Altered level of consciousness

altered level of consciousness is not a disorder but a symptom of a particular disorder

Coma-a clinical state of unarousability and unresponsiveness to any internal or external stimuli, it can last for days, weeks, months or years

CAUSES include neurologic (brain injury, stroke), metabolic (DKA, renal failure), toxicologic (drug overdose, alcohol intoxication)

PATHOPHYSIOLOGY:
because of causes there will be a disruption of the cells of the nervous system that will cause a faulty impulse transmission that will result to ALOC

SIGNS AND SYMPTOMS
-there will be an alteration in pupillary response (negative PERLA- pupils are equal, regular, round in shape, and reactive to light and accommodation). the pupils will be fixed and dilated.
-alteration in eye opening response, verbal response, motor response, and behavioral response.

DIAGNOSIS
It can be diagnosis by using glascow coma scale and by complete assesssment of the nervous system

*if the comatose patient has an abnormal pupillary response the cause is neurologic
visualization procedures include x-ray, CT scan and MRI

*if the comatose patient has a normal pupillary response the cause metabolic or toxicologic
Liver function test include:
SGPT- SERUM GLUTAMIC PYRUVIC TRANSAMINASE
ALT-ALANINE AMINO TRANSFERASE
SGOT - SERUM GLUTAMIC OXALOACETIC TRANSAMINASE
AST - ASPARTASE AMINO TRANSFERASE
RENAL FUNCTION TESTS: BUN AND CREA
BLOOD TEST
DRUG TEST
ABG - ARTERIAL BLOOD GAS

MANAGEMENT
-maintain patent airway
level 2 and 3 - position the patient semi fowlers
level 4 - mechanical ventilation and intubation
-protect the patient- raise the padded side rails
-maintain fluid and nutritional balance- hydration, IV therapy, ngt, ogt, tpn, ppn
-provide oral and skin care - wet cottonballs, turn patient side to side and stretch the linen
-maintain normal body temperature
-maintain corneal integrity - administer artificial tears as prescribed, aplly eye patches
-maintain bowel and bladder integrity
-manage complications (pneumonia, aspiration, pressure ulcer, respiratory difficulties)