CARE OF the unconscious.ppt

CARE OF AN UNCONSCIOUS PATIENT Ambor Julius NURC 106 CARE OF AN UNCONSCIOUS PATIENT Virginia Henderson' Definition of A Nurse “Nurse is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the eyes of the newly blind, a mea...

CARE OF AN UNCONSCIOUS PATIENT Ambor Julius NURC 106 CARE OF AN UNCONSCIOUS PATIENT Virginia Henderson' Definition of A Nurse “Nurse is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge and confidence for the young mother, the ‘mouthpiece’ for those too weak or withdrawn to speak and so on”  Introduction Unconsciousness can be defined as a state of unawareness. Care of unconscious patients therefore involves the activities that are organized to meet the needs of a patient with an altered level of consciousness.  COMMON CAUSES OF UNCONCIOUSNESS Diabetic Hypoglycemic Attacks Grand mal Seizures Alcoholism Electrical Burns Stroke of any form (Heatstroke, CVA etc.)  COMMON CAUSES OF UNCONCIOUSNESS Intra cranial Embolism (Head injury) Poisoning of any form (food, lead, chemical etc. Shock (Hemorrhagic, anaphylactic, traumatic etc.) Febrile convulsions Allergies (Drugs, Insect bites etc.)  Types of unconsciousness Stupor: this is a state of partial consciousness. The patient is not capable of answering simple questions such as his name and address, however he does respond to painful stimuli. Coma: this is a state of complete unconsciousness in which all reflexes are absent and the patient does not respond to any stimuli whatsoever.  Types of unconsciousness cont’d Coma Vigil: is a state of complete unconsciousness where the patient’s eyes are wide open. ~ This indicates that the patient is extremely exhausted (prostration). ~ It is sometimes accompanied by low muttering delirium.  Requirements needed to care 4 the unconscious Bath trolley Mouth care tray Diagnostic sets TPR tray Injection tray Oxygen cylinder with its apparatus Sphygmomanometer and stethoscope Naso-gastric tube feeding tray Suction apparatus  Steps Since an unconscious patient cannot do much for himself, he will rely solely on the nurse to assist him carry out activities of daily living. The nursing cares will be discussed under the following headings; Psychological support, Maintenance of airway, Position and rest, Observation, Personal hygiene, Nutrition, Elimination, Administration of medication, Prevention of injury.  Psychological support Establish a good rapport with patient and relatives. Explain every procedure to the patient even though he is unconscious. Reassure relatives continually. Invite chaplain or Imam to pray with patient where necessary. Treat patient with respect and dignity.  Maintenance of airway Establish patent airway by opening all windows if indoors or keep on lookers at a distance if outdoor to ensure sufficient fresh air around the patient. Also undo tight clothing round the neck, chest and waist. Frequently suction if mucus accumulates in the oropharyngeal cavity. Administer oxygen when necessary.  Position and rest Put patient in the lateral or semi prone position with head turned to one side. Change patient’s position 2hourly (quarter turn) Use sand bags to prevent foot drop. Keep environment quiet and carry out nursing procedures together if possible to avoid unnecessary disturbance of patient.  Observation Check patient’s temperature hourly, two hourly and four hourly as patient’s condition improves. Check BP half hourly as condition improves check one hourly, two hourly and then four hourly. Check depth of consciousness using the Glasgow coma scale. Record intake and output of patient Observe for twitching in any part of the body  GLASGOW COMA SCALE It is designed for use in serial assessment of patients in coma from either medical or surgical causes. It is commonly used in the pre-hospital or acute care settings to evaluate for mental status in both traumatic and non – traumatic presentations.  GLASGOW COMA SCALE cont´d Best eye response – spontaneously (+4), to verbal command (+3) to pain (+2), no eye opening (+1), not assessable (+1c) Best verbal response- orientation (+5), confusion(+4), Inappropriate words (+3), incomprehensive sounds (+2) , no verbal sounds (+1), intubated (+1t)  GCS cont’d Best motor response- obeys command (+6), localized pain (+5), withdrawal from pain (+4), flexion to pain (+3), Extension to pain (+2), no motor response (+1) A trauma patient presenting with GCS of less than 15 needs a close attention and reassessment. Any declining GCS in any setting should be promptly assessed of the airway and intervene.  Personal hygiene Give bed bath, at most twice daily or when necessary. Keep patient reasonably warm. Give mouth care twice daily or when necessary. Treat pressure areas four hourly. Keep finger and toe nails clean and short (care of the hands and feet) Change patient’s bed sheets and clothing frequently.  Nutrition Nutritional status of the patient should be sustained by intravenous feeds or infusions and nasogastric tube feeding. Ensure patient is nil per os. Oral feeds should be initiated when swallowing reflex returns and the patient has gained consciousness. Patient should be served with fluid diet, light and normal diets as condition improves.  Elimination Patient should be catheterized. Soiled linen should be changed as often as possible when soiled with faeces/stool. Keep and record accurate intake and output.  