Management of the Unconscious Patient By Donna, Gill, Sharon and Catherine.
Neurological Status Glasgow Coma Scale this is a tool used to evaluate three categories of behaviour that reflect activities in the high centre of the brain. • Eye Opening • Verbal Response • Motor Response
GCS cont: • The first score provides a base line for future scorings. • Yasmin’s score is currently 8 • The lowest score the patient can achieve is 3 indicating total unresponsiveness. • The maximum score is 15 indicating an awake, alert and fully responsive patient. A Score Less than 15 is usually an indication there is a cause for concern.
GCS Cont: • By using the GCS it should be possible to detect deterioration before changes in vital signs occur. • Relating to Yasmin the GCS will be observed every 30mins until her condition stabilises or reaches a score of 15.
Respiratory Function • Maintaining a patient airway and promoting adequate ventilation are nursing priorities. • To maintain a patent airway the lateral recumbent position is advised, to prevent the occlusion of the airway from the tongue falling back against the pharyngeal wall, this will also facilitate the drainage of secretions. • Correct positioning of the unconscious patient also minimises the risks associated with immobility in terms of circulation and musculoskeletal system.
Immobility • As Yasmin is unconscious she will be immobile, she should be repositioned regularly after assessment of respiratory function and pressure areas (waterlow scoring and nimbus mattress). • The use of anti-embolism stockings, and anticoagulants are necessary for the prevention of DVT as they increase the velocity of blood flow not only in the legs but also in the pelvic veins and inferior vena cava. • The physiotherapist will be of benefit with the introduction of passive limb movements that will also encourage blood flow back to the heart
Cardiovascular function • Monitoring the cardiovascular function in unconscious patients is of high importance • Be aware of any changes in vital signs that indicate further deterioration, including heart rate and rhythm, BP, and temperature. • Observe the patient for any changes in colour for example pallor or cyanosis including the peripheries. • Observe for signs of infection including tachycardia, hypotension, and pyrexia.
Pain • Yasmin had abdomen pain, tenderness, and bruising on admission to A & E. • After her admission to ITU she will monitored for signs of pain and discomfort • In signs of pain we should consider repositioning the patient or administering prescribed analgesia. • Monitor the effectiveness of the interventions given.
Renal and Gastrointestinal needs • As Yasmin is unconscious a urinary catheter should have been inserted, and her urine output should have been recorded hourly. • Yasmin’s bowel functions should be monitored and recorded • Observe and report any signs of diarrhoea or constipation • If constipation occurs consider using laxatives to prevent faecal impaction which is common in immobile unconscious patients.
Nutrition and hydration • Consider enteral feeding to provide nutritional support • Monitor and record fluid balance • Administer IV fluids as prescribed • The unconscious patient is dependant on the healthcare team to deliver the correct nutritional requirements. • In relation to Yasmin she was given 1 litre of Sodium chloride and 500 mls of normal saline • As Yasmins blood glucose levels are very low 2.2 an IV insulin sliding scale regimen may be required to maintain blood glucose levels within the normal range 4-6mmol
Hygiene needs • Personal hygiene is considered part of the essence of care and needs to be carried out to an uncompromising standard. • Regular skin care including eye, mouth, and catheter care should be given as well as care of any invasive sites.
Psychosocial needs • It is important that all procedures are explained to Yasmin even though she is unconscious. • The healthcare team should liaise with family members regarding her condition. • Communicating with relatives can aide an enhance the nurse-patient relationship by fostering understanding and empathy. • Discussions with family members can encourage appropriate interactions and involvement in Yasmin’s care.