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Disorders Of Consciousness

WHAT YOU SHOULD KNOW:

  • Disorders of consciousness (KON-shus-nes) are conditions where the state of awareness or wakefulness is disturbed. Consciousness is normally controlled by different parts of the brain. These systems keep a person alert and aware of himself and his environment. Disorders of consciousness may include coma, vegetative state, minimally conscