UNCONSCIOUSNESS

welcome
UNCONSCIOUSNESS
Presented by
Uma Devi.N
M.SC (N) 1ST YEAR
INTRODUCTION
The brain requires a

constant supply of
oxygenated blood and
glucose to
function.Interuption
of the supply will cause
loss of consciousness with
in a few seconds and
permanent brain damage
HISTORY OF
UNCONSCIOUSNESS
The term
“unconscious”
in GERMAN word
“Unbewusste” was coined
by the 18th century .
German Romanic
philosopher “friedrich
schelling” and later
introduced into English by
the poet and essayist
“Samuel Taylor
Coleridge.”
ANATOMY AND PHYSIOLOGY OF
BRAIN
ANATOMY AND PHYSIOLOGY
OF BRAIN
BRAIN
ANATOMY AND PHYSIOLOGY OF BRAIN
ANATOMY AND PHYSIOLOGY OF BRAIN
BRAIN
The human brain is the central organ of the
human nervous system. The human brain, with the spinal
cord, makes up the central nervous system. The brain
consists of the cerebrum, its largest part,
the brainstem and the cerebellum. The brain is the organ
that controls most of the activities of the body . The
brain processes, integrates, and coordinates all of the
information it receives from the sense organs Sensory
information is interpreted and analyzed, and decisions
are made as to the instructions transmitted to the rest of
the body. The brain is contained in, and protected by the
skull bones of the head .
DEFINITION
An altered level of
consciousness is apparent
in the patient who is not
oriented , does not follow
commands or needs
persistent stimuli to
achieve
a state of alterness.
SMELTZER SUZANNE .C.
PHYSIOLOGY
• Disruption of
reticular activating
system, which is
extends the length of
the brain stem and up
to thalamus .
• Disrupt the function

of both cerebral
hemispheres .
• Metabolically
depress overall brain
PHYSIOLOGY
• Decrease the blood flow .
• Disruption of the blood

flow .
• Damage to the brain .
• Pressure on the
surrounding brain tissue.
ETIOLOGY
NEUROLOGIC DISTURBANCES
:
 Head injury ,
 Stroke ,
TOXICOLOGIC :
• Drug over dose ,
• Alcohol intoxication ,
METABOLIC :
 Metabolic or renal failure,
 Diabetic keto acidosis,
ETIOLOGY
PSYCHOGENIC :
 Hysteria ,
 Catatonia ,
OTHERS :
 Infections ,
 Nutritional Deficiency ,
 Hypoglycemia ,
 Hypotension ,
 Hypertension
PREDISPOSING FACTORS
 Stress ,
Impaired physical
status ,
Ingestion of high
dose drugs
LEVELS OF UNCONSCIOUSNESS
EXCITORY
UNCONSCIOUNESS :
patient does not
respond coherently,
but easily disturbed by
sensory stimuli .
E.G :
patient who are going
under anesthesia .
LEVELS OF
UNCONSCIOUSNESS CONTN
Somnolent :
patient is extremely
drowsy and will response
only of spoken to directly and
perhaps touched .
E.G:
Post operative patient
LEVELS OF
UNCONSCIOUSNESS CONTN
Stuperous :
patient responds only to
painful stimuli such as pricking
or pinching of the skin.
E.G :
Intra cranial hemorrhage
patients
LEVELS OF
UNCONSCIOUSNESS
COMA : CONTN
It is a clinical state of
unconsciousness in which
the patient is unaware of self
or the environment for
prolonged periods ( Days to
Months)
LEVELS OF
UNCONSCIOUSNESS
VEGETATIVE STATE :
CONTN
The patient is
described as wakeful but
devoid of conscious content ,
with out cognitive or
affective mental functions
PATHO - PHYSIOLOGY
Direct compression on brain stem
Hypoxia
Ischemia
Disruption in the basic functional neurons

PATHO – PHYSIOLOGY CONTN
Faulty impulse transmission
Impeding communication with in the

brain
Cellular edema
Disruption in the chemical transmission

SIGNS AND SYMPTOMS
Changes in the :
 Pupillary response,
 Eye opening response ,
 Verbal response ,
 Motor response ,
Behavioral changes :
• Restlessness ,
• Increased anxiety ,
DIAGNOSTIC EVALUATION
HISTORY COLLECTION :
• Previous history of stroke,
Head injury, neurologic
surgery .
EVALUATION OF
NEUROLOGIC STATUS :
 Level of consciousness ,
 Pupils ,
 Cranial nerve examination,
 Motor response ,
 Sensation ,
GLASCO COMA SCALE :
 Level of consciousness ,
 Eye opening ,
 Motor Response
To assess the motor response :
Apply a painful or other noxious stimulus to
central part of the body that is,
 Trapezius squeezing ,
 Supra orbital pressure ,
 a sternal rub ,
TRAPEZIUS SQUEEZING:
which involves
gripping and twisting a
portion of the
trapezius muscle in the
patient's shoulder[1]
SUPRA ORBITAL
PRESSURE :
this is the manual
stimulation of the
supraorbital nerve by
pressing a thumb into the
indentation above the eye,
near the nose.

