The Unconscious Patient - Essay Example

? The Unconscious Patient The Unconscious Patient Qn Causes of unconsciousness Unconsciousness is reported when an individual cannot respond to some stimuli and seems to be asleep, either for a short or long time. In most cases, this condition is brought forward by complications arising from alcohol or drug abuse, injuries, or major illnesses. Though there are many causes, the following can be the most probable in relation to Spenser’s condition: Alcoholism In this case, unconsciousness can be prevalent to any person who has a sense of smell. Extreme levels of drinking can cause unconsciousness, through shutting down some parts of a person’s brain that control his breathing. Just like Spencer takes 4-6 cans of beer in a day, any other individual who takes alcohol at this rate may be at risk of being unconscious Major illnesses Apart from alcoholism and substance abuse, short term unconsciousness may also be experienced in some individuals. This may be caused by low blood sugar levels, dehydration, or momentary low blood pressure. Other causes include coughing very hard, straining at some stage in bowel movement, or very fast breathing; also called hyperventilating. However, as far as Spencer is concerned, unconsciousness may be caused by serious nervous or heart system problems since his history shows he suffers from Acute Coronary Syndrome (ACS). This is a medical emergency that entails chest discomfort or pain as a result of unstable angina or a heart attack. Qn 2. Julia used AVPU as a fast primary assessment followed by Glasgow Coma Scale (GCS) to assess the level of unconsciousness for Spencer’s case. GCS is a frequently used assessment tool if an individual is unconscious, has a head injury, or is in a coma. There are three things that GCS reviews to evaluate the level of unconsciousness. They include verbal response, movement, and eye response. During the assessment, higher scores at fifteen show greater level of consciousness, further indicating that the person was totally awake and therefore aware.  According to Ong, Selladurai BM, Dhillon MK, Atan M, & Lye, MS, 1996, if the scores are as low as three, then this indicates very deep levels of unconsciousness. The scores attained at all areas are summed up to get the total score. In the case study, Spencer had a GCS of 7/15 and did not respond to verbal commands. However, he responded centrally to painful stimuli. This score is usually associated with a state of coma. Research shows that patients with GCS scores between the range of 3 and 8 are often comatose, or are unconscious such that they cannot interact with their immediate environments. From these information, it is clear that the verbal response on the patient failed and thus some stimuli was needed to obtain a response from him. He was therefore not aware of the surroundings. The Trapezium squeeze was used to twist Spencer’s muscle so that Julia could assess his response to painful stimuli (Sternbach, 2000). I would recommend that Julia also try to observe the patient’s motor response by giving some commands such as “lift your legs from the bed”,  so that his weaknesses can be noted. In addition, inconsistent and inaccurate recordings could have a harmful effect on the patient’s comfort and may affect his care plan. I recommend that Julia or any other nurse handling the patient be educated on how to use the tool correctly so that potential irregularities could be addressed. QN.3. deteriorating changes that may occur as a result of the collapse and how the patient will respond to those changes in his GCS status The patient in this context may experience deterioration in his consciousness provided that there is an underlying problem with his brain due to head injury. When the patient loses consciousness, the tongue often fall back in his pharynx and blocks the airway. He loses the cough reflex, and regurgitated stomach contents or blood are aspirated into his lungs. The patient should therefore have his airway supported by slanting the head and lifting his chin as well as placing them into the position of the coma to avoid aspiration (Jennett & Bond, 1975). Patients with a GCS level below 8 are at risk of having difficulties in maintaining their airway. In this sense, they must be saved fully before going to establish the cause. It may include fluid resuscitation, giving supplemental oxygen, and endotracheal intubation. However, such patients may respond by opening their eyes sometimes or groan and extract limbs from painful stimuli. Qn 4. Nursing care to be given to Mr. Spencer a) Problem: alcoholism Intervention: As a nurse, I would give Spencer clear advice to stop or reduce drinking, while at the same time expressing concern about his current alcoholic habit and the health risks related to it. I can also discuss with him the strategies for “low risk” drinking. Rationale: It can encourage Spenser to enter specialized treatment with an aim of abstaining from drinking, thus reduce the risks. b) Problem: Acute Coronary Syndrome (ACS) Intervention: Focus on stabilizing the condition of the patient, easing ischemic pain, and giving antithrombotic therapy Rationale: To reduce myocardial injuries and stop further ischemia. c) Problem: hypertension Intervention: monitoring blood pressure of the patient’s hands and recording the existence of the pulses in the peripheral arteries. I can also check on Spencer’s responses to medications. Rationale: This is to maintain blood pressure within the suitable range. d) Problem: hyperlipidaemia Intervention: Combining exercises with a diet that is low in saturated fats as well as motivating and supporting the patient to take nutritional supplements such as oat bran, fish oil, and plant sterols. Rationale: The combination will reduce Low-density lipoprotein cholesterol levels and at the same time increase high-density lipoprotein cholesterol level. e) Problem: Coma Intervention: I would recommend a vigorous sensory stimulation to be administered on the patient. Rationale: To strengthen the recovery procedure using intensive health, controlled sensory stimulation, and nutritional intervention (Littlejohns LR, Bader MK, March K, 2003). Qn 5. Preventing secondary brain injury Factors that can lead to secondary brain injuries include hypercapnia, intracranial hypertension, hypotension, and hypoxia. To prevent these factors, interventions need to begin in the pre-hospital care phase and