Critical Care

1. Holistic Care of Critical and
Unconscious Patient
1/1/2020

2. Outline of the Session
1/1/2020
 Define conscious and unconscious patient
 Define critical patient
 Enlist the common causes of unconsciousness
 State the symptoms of unconscious patient
 Discuss the Holistic nursing management of
unconscious and critical ill patient

3. Introduction
1/1/2020
 Consciousness: Consciousness is a state of being
wakeful and awake of self, environment and time.
 Unconsciousness: It is a state of being un
awakefulness, which occurs when the ability to
maintain a awareness of self and environment is
lost, it involves a complete or near-complete lack of
responsiveness to people and other environmental
stimuli.

4. Contd…
1/1/2020
 Critical: The patient has unstable vitals that are not
normal, and could be unconscious. Indicators for
recovery are unfavorable.

5. Related Condition that leads
Unconciousness
1/1/2020
 Brain tumor
 Brain abscess (rare)
 Cerebral hemorrhage
 Cerebral infraction (large)
 Subdural hematoma
 Metabolic encephalopathy
 Poison, alcohol and drugs
 Fluid, electrolyte or acid-base imbalances
 Infections (encephalitis, meningitis)

6. Symptoms
1/1/2020
 The person will be unresponsive
 Amnesia for events prior to, during, and even after
the period of unconsciousness
 Confusion, Drowsiness, Headache
 Inability to speak or move parts of his or her body
(see stroke symptoms)
 Lightheadedness
 Loss of bowel or bladder control (incontinence)
 Rapid heartbeat (palpitations)

7. Nursing Management
1/1/2020
Assessment:
 Respiratory rate
 Pulse rate
 Blood pressure
 Temperature
 Blood glucose levels
 Oxygen saturation
 Skin condition
 Musculo skeleton system

8. Nursing diagnosis
1/1/2020
 Risk for suffocation related to loss of gag reflex.
 Risk for aspiration related to lack of effective airway
clearance.
 Altered oral mucosa membranes related to mouth
breathing.
 Altered nutrition: less than body requirement related to
inability to eat and swallow.

9. Nursing Diagnosis
1/1/2020
 Fecal incontinence related to inability to respond to
normal cues about evacuation.
 Risk for impaired skin integrity related to immobility.
 Self care deficit related to inability to perform daily
activities.
 Risk for contractures related to disuse.

10. Contd…
1/1/2020
 Risk for fluid volume deficit related to inability to
intake fluid.
 Risk for injury related to lack of responsiveness.
 Altered family process related to uncertain future or
impending death.

11. Management of Airway and Breathing
1/1/2020
 Proper positioning
• Head should be elevated (30-45degree) in the case of
head injury but contraindicated in spinal cord injury.
 Suction the mouth, pharynx, and trachea as often as
necessary to prevent aspiration of secretions.
 Administer oxygen as ordered.

12. This lateral recumbent position is often referred
to as the "coma position."
1/1/2020

13. Assessment of level of consciousness
by GCS
1/1/2020

14. Meeting Nutritional needs
1/1/2020
 A patient who is unconscious or critically is fed and
medicated by gavage/ NG feeding
 Parental feeding: Total parental nutrition for critical
patient.
 Fluids are maintained by IV therapy.
Provide diet as prescribed by
dietician
• Renal diet
• Low sodium

15. Contd…
1/1/2020
 Keep accurate records of IV intake and urine
output. Observe the patient for signs of
dehydration or fluid overload.
 Keep accurate records of all intakes (Feeding
formula, water, liquid medications).

16. Contd…
 While feeding place the
patient in a sitting
position (Fowler’s or
semi-Fowlers) and
support with pillows.
 This permits gravity to
help move the feeding or
medication which
reduces aspiration of
feeding into the airway.
1/1/2020

17. Positioning
1/1/2020
 Particular attention to maintaining proper body
alignment.
 Limbs must be supported in a position of function.
Do not allow flaccid limbs to rest unsupported.
 When turning the patient, maintain alignment and
do not allow the arms to be caught under the torso.

18. Contd…
1/1/2020
 Change the patient's position to a new weight-
bearing surface every two hours on well nourish.
 For malnourish and old people 1 hourly.
 Also during the position change care should be
taken to minimize the friction.

19. Skin care
1/1/2020
 Observe the skin for evidence of skin breakdown.
 Change the patient’s position at least every two hours
and provide back care.
 The patient should be given a complete bath every
other day. (This prevents drying of the skin.)
 The patient's face and perineal area should be bathed
daily.

20. Provide more care
and attention to the
more pressurized
area
1/1/2020

21. Contd…
1/1/2020
 The skin should be lubricated with moisturizing
lotion after bathing.
 The nails should be kept short, as many patients
will scratch themselves.
 Change the bed linen if damp or soiled

22. Contd…
 Use the static support
device such as high
density foam air or
liquid mattress which
helps to distribute the
pressure and reduce
pressure ulcer.
1/1/2020

23. Oral Care
1/1/2020
 The unconscious patient is often a mouth breather.
This causes saliva to dry and adhere to the mouth and
tooth surfaces.
 Provide oral hygiene at least twice per shift.
 Always have suction apparatus immediately available
when giving mouth care to the unconscious patient.

24. Contd…
1/1/2020
 Apply glycerine to the lips to prevent drying.
 Keep the nostrils free of crusted secretions.
Prevent drying with a light coat of lotion, or
water-soluble lubricant.

25. Eye Care
1/1/2020
 Carry out eye care because the blink reflex is absent
during unconsciousness/ critical patient. This may
lead to corneal drying, irritation and ulceration.
 Check the eyes frequently for signs of irritation or
infection.
 Artificial tears may be ordered for instillation at
frequent intervals to prevent irritation.

26. Care of Bowel and Bladder
1/1/2020
 The bowel should be evacuated regularly to prevent
constipation.
 Keep accurate record of bowel movements. Note
time, amount, color, and consistency.
 Stool softener may be ordered by the physician to
prevent constipation or impaction. It is generally
administered once per day.

27. Contd…
1/1/2020
 The bladder should be emptied regularly to prevent
infection or stone formation.
 Adequate fluids should be given to prevent
dehydration.
 Keep accurate intake and output records.
 Provide catheter care at least once per shift to
prevent infection in catheterized patients. If
incontience then wash each voiding.
 If intermittent catheter is used then check sensation
timely.

28. Maintain Activity and Mobility to Reduce
Disuse Syndrome
1/1/2020
 Provide passive range of motion Exercise the
affected extremities passively through range of
motion four to five times daily to maintain joint
mobility and enhance circulation to prevent
contracture.

29. Contd…
1/1/2020
Utilize a foot board at the end of the bed to decrease
the possibility of foot drop.
Use heel protecter to prevent
sore and foot drop.

30. Safety and Security Needs
1/1/2020
 Use restraints only with physician's order.
 Use "mitten" restraints to prevent the patient from
pulling at catheters, IV lines, his hair, and so on.
(Patients not in deep coma may scratch or pick at
themselves.)

31. Contd…
1/1/2020
 The restless, confused patient will actively
resist restraint but some freedom of movement
of the arms and legs.
 Take precautions to prevent restraint from
becoming restricting. Do not cut-off
circulation. Do not irritate the skin.

32. Contd…
1/1/2020
 Protect the patient from injury.
 Keep side rails up.
 Pad the rails with pillows or folded blankets.
 Keep stray objects out of the bed.
 Use draw sheets for easier turning.
 Keep suction equipment available at the bedside for
emergencies.

33. Communication
1/1/2020
 Hearing is the last sense to go when a person
becomes unconscious.
 Orient the client to self, situation, place, and time.
 Address the client by name and explain all
procedures prior to implementation.

34. Contd…
1/1/2020
 Use touch deliberately.
 Actively listen to significant others.
 Encourage significant others to talk to and
touch the client often.

35. Contd…
1/1/2020
 Speak slowly, using visual cues and gestures; be
consistent and repeat as necessary.
 Treat the client with the same respect and dignity you
display to all clients.
 Do speech therapy after the progress.
 Initiate referral to speech therapist for individuals with
compromised LOC, dyspraxic speech, or speech
difficulties

36. Psychological Support and Respect
Their Culture
1/1/2020
 Though the patient is unable to perceive we should
provide with due respect to his or her dignity.
 Provide care with due respect to his or her culture.
 Communicate with the patient while providing the
care.

37. Strengthening Family Coping
1/1/2020
 Reassure and provide the counseling patient
visitors.
 Encourage the family to maintain outside interests.
 Teach stress management techniques, such as
relaxation exercises, use of community and faith-
based support networks.

38. Contd…
1/1/2020
 Encourage participation in support group for
family respite program for caregivers, or other
available resources in area.
 Involve as many family and friends in care as
possible.
 Provide information about disease condition of the
patient

39. Seven Cs of Care of Terminally Ill patient
Concern : Compassion, worth, tender and involvement.
Competence: Skill and knowledge about illness
management eg pain, nausea, shortness of breath,
insomnia.
Communication: allowing patient to speak
Children: Allowing children to visit patient , brings
consolation.
Cohesion: Family cohesion
Cheerfulness: Gentle and appropriate sense of human.
 Humor can be palliative.
Consistency: Continuing, persistent attention and
involvement till the end.

40. 1/1/2020
Thank you