A STERNAL RUB :
This involves creating a
turning pressure (akin to a
grinding motion with a
pestle and mortar) on the
patient's sternum
ASSESS THE PUPILS
NORMAL SHAPE OF THE
PUPILS;
Round
in
shape
ASSESS THE PUPILS
VARIATIONS IN
PUPILS ARE :
• Keyhole,(Colobama)
• Ovoid.
ASSESS THE PUPILS
• Hold both eye lids .
• Open and shine a light into
eyes .
• Pupils should constrict
immediately and equally ,
bilaterally .
• After remove the light,
they should immediately
dilate back into baseline.
Assess the reflexes
• Pupillary light reflex ,
• Corneal reflex ,
• Ocular reflex :
- oculo cephalic reflex ,
- oculo vestibular reflex ,

• Gag reflex ,
CORNEAL REFLEX
CORNEAL REFLEX
• To detect function of the TRIGEMMINAL
NERVE - cranial nerve 5

OCULAR REFLEX
Oculo cephalic reflex :
(Dolls eye reflex )
The head is briskly
turned from side to side.
Detection of eye rotation,
Head is flexed and extended.
OCULO CEPHALIC REFLEX
For this cranial nerve which is involved ,
 Cranial nerve 3 – ocular motor nerve ,
 Cranial nerve 4 – Trochlear Nerve ,
 Cranial nerve 8 – Vestibulo cochlear nerve ,

OCULO VESTIBULAR REFLEX
OCULO VESTIBULAR REFLEX
For this cranial which is involved in ,
 Cranial Nerve 6 – Abducence Nerve,
 Cranial Nerve 8 – Vestibular nerve ,

GAG REFLEX
(pharyngeal reflex)
• Reflex contraction the back
of the throat.
• Evoked by touching the roof
of the mouth ,the back of
the tongue ,the area around
the tonsils and the back of
the throat.
GAG REFLEX
To assess the ,
 Cranial Nerve 9 – Glosso pharyngeal Nerve ,
 Cranial Nerve 11 – Spinal accessory nerve

C.T. SCAN
To check for ,
1. Cerebral edema ,
2. Infarctions,
3. Hydrocephalus,
4. Shift of brain structure,

Abnormal CT head
scan
M.R.I SCAN
TO CHECK FOR ,
• Type of tissue damage ,
• Tumors ,
• Vascular Abnormalities,
• Intra cranial bleeding,

LUMBAR PUNCTURE
To identify the ,
• Cerebral meningitis ,
• CSF evaluation.,
HEMATOLOGICAL EVALUATION
• CBC – Complete blood
cell
• Level of drugs in blood ,
E.G. Aspirin, Paracetamol,

ELECTRO ENCEPHLO GRAPHY
To detect the
electrical activity of
cerebral cortex layer .

INTRA CRANIAL PRUSSURE
Combined Volume
of 3 intracranial
compartment that is ,
 Blood ,
 CSF ,
 Brain tissue ,
Normal ICP is 5 –
15mmhg.
POSITRON EMISSION TOMOGRAPHY
To detect the
neoplastic lesions
PET IMAGES
Digital venous angiography
• To assess the
visualization of vascular
structure,
• Detect transient
ischemic attacks,
• Intra cranial tumors,
MANAGEMENT
Medical management :
1. Anti emetics,
2. Loop diuretics,
3. Neuro transmittors,
4. Anti coagulants,
5. Antibiotics,
6. Antipyretics,
SURGICAL MANAGEMENT
SURGICAL MANAGEMENT
NURSING MANAGEMENT
Nursing Interventions :
 Assessment Of Neurological Status ,
 Maintaining Patent Airway ,
Protecting The Client ,
Maintain Fluid Balance ,
Family Support And Education ,

NURSING INTERVENTIONS
Managing the nutritional needs,
Maintaining the skin integrity,
Prevent urinary infection,
Providing sensory stimulation ,
To prevent complication ,

EMERGENCY NURSING CARE
Check cause and clues,
Loosen clothes ,
Ease breathing ,
Keep neck straight , chin forward ,
Clean the secretion ,
Remove artificial teeth ,
Keep warm and comfortable ,
Observe LOC ,
SUMMERY
CONCLUSION

UNCONSCIOUSNESS

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welcome

The brain requires a

• Disrupt the function

• Disruption of the blood

• Damage to the brain .

the patient is unaware of self

or the environment for

prolonged periods ( Days to

Disruption in the basic functional neurons

Impeding communication with in the

Disruption in the chemical transmission

Apply a painful or other noxious stimulus to

central part of the body that is,

 Supra orbital pressure ,

gripping and twisting a

trapezius muscle in the

this is the manual

pressing a thumb into the

indentation above the eye,

near the nose.

This involves creating a

turning pressure (akin to a

grinding motion with a

pestle and mortar) on the

- oculo cephalic reflex ,

- oculo vestibular reflex ,

• To detect function of the TRIGEMMINAL

NERVE - cranial nerve 5

For this cranial nerve which is involved ,

 Cranial nerve 3 – ocular motor nerve ,

 Cranial nerve 4 – Trochlear Nerve ,

 Cranial nerve 8 – Vestibulo cochlear nerve ,

For this cranial which is involved in ,

 Cranial Nerve 6 – Abducence Nerve,

 Cranial Nerve 8 – Vestibular nerve ,

• Evoked by touching the roof

of the mouth ,the back of

the tongue ,the area around

the tonsils and the back of

 Cranial Nerve 9 – Glosso pharyngeal Nerve ,

 Cranial Nerve 11 – Spinal accessory nerve

4. Shift of brain structure,

• Type of tissue damage ,

• Intra cranial bleeding,

• CBC – Complete blood

• Level of drugs in blood ,

E.G. Aspirin, Paracetamol,

cerebral cortex layer .

 Assessment Of Neurological Status ,

 Maintaining Patent Airway ,

Protecting The Client ,

Maintain Fluid Balance ,

Family Support And Education ,

Managing the nutritional needs,

Maintaining the skin integrity,

Prevent urinary infection,

Providing sensory stimulation ,

To prevent complication ,

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