Precautions when caring for patient with levels of consciousness

A person, even when unconscious, is still prone to injuries and accidents. Therefore, nursing or home care would still involve adding safety precautions to the care plan.

Due to client’s altered level of consciousness, he or she is usually restricted to lying in bed therefore our first safety precaution would be putting up the side rails on both sides, to prevent any falls. These should be padded, of course to prevent any skin injury or falls.

The nurse or significant other should also watch out for any potential injuring agents, such as invasive lines and equipments. Sharps and any heavy objects should be put away to prevent them from serious injuries.

Materials used for safety precautions should also be checked: side rails, restraints, etc. if there are any, the nurse should always check if the dressings are too tight or already damp, soiled or damp bedding, environmental irritants, and tubes and drains used for the patient.

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We should also apply universal safety precautions, which is mainly on the transmission of diseases or microorganisms. People who interact with the patient (including us) should always maintain an aseptic technique. Proper hand washing, wearing masks and other protective equipment can protect us and the patient as well. Keeping bed sheets, linens, and clothes dry can prevent harbouring of microorganisms. Remind the significant others on this precaution to prevent them from giving the client any diseases.

Injury includes perforation of the skin, so we nurses must take care of skin integrity as well, also to prevent infection. Skin care through proper bed bathing (unless contraindicated), oral care and positioning can prevent injury.

Keeping any materials that can obstruct the patient’s airway can also be a safety precaution.

When positioning or turning, and performing interventions on the patient, be sure to practice proper precautions stated above to prevent injuries, falls, and accidents.

Lastly, protection of client involves protecting their dignity as well. Protection needs to be holistic in nature as well, as applied in every care plan carried by a nurse. When caring for the patient, nurses should treat him or her as a fully conscious patient and as a person. Simple gestures such as maintaining privacy and talking to him or her during visits, preserves the patient’s dignity. It also involves not speaking negatively on his or her condition or prognosis, since the client may still hear even when unconscious.

2. Develop a matrix identifying early and late signs of increased intracranial pressure.

↑Intracranial Pressure

Expanding of Intracranial lesion

Compression of brain

Pupillary changes

Sudden change in condition

Change in LOC

Early stages

Slowing of speech, delaying of response to verbal stimuli

Restlessness (without apparent cause), confusion, increasing drowsiness

Opposite of PERRLA

Further ↑in ICP, further compression

Alterations in LOC

Respiratory and Vasomotor changes

Stupor

Cushing’s Triad

Reaction to only loud and painful stimuli

Projectile Vomiting

Late stages

Coma

further aggregation of

Decerebration

Cheyne – Stokes Respiration

Decortication

Fixed pupillary dilation

Flaccidity

DEATH

WEB ASSIGNMENTS

Using the Internet, find a case study of a patient having generalized seizures. What type of treatment was effective? Explain your findings.

In this case study, the patient arrived in the ER who was inflicted with TBI, experienced generalized seizures during the emergent Computed Tomography. Management done with this patient was given Lorazepam (Ativan) and a phenytoin (Dilantin) bolus, in order to control the patient’s seizures.

The patient’s TBI caused him to have impending cerebral herniation due to changes in the cranial ICP. Cerebral oxygen demands were greatly increasing, therefore one of the nursing considerations included management of the variables that affected these demands. One of them were seizures, in which was effectively managed through the administration of 4 mg of IV lorazepam over 2-5 minutes (may be repeated every 10-15 minutes as needed to a maximum dose of 8 mg). Lorazepam, a benzodiazepine, was known to cause respiratory depression and hypotension so the patient was intubated and his BP tolerated the medication.

During seizures, nurses’ role were mostly on recording the events of the cycle, as well as keeping the patient safe. After the cycle, patients were usually given anti seizure medications such as Lorazepam and Phenytoin to prevent any more occurrences of seizures. This was an important factor for the patient’s case since it would greatly aggregate his condition if he had again experienced seizures while in a critical state.

Research an article regarding a new treatment for migraine headaches. Summarize the findings.

Migraine is a debilitating condition which is characterized by moderate to severe cephalgia. This can be triggered by menstrual cycles, stress, depression, bright lights, sleep deprivation, fatigue, drug overuse, and certain food products. This causes great discomfort on a person because of its pain cycles, usually manifested by one-sided pain which is pulsating in nature. It may be classified as acute or chronic.

Medical treatment for this is usually antimigraine agents called the ‘triptans’, which are serotonin receptor agonists.

Migraine has been considered a debilitating and troublesome condition for people, causing numerous studies and research to be done for treatment of this condition. Here are a few of the numerous treatments done regarding the treatment of migraine:

CAMBIA (Diclofenac Potassium For Oral Solution), is a new drug for treatment of acute migraine. It has been approved by FDA in the US last 2009. This is an NSAID which addresses acute migraine attacks, relieving its symptoms quickly. It is contraindicated, however, for those with tension and cluster migraines (different types of migraines), hypertension, asthma, and pregnant women.

BOTOX® (onabotulinumtoxinA), is also another drug approved by the FDA last October 2010, for prophylactic treatment of headaches in adults with chronic migraine. Chronic migraine is characterized by headaches that occur for 15 days or more per month, 4 hours or longer a day. In this study, they have found that when injected with BOTOX neurotoxin, chronic migraine sufferers have decreased bouts of headache lasting for up to 3 months. Treatment is usually on administration of 31 BOTOX neurotoxin injections, into 7 specific head and neck sites with a total of 155U per treatment session.

There are treatments too, that does not mainly focus on medications:

Psychological migraine treatment, a study conducted by Elizabeth Seng and Dr. Kenneth Holroyd from Ohio University in the US, is very helpful especially for those with chronic migraines. They made an experiment with two groups of people: the control group have their migraine treated by medication alone, while the experimental group’s treatment involved medication therapy, and behavioral management. This study has shown that medication therapy with behavioral management greatly helped these patients improve their confidence for effective self-management of migraine. This caused them to gain greater therapeutic effects than those who took medication therapy only. This study has once again proven the fact that treatment should be done holistically, or even just by applying the mere principle of it. In this study, the researchers considered the psychological well-being of the patients as well, and it was proven to be effective.

In another study, it has been noted that a 30 minute massage for those with tension headaches greatly helps the affected person. Favorable results were evident within 24 hours after the massage. This shows that headache can be treated even without acetaminophen drugs.

Another article shows another study conducted by researchers from Medtronic, Inc. wherein they use Occipital Nerve Stimulation to help treat chronic migraine. The study isn’t done yet, though, but according to the researchers, this is a new promising way of treating the said debilitating condition. In the study, thin leads were placed under the skin of the samples near the occipital nerves, which starts from the spinal cord and eventually ending in the brain. These leads were collected to a neurostimulator which relayed controlled impulses to the occipital nerves. This study involves several groups, one of which used the ONS treatment, and another uses medication only.