Consciousness-
A state of awareness of yourself and your surroundings.

Ability to perceive sensory stimuli and respond appropriately to them.

 Unconsciousness-
Unconsciousness is a state in which a patient is totally unaware of both self and external
surroundings, and unable to respond meaningfully to external stimuli.

Coma is a state of sustained unconsciousness in which the client does not respond to verbal
stimuli, does not move voluntary.

 Level of consciousness-
Alertness, oriented:- open eyes spontaneously, responds to stimuli appropriately.

 Lethargy, sleepy:- slow to respond but appropriate response, open eyes to stimuli,
oriented.
 Stupor:- aroused by and open eyes to painful stimuli, never fully awake, confused, unclear
conversation.
 Semi com stage:- move in response to painful stimuli, no conversation, pupillary reflex
present.
 Coma:- unresponsive accept to sever pain, no protective reflexes, fixed pupils, no voluntary
movement.

 Assessment of consciousness-
For the care to be effective, a nurse should perform frequent, systemic and objective assessment
on the comatose client. During the first few hours of coma, neurological assessment is to be
done as often as 15 minutes.

Comatose client are completely depend on other because consciousness and protective reflex
are impaired. Nurses are responsible for meeting basic human needs and preventing the
complications associated with coma.

1. Physical assessment.
2. Level of consciousness.
3. Glasgow coma scale is used to assess the consciousness.
 Eye opening:-

Test and score-

Spontaneous-4

To speech-3

To pain-2

No response-1

 Verbal response:-

Test and score-

Oriented-5

Confused-4

Inappropriate words-3

Incomprehensible siund-2

No response-1

 Motor response:-
Test and score-
Obeys commands-6

Localizes -5

Withdrawal-4

Flexes-3

Extends-2

No response-1

Thus, the client's response is rated on a scale from 3 to 15.

A score 3 indicate severe neurological impairment. A score 15 indicates that the client is fully
responsive. A score less than 7 require frequent assessment.

 Pattern of respiration-
 Disturbances of the respiratory centre of brain may result in various respiratory patterns.

Cheyne stroke's respiration-

It suggests lesions deep in both the hemisphere, area of basal ganglia and upper brain stem.

 Hyperventilation:-

Onset of metabolic problem or brain stem damage.

Ataxic respiration with irregularity in depth and rate:-

Damage to medullary centre.

 Eyes-
Pupils (size, equality and reaction to light).

Fixed dilated pupils- injury at the level of mid brain.

Eye movements- Normally eyes move from side to side. Eye movement absent in deep coma.

Corneal reflexe- when touched in a wisp of clean cotton, blink response is normal. If abnormal,
function of 5th and 7th cranial nerve may have been affected. Unilateral lesion may be present,
corneal reflexe is absent in deep coma.

Facial symmetry

Normally symmetry

 Asymmetric- sagging or decrease in wrinkles- sign of paralysis.

 Swallowing reflex-
Drooling versus spontaneous swallowing.

Drooling is present in 10th and 12th cranial nerve.

 Neck-
Stiff neck-subarchnoid heamorrhage, meningitis.

Absent of spontaneous neck movement- fracture or dislocation of cerebral spine.

 Motor response-
Spontaneous purposeful movement- client fully awake.

Absent motor response- in deep coma.

 Body functions-
Circulation, respiration, elimination, fluids and electrolyte balance are examined in a systematic
and ongoing manner.

Thank you