Administration of medication Prescribed drugs should be given as ordered and the desired and side effects observed for.  Prevention of injury Side rails should be raised on the patient’s bed to protect him from falling. The side rails should be padded to prevent injury. Assist patient with physiotherapy exercises e.g. extremities of patient must be moved twice daily to preserve joint functioning  Conclusion The above nursing care should also be administered to a terminally ill (a dying) patient. In addition relatives of a terminally ill patient should be given psychological support during this period. LAST OFFICES  LAST OFFICES Last offices is care given to the dead body. A person is clinically dead when there is total absence of activity in the brain and central nervous system as well as the cardiovascular and the respiratory system as observed and declared by a physician.  Indications/Purpose Confirmed clinically dead To maintain the dignity of the dead person. To maintain a proper alignment of the deceased Infection control measures Legal issues. Cultural religious and spiritual considerations.  Contraindications If the person is not declared clinically dead. If the deceased relatives are not in agreement. Religious Culture  Requirements on a trolley Top shelf Bowl or basin in which to mix cold and hot water Face towel, sponge Soap in a dish Powder, pomade Comb and brush Nail brush and nail scissors Use back of palm to check temperature of water  Bottom shelf Bowl or bucket to receive used water Two jugs (one for hot water and the other for cold water) Bath towels Draw sheet or cloth and draw mackintosh Bed sheet or linen as required Gown Soiled linen bin Receiver containing forceps. E.g. scissors and two pairs of forceps  Bottom shelf requirements cont. Galipot with cotton wool Dressings Bandages Scissors Receiver Plaster Identification label Clean personal linen or mortuary gown and sheet Gloves  When a nurse realizes a patient has ceased He/she must: breathing Screen the bed Contact nurse in charge to inform the doctor Note the time vital signs ceased and document(all documentations must be in red ink) Ensure that doctor certifies death, before proceeding to the next step  When a nurse realizes a patient has ceased Removebreathing cont’d all bed appliances and equipment used on patient. Examples: intravenous infusion, naso-gastric tube, heel pad, urethral catheter and all other tubings. Straighten limbs Close eyes and mouth, if not closed, a small wet piece of cotton wool swab should be placed on the eyelids.  When a nurse realizes a patient has ceased breathing cont’d Use bandage to support jaw. Cover head and body with a sheet and leave for one hour. Inform relatives if they wish to see decease body, allow them to do so. Give emotional support to grieving relatives.  Procedure for Last Offices The nurse should Wear protective clothing’s e.g. gown, gloves. Should work under quiet atmosphere Turn deceased to lateral position with a receiver in position to collect oral secretions. Then to the supine position, a gentle pressure over the lower abdomen will empty the bladder into receiver.  Procedure Cont’d Give the deceased a bed bath Clean nostril, ears and mouth Replace dentures if any Trim the nails and shave male patient Remove all jewelry except wedding ring, unless requested by relatives to remain.  Procedure Cont’d Re-dress wound if any, secure dressing with tape or loose bandage. Pack orifices-nostrils, ears, rectum and vagina (if necessary) with cotton wool using forceps to prevent leakage. Put a label on the deceased arm or body bearing the following;  Procedure Cont’d Full name Age Sex Ward Diagnosis Date and time of admission Date and time of death  Procedure Cont’d Wrap body in a sheet, ensuring that face and feet are covered and all the limbs are held securely in position Place deceased on a special mortuary trolley Make arrangements to transfer the body to the mortuary by the mortuary attendants Check deceased property with a second nurse  Procedure Cont’d It may be important to family and caretakers to assist with bathing, thereby continuing to provide the care given in the period before death. It is an expression of respect and affection, part of processes of adjusting to loss and expressing grief.  Procedure Cont’d List property in the valuable or property book, lock the property in a safe place or hand them over to the next of kin if available and ask person to sign the book Clear away any equipment used and disinfect. Disinfect and clean the bed, lockers and all appliances etc. Document in admission and discharge book and ward state.  Procedure Cont’d Take deceased folder to the revenue office for calculation/assessment of hospital fee, NHIS Inform relatives to come to the ward prior to going to the mortuary for the death certificate.  Procedure Cont’d NB. If an unexpected death occurs during the night, the senior nurse/night superintendent on duty sometimes confirms the death if an agreed policy has been implemented in the facility. An unexpected death must be confirmed by attending medical officer.  Management of patient brought The nurse must: in dead Reassure the relatives. Give them a seat. Call in the doctor to certify death and fill the Coroner’s forms. Direct relatives to send the forms to police station. Manage the corpse as done to those who die in hospital.  Conclusion Nursing: "The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” THANK YOU QUESTIONS?