Whenever these areas become excited impulses are transmitted to the RAS, further increasing the level of activity, and in turn the RAS stimulates the cerebral cortex, thus increasing the excitation of both regions. Thrombus formation is caused by venous stasis, decreased vasomotor tone, pressure on the blood vessels and a hypercoagulable state (Hickey 2003a). The Waterlow Pressure Sore Prevention/Treatment Policy. Waterlow J (1998) The treatment and use of the Waterlow card. ‘Coma cocktails’ should be avoided.3 In cases where there is clinical suspicion of toxicity, specific antidotes should be used, eg naloxone in opiate toxicity. second edition. Therefore, accurate fluid balance should be monitored and recorded to allow the identification of potential fluid or electrolyte imbalances (Gobbi and Torrance 2000). Thus, in addition to managing the underlying cause of unconsciousness, the nurse should also implement a framework of care that seeks to prevent further complications. A 2012 study found that primary care physicians with an unconscious bias toward white patients tended to dominate conversations with black patients during routine visits and pay less attention to these patients’ social and emotional needs. The first is a diffuse insult to both cerebral hemispheres and the second a disruption of the ascending reticular activating system in the midbrain and pons, where signals are carried to the thalamus and cortex. We can now extend to other conditions that may be part of your everyday lives and help you on a broad level if that is what you need. Now that you have completed this article, you might like to write a practice profile. This helps to retain patient dignity, allows close monitoring of urinary output and prevents skin breakdown. However, there is evidence that patients can recall with accuracy conversations that have taken place while unconscious (Pemberton 2000). In Barker E (Ed) Neuroscience Nursing. This suggests that consciousness depends on whether the individual can be aroused to wakefulness. Cheyne–Stokes breathing is seen with many underlying pathologies and is not helpful in making a firm diagnosis. Diagnosis and treatment of unconscious patient. However, the patient may recover fully which can be a rewarding and uplifting experience. This chapter has presented a physiologic approach to the differential diagnosis and the emergency management of the stuporous and comatose patient. Ataxic breathing (Biot's respiration) – groups of quick, shallow inspirations followed by regular or irregular periods of apnoea, suggesting a lesion in the lower pons.11, Central neurogenic hyperventilation – breathing characterised by deep and rapid breaths at a rate of at least 25 breaths per minute indicating a lesion in the pons or midbrain.12. Alterations in blood pressure need to be viewed in relation to pulse rate, pulse quality and pulse pressure (Hickey 2003a). The GCS meas\ures the degree of consciousness under three distinct categories, and each category is further subdivided and given a score as shown in Box 1 (see also the version adapted by NICE 2003). Completion of a risk assessment may help to highlight any potential compromise to the maintenance of a safe environment. Curr Opin Obstet Gynecol . Signals from specific parts of the thalamus initiate activity in specific parts of the cerebral cortex, as opposed to the diffuse flow of impulses from the mesencephalon that causes generalised cerebral activity (Pemberton 2000). Draw blood for baseline electrolytes. If unconsciousness is prolonged and an artificial airway is still required then a tracheostomy should be considered (Hooper 1996). WB Saunders, London. Associate Professor of Anesthesiology and Intensive Care. Nursing Management of unconsciousness patient:-a. 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