? ? coma

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? ?coma

• ??
• 2006-4-20

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Definition

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????????disturbance of consciousness

• ???????????????
• ??somnolence ?????????,?????????,???????????,????
  ??
• ????confusion ????????????????????,????,?????????
  ??????????
• ??stupor ????????,?????????????????????
• ??coma??????????

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Summary

• Disturbance of consciousness is impediment(??)
• of having an awareness of ones environment
• and ones own existence,sensations and
• thoughts.
• According to the degree of disturbance of
  consciousness, it can be divided somnolence,
  confusion, stupor,coma.

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What is Coma and Persistent Vegetative State?

• A coma is a profound or deep state of
  unconsciousness. An individual in a state of coma
  is alive but unable to move or respond to his
  environment. Coma may occur as a complication of
  an underlying illness, or as a result of
  injuries, such as head trauma.

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• A persistent vegetative state ( brain-death)
  sometimes follows a coma. Individuals in such a
  state have lost their thinking abilities and
  awareness of their surroundings, but retain
  non-cognitive function and normal sleep patterns.
  Even though those in a persistent vegetative
  state lose their higher brain functions, other
  key functions such as breathing and circulation
  remain relatively intact. Spontaneous movements
  may occur, and the eyes may open in response to
  external stimuli. They may even occasionally
  grimace(?????), cry, or laugh.

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Etiology

• 1.???? cerebral disease
• (1)???????? (meningitis) ?
• (2)????????????????????????????????
• 2.????? general disease
• (1)???????
• (2)????????
• (3)????????
• (4)?????
• (5)?????

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Assessment

• History collection
• The degree of disturbance of consciousness
• Vital signs
• Laboratory examination
• Differentiate diagnosis

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History collection

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The degree of disturbance of consciousness???????
??

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The degree of disturbance of consciousness

• ???????????(P187)

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Vital signs

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• P????????????
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• R?????????????????
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Vital signs

• BP????????????
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• Pupil
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• eyeground????????

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Vital signs

• Meningeal signs?????????????
• skin??????
• ???????????
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• mobility???????????
• reflection?????????????????

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Laboratory examination

• routineblood?urine?stool
• specialECG?X??B?

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Differentiate diagnosis

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Is there any treatment?

• Once an individual is out of immediate danger,
  the medical care team focuses on preventing
  infections and maintaining a healthy physical
  state. This will often include preventing
  pneumonia and bedsores(??) and providing balanced
  nutrition.
• Physical therapy may also be used to prevent
  contractures(??)(permanent muscular contractions)
  and deformities (??)of the bones, joints, and
  muscles that would limit recovery for those who
  emerge from coma.

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Nursing

• observation
• 1. ??????1530??????????
• 2. ??????4????
• Keep airway open
• Keep balance of water/electrolytes/acid-basse

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Nursing

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Nursing

• Etiology treatment
• 1. ??????
• 2. ???
• 3. ????
• 4. ???????????
• 5. ?????????
• 6. ?????????????
• 7. ???
• 8. ????

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Nursing

• Preventing complications
• 1. ????
• 2. ???????
• 3. ????
• 4. ?????????

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What is the prognosis?

• The outcome for coma and persistent vegetative
  state depends on the cause, severity, and site of
  neurological damage. Individuals may emerge from
  coma with a combination of physical,
  intellectual, and psychological difficulties that
  need special attention.

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• Recovery usually occurs gradually, with some
  acquiring more and more ability to respond. Some
  individuals never progress beyond very basic
  responses, but many recover full awareness.
  Individuals recovering from coma require close
  medical supervision. A coma rarely lasts more
  than 2 to 4 weeks. Some patients may regain a
  degree of awareness after persistent vegetative
  state. Others may remain in that state for years
  or even decades. The most common cause of death
  for someone in a persistent vegetative state is
  infection, such as pneumonia.

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