Definition of Coma:
Coma is a state of prolonged unconsciousness that can be caused by a variety of problems traumatic head injury, stroke, brain tumor, drug or alcohol intoxication, or even an underlying illness, such as diabetes or an infection. This article will present the main causes and nursing management of coma or comatose patient.
Causes of Coma:
A. Metabolic disturbance:
a) Drug overdose /Poisoning
- Hypoglycaemia,
- Ketoacidosis,
- Hyperosmolar coma.
c) Hyponatraemia / Electrolytes imbalance
d) Uraemia
e) Hepatic failure/ Hepatic encephalopathy.
f) Respiratory failure
g) Hypothermia
B. Trauma: Head injury
a) Cerebral contusion
b) Extradural haematoma
c) Subdural haematoma
C. Cerebrovascular disease (CVD/stroke):
a) Subarachnoid haemorrhage
b) Intracerebral haemorrhage
c) Brain-stem infarction/haemorrhage
d) Cerebral venous sinus thrombosis
D. Infections :
a) Meningitis
b) Encephalitis
c) Cerebral abscess
d) General sepsis.
E. Others:
a) Cerebral malaria.
b) Epilepsy
c) Brain tumour
d) Thiamin deficiency.
Nursing Management of Coma or Comatose Patient:
Nursing Assessment:
- Evaluation of mental status.
- Cranial nerve functioning.
- Reflexes.
- Motor and sensory functioning.
- Glasgow coma scale.
Nursing Diagnosis:
- Ineffective airway clearance related to altered level of consciousness.
- Risk for injury related to decreased level of consciousness.
- Risk for impaired skin integrity related to immobility.
- Impaired urinary elimination related to impairment in sensing and control.
- Disturbed sensory perception related to neurologic impairment.
- Interrupted family process related to health crisis.
- Risk for impaired nutritional status.
Nursing Intervention:
1. Maintaining patent airway:
- Elevating the head end of the bed to 30 degree prevents aspiration,
- Positioning the patient in lateral or semi prone position,
- Suctioning,
- Chest physiotherapy,
- Auscultate in every & hours,
- Endo tracheal tube or tracheostomy.
2. Protecting the client:
- Padded side rails,
- Restrains,
- Take care to avoid any injury,
- Talk with the client in-between the procedures,
- Speak positively to enhance the self-esteem and confidence of the patient.
3. Maintaining fluid balance and managing nutritional needs:
- Assess the hydration status,
- More amount of liquid,
- Start IV line,
- Liquid diet,
- NG tube.
4. Maintaining skin integrity:
- Regular changing in position,
- Passive exercises,
- Back massage,
- Use splints or foam boots to prevent foot drop,
- Special beds to prevent pressure on bony prominences.
5. Preventing urinary retention:
- Palpate for a full bladder,
- Insert an indwelling catheter,
- Condom catheter for male and absorbent pads for females in case of incontinence,
- Inducing stimulation to urinate.
6. Providing sensory stimulation:
- Provided at proper time to avoid sensory deprivation.
- Efforts are made to maintain the sense of daily rhythm by keeping the usual day and night patterns for activity and sleep.
- Maintain the same schedule each day.
- Orient the client to the day, date, and time accordingly.
- Touch and talk.
- Proper communication.
- Always address the client by name, and explain the procedure each time.
Maria Khatun Mona is a Founder and Editor of Nursing Exercise Blog. She is a Nursing and Midwifery Expert. Currently she is working as a Registered Nurse at Evercare Hospital, Dhaka, Bangladesh. She has great passion in writing different articles on Nursing and Midwifery. Mail her at “maria.mona023@gmail.com”