go on into the critical care unit. Recognizing these factors in the early stages as well as timely intervention can enhance the neurologic effect of the patient with brutal head injuries. One of the oral medications prescribed to treat patients with Diabetes 2 is Glyburide. conventionally used as antiglycemic medication, this drug is meant to block entree to the sulphonylurea receptors, thus effectively drain edema, intracranial pressure, and swelling brought about by secondary brain injury; consequences that can come about in the days after the initial injury. However, research in animals indicate that glyburide is effective in preventing the adverse effects of secondary brain injury, though it works more effectively if the patient takes it prior to the second injury (Downward, Hulka, & Mullins, 2000). A research from a team in the University of Pittsburgh faculty of medicine indicate that treatment with n means that blocks oxidation of an essential part of the mitochondrial membrane hinders the secondary damage of adverse traumatic brain injuries and preserves functions that would have been impaired before. The team developed an agent prescribed as XJB-5-131, meant to cross the blood-brain blockade and stop the oxidation of cardiolipin. Increased Intracranial Pressure (ICP) mirrors the presence of a huge effect in the brain and is related to a poor outcome in patients with acute neurological injuries. If not dealt with, it negatively impacts the cerebral blood flow as well as cerebral perfusion pressure, may lead to direct compression of important cerebral elements, and most importantly, can cause herniation. Nursing care of a patient with ICP involves the maintenance of an sufficient cerebral perfusion pressure, optimization of the delivery of oxygen, and prevention of intracranial hypertension.  One of the key aspects to be keen on is the positioning of the patient. His head should be positioned midline to promote jugular venous drainage while the head of the bed is raised to approximately 15-30 degrees (Herr, Coyne, and Key, 2006). The method is known to be effective in optimizing CPP and reducing intracranial pressure in adult patients. Adult patients with infections and tumors should be placed in a supine flat position as a result of linear decrease in CBF. QN 6. Medications and dosages Mr. Spencer may be prescribed for: Hypertension i) Bystolic Oral use Bangalore, S., Kamalakkannan, G., Parkar, S., & Messerli, F, 2007 argue that Bystolic works by preventing some natural substances formed by the body from acting on the blood vessels and the heart, thus in turn reducing blood pressure, reduce strain on the heart, and lowers the pulse. The dosage is based on the patient’s medical condition and his response to treatment. ii) Norvasc Oral Used with or without additional medications to treat high blood pressure. It works through relaxing blood vessels to enable the blood flow more easily. Norvasc is taken by mouth as directed by the doctor, often once per day. Type 2 diabetes i) DPP-4 inhibitors They work by slowing down the DPP-4 enzyme, thus improving the level of active incretin hormones that serve to lower blood glucose levels through increasing insulin secretion and lowering glucagon secretion. Taken twice daily but pregnant or breastfeeding women are not allowed the medication. ii) Meglitinides They lower blood glucose degrees by arousing the pancreas to discharge more insulin. They act quickly and do not last for a long time, and thus one tablet is taken prior to each meal to enable insulin deal with that meal. Hyperlipidaemia i) Statins They are the most commonly prescribed kind of medication for lipid lowering. The patient should take the drugs for four weeks then repeat lipid level tests. ii) Niacin It is the oldest agent used to lower lipid and is proved to lower total mortality and cardiovascular morbidity.A patient should be tested before the starting the therapy, 12 weeks of the initial year followed by every six months. Unstable Angina i) Enoxaparin Patients with unstable angina should be treated for a 14 days in an open label dose. In hospital, they are given 1.25mg/kg of the drug subcutaneously in every 12hours ii) Asprin It slows the clotting action of blood by lowering the clumping of platelets. Aspirin should be taken daily for the number of days prescribed by the doctor depending on the patient’s condition. References Bangalore, S., Kamalakkannan, G., Parkar, S., & Messerli, F. H. (2007). Fixed-dose combinations improve medication compliance: a meta-analysis. The American journal of medicine, 120(8), 713-719. Bullock MR, Povlishock JT. Guidelines for the management of severe head injury. Neurotruama. 1996;13:653 Downward C, Hulka F, Mullins R, et al. Relationship of cerebral perfusion pressure and survival in pediatric brain-injured patients. J Trauma. 2000;49:654-659 Herr, K., Coyne, P. J., Key, T., Manworren, R., McCaffery, M., Merkel, S., ... & Wild, L. (2006). Pain assessment in the nonverbal patient: position statement with clinical practice recommendations. Pain Management Nursing, 7(2), 44-52. Jennett, B., & Bond, M. (1975). Assessment of outcome after severe brain damage: a practical scale. The Lancet, 305(7905), 480-484. Jing Ji, Anthony E Kline, Andrew Amoscato, Hulya Bay?r. Lipidomics identifies cardiolipin oxidation as a mitochondrial target for redox therapy of brain injury. Nature Neuroscience, 2012; DOI: 10.1038/nn.3195 Littlejohns LR, Bader MK, March K. Brain tissue oxygen monitoring in severe brain injury, I: research and usefulness in critical care. Crit Care Nurse. 2003. Luks, A. M., & Swenson, E. R. (2008). Medication and dosage considerations in the prophylaxis and treatment of high-altitude illness. CHEST Journal, 133(3), 744-755. Medana, I. M., Day, N. P., Hien, T. T., Mai, N. T. H., Bethell, D., Phu, N. H., ... & Turner, G. D. (2002). Axonal injury in cerebral malaria. The American journal of pathology, 160(2), 655-666. Ong L, Selladurai BM, Dhillon MK, Atan M, Lye, MS. The prognostic value of the Glasgow Coma Scale, hypoxia and computerized tomography in outcome prediction of pediatric head injury. Pediatric Neurosurg. 1996;24:285-291. Sternbach, G. L. (2000). The Glasgow coma scale. The journal of emergency medicine, 19(1), 67-71. Wijdicks, E. F., Bamlet, W. R., Maramattom, B. V., Manno, E. M., & McClelland, R. L. (2005). Validation of a new coma scale: the FOUR score. Annals of neurology, 58(4), 585-593.         Read More