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Comatose Patient
Nursing Care of the Comatose Patient
| Question | Answer |
|---|---|
| A state of unconsciousness in which both wakefulness and awareness are lacking. | coma |
| When a patient experiences a _____ they cannot be aroused and demonstrate no voluntary movements. | coma |
| Both a _______ and a ______ just look at geographical location of the brain. | cat scan and MRI |
| When a person has a cat scan or an MRI, what is being looked for? | Is there something that shouldn't be there? Has something pushed to the side? Is an area that has been perfused at one point not perfused? Nothing about physiology, only geographical structures. |
| The scan that determines the physiology of the brain itself is the ___ ____ and you would use glucose to do that. | PET Scan |
| A ____ is an emergent test and a ______ is not an emergent test. | cat scan and MRI |
| _____ is a symptom of other things. | Coma |
| What common condition we deal with every day will produce a coma? | Hypoglycemia |
| What is one of the first things that you should do if a patient is unresponsive? | Do a blood sugar on them and you will know if you are dealing with a coma or not. |
| This state involves both arousal or wakefulness and awareness? | consciousness |
| What are the metabolic and toxic conditions that could cause a coma? | Cardiopulmonary decompensation, poisoning and alcohol, hypertensive encephalopathy and acute HTN crisis,meningitis, and other metabolic disturbances. |
| What structural lesions could cause a coma? | Vascular lesions, trauma, brain tumors and brain abscesses. |
| What is the biggest metabolic or toxic condition that can cause a coma? Why? | Cardiopulmonary decompensation. If have a patient that has cardiomyopathy and has a low ejection fraction and they are not pumping blood to that brain, the patient will become comatose. |
| What type of poisoning is common in causing a coma? | Lead poisoning because lead goes straight to the brain. |
| _____ ______ poisoning patients present in a comatose state. | Acute alcohol |
| To be fully conscious you need to be _____ and _____. | Awake and aware |
| Why is the reticular activating system so important? | It is a bundle of fibers that runs all the way up your spinal cord to your hypothalmus. This system is what causes medication and anesthesia to work. |
| The _______ is the relay center for the brain. | hypothalmus |
| Common dysfunctions that cause coma are: | Dysfunctions of the reticular activating system, cerebral hemisphere, midbrain or pons, or occurrence of ischemia, hypoxia, infection, and metabolic exposure. |
| How is the pathophysiologic continuum of coma comparable with the stages of anesthesia? | It can be light, deep, and you can go from a patient fixed and dialated to someone like Terry Schiavo who is in a chair and appears to be looking around, smiling, gritting her teeth, and moving arms and legs, but none of it is in response to anything. |
| An immature nervous system is similar to a _____ ______ _______. | Decompensating (insulted) nervous system |
| What are the things we will see in a patient who is comatose? What could these indicate? | Changes in LOC; breathing patterns, pupillary responses, ocular positioning and reflexes; motor responses. These could help the physician in locating where the problem is. |
| What is the most critical index of CNS dysfunction? | Level of consciousness |
| What may LOC indicate in a patient? | Improvement or deterioriation; confusion; disorientation; lethargy; obtundation; stupor; coma |
| It is important to be sure to itercede as soon as possible when a patient begins to have a dysfunction of the CNS. How do we know to do this? | By assessing LOC. |
| When describing the patient's pattern of breathing what should we include in our description? | Rate, Rhythm, and Pattern |
| Your brainstem area controls _______ and the pupils. | arousals |
| _______ changes are a valuable guide to the present level of brainstem dysfunction. | pupillary |
| By the time a patient gets to a dilated pupil they have already lost all the what? | cerbrum and those higher levels of functioning |
| Drugs, ischemia, hypothermia, and history may affect the _______ | pupils |
| If there is a change in the patients pupils what should you do as a nurse? | Go back and see what has changed with that patient. Has there been a medication change, is the patient ischemic or hypothermic. |
| A condition when the eyes jiggle. | Nystagmus |
| A brain stem stroke can cause what condition? | nystagmus |
| What do we look for when assessing oculomotor responses? | Eye position, eye movements, and oculomotor responses to stimuli. |
| What are motor responses used for in a patient with a possible neuro problem? | They are used to assess the level of response to stimuli. |
| If checking for motor responses, we should be sure to place the limb in a _____ _______. | Neutral position |
| What is the goal of medical management of the patient in a coma? | Identifying and treatment of the underlying cause of the condition. |
| How do we perform medical management of the patient in a coma? | Support the vital functions and prevent further neurologic deterioration. |
| How do we prevent further neurologic deterioration in a patient in a coma? | Watching things like oxygenation and perfusion. |
| What would chronic care of a patient in a coma entail? | Prevention and treatment of chronic problems such as UTI's, pneumonias, and sepsis. |
| What are the nursing priorities for a patient in a coma? | Assessing for changes in neurologic status; supporting all bodily functions; prevention of complications; providing psychosocial and informational support to the family; initiating rehabilitation measures. |
| How do we assess for changes in neurologic status in a comatose patient? | You do that by knowing where the patient is starting out at. You do the same neurological status check that you would do on anyone else, but you are going to expect different results. |
| Memories that are being processed by a patient the comes out of a coma end or stop when? | Up to when they went into the coma. |
| Why is it important to provide psychosocial and informational support to the family? | It is a hard situation for the family and it is not up to us to decide what the outcome is. |
| What is the main action in oxygenation of the patient in a coma? | Maintaining a patent airway and ventilation. |
| What will we assess in working to maintain a patent airway and ventilation in the patient in a coma? | Assess rate, depth, and rhythm of respirations; |
| How types of things would we plan for maintaining the patent airway and ventilation in the patient in a coma? | Plan how to position in bed, oxygen, PT? |
| What interventions are we going to perform when working to maintain a patent airway in the patient in a coma? | Monitor ABG's; suctioning PRN no longer than seconds; plan patient activities; maintan normothermia. |
| What would we do as nurses in preventing impaired tissue integrity in the patient in a coma? | Promote optimal respiratory function; auscultate lung fields q2-4 hrs; turn off tube feedin when lying patient flat. |
| How do we promote optimal respiratory function in a patient who is in a coma? | vary position of the bed, turn and reposition patient, and chest physical therapy. |
| What is the cause of altered nutrition in the patient who is in a coma? | an insulted nervous system causes this |
| In preventing altered nutrition in the patient who is in a coma, what do we assess? | Hydration and nutrition assessments focusing on altered oral mucous membranes, skin turgor, intake and output, swallow studies, PEG tube. |
| A damaged hypothalmus causes the coma patient to _______. | sweat |
| How do we prevent aspiration in patients who are in a coma? | Suction PRN, safe tube feedings, monitor for residual q4 hrs, monitor for abdominal distention, turn feeding off when lowering the patients HOB. |
| What do we need to be sure we are doing when giving the coma patient tube feedings? | Elevate HOB 45 degrees, if HOB lowered, hold the feedings, check the placement before initiating the feedings. |
| If someone in a coma, alzheimers or other medical conditions drools, the are at a risk for? | aspiration |
| What do we do to care for the coma patient with altered patterns of urinary and bowel elimination? | Give adequate fluid intake, maintain urine pH below 6.0, give foods or formula high in calcium and oxalate, provide bowel maintenance. |
| What things do we do to provide bowel maintenance to patients in a coma? | Provide fluids, nutrition, suppositories, and medications. |
| Patients in a coma are at risk for a developing a ______ because of the use of a _____. | UTI, foley or diaper |
| What is the goal of activity and exercise in the patient who is in a coma? | To maintan limb mobility and prevent contractures. |
| Why do we not do rectal stimulation or disimpactions anymore? | Because of the vagal nerve response. |
| How do we maintain limb mobility and prevent contractures in the patient in a coma? | Perform ROM exercises, support extremity with pillows, consult with PT/OT, turn and reposition patient q 2 hrs, maintain good alignment, use footboard or tennis shoes. |
| What can be done to prevent pressure ulcers on the patient who is in a coma? | Reposition q 2 hrs, prevent shearing force, specialized beds or mattress, meticulous skin care, massage nonreddened or vulnerable areas, skin care consult adequate nutritional support, assitive devices. |
| What actions can we as a nurse perform in order to promote factors that improve venous blood flow? | Elevate extremities PRN, use antiembolic stockings and or devices, avoid leg crossing, turn and reposition q 2 hrs, and use of lovenox. |
| Why do the doctors use lovenox? | Because lovenox has less side effects, easy to administer, and it generally does a good job. |
| What is the lab test that needs to be done if a patient is on Lovenox? Why? | Platelets because it is a low molecular heparin product. |
| What is the antedote for Lovenox? | Protamine Sulfate |
| What are the signs of a DVT? | Redness, swelling and pain. |
| How do we reduce an monitor bone demineralization in the patient in a coma? | Monitor for hypercalcemia, use a tilt table and provide adequate hydration. |
| How do we monitor for hypercalcemia in the patient in a coma? | Serum levels, nausea/vomiting, polydipsia, polyuria, and lethargy. |
| What is the purpose of temperature maintenance in the patient in a coma? | Reducing cerebral metabolic rate. |
| A normal response in the person in a coma with temperature maintenance is | Fluctuation in temperature r/t neurological insult. |
| When you have a temperature, you increase the metabolic rate of your | brain tissue |
| Where is the body's temperature center? | hypothalmus |
| What kind of medications might be administered to help the comatose patient to maintain temperature. | Sedatives, barbiturates, or paralyzing agents. |
| Why are comatose patients at risk for injury or falls? | Not because they are getting up out of bed, but instead because we are moving them an repositioning them. |
| Most medications work off an intact nervous system, so a patient in a ____ may have different responses to the meds they are receiving. | coma |
| Why would padded side rails be used in the patient in a coma? | To protect them if they tend to thrash about in the bed. |
| It is ok to talk with the patient to promote love and belonging and psychosocial well being as long as there is no | ICP |
| Elevated temperature will do what to the heart rate? | It will elevate it. |
| You need an intact nervous system to move _____ around. | blood |
| Neurovascular tone loss will cause a _____ in BP and a ____ in heartrate. | decrease, increase |
| What is likely to happen to the patient who has a sustained What is likely to happen to the patient with a sustained HR above 120 bpm? | death |
Created by:
4th semester jjc
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