Care of the Patient in a Vegetative State

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Care of the Patient in a Vegetative State

• VOCN 265
• Developmental Levels Older Adult
• Content 19-B

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Definitions

• Vegetative State (VS)- paradoxical state of
  wakeful unresponsiveness. Eyes are open but no
  awareness of self or environment.
• Persistent VS- vegetative state continues beyond
  30 days
• Permanent VS- beyond 3 months with anoxia or
  beyond12 months after trauma

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Definition

• Comatose - an abnormal deep stupor occurring in
  or due to illness or injury. A coma is a profound
  or deep state of unconsciousness. The affected
  individual is alive but is not able to react or
  respond to life around him/her.
• Minimal Conscious State fluctuating evidence of
  awareness of self and environment. May say words,
  phrases, gesture, memory, attention, intention

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Causes

• Trauma
• Hypoxia
• Metabolic
• Degenerative Disease

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Prognosis

• Depends on the age, cause, severity, and site of
  neurological damage.
• 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, ex.
  pneumonia.

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Clinical Assessment of VS

• No evidence of awareness of self, others or
  environment
• No evidence of reproducible, purposeful or
  sustained behaviors in response to visual,
  auditory, tactile, or noxious stimuli
• No evidence of comprehending or expressing
  language
• Intermittent wakefulness in correlation to
  sleep-wake cycle.
• Preserved autonomic function to survive medical
  and nursing care
• Bowel and bladder incontinence
• May have some cranial nerve function and spinal
  reflexes

American Academy of Neurology criteria
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Clinical Assessment of VS

• Eyes are open and moving during wake hours BUT no
  visual tracking
• Closed during sleep cycle
• May groan, moan
• Move arms and legs
• Facial expressions
• Smiles, laugh
• Heart rate, blood pressure and respiration
  continue

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Diagnostic Tests

• CT scan (Computed tomography)
  MRI (Magnetic resonance imaging)
• Progressive cerebral cortical atrophy or damage
  (d/t trauma or hypoxic event)
• EEG (Electroencephalogram)
• Show severe background slowing
• Brainwave functioning
• PET (Positron emission tomography)
• Confirms absence of consciousness by
  demonstrating levels of oxygen and glucose
  metabolism in cerebral cortex

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Complications

• Infections
• Pneumonia
• Ulcers
• Contractures
• Aspirations

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Priorities of Care

• Preventing Infection
• Ex. Pneumonia
• Preventing contractures
• Skin Integrity
• Incontinent Care
• Agitation
• Nutrition
• Hydration
• Neuro checks
• Report eye tracking and emotional response

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Intervention

• Preventing Infection
• Oral care
• Positioning
• Aspiration precautions
• Preventing contractures
• ROM exercises
• braces
• Skin Integrity
• Incontinent Care
• Turn q2
• Assessment

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Intervention

• Nutrition
• Type
• Protein
• Calories/weight management
• Hydration
• IO
• Agitation
• LOC
• Changes
• Emotional psych-social
• Patient

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Controversial treatment

• Sensory Stimulation
• Inconclusive evidence for treatment
• Deep brain stimulation
• Implanted electrodes
• Drug Therapy

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• Lets Develop a Nursing Care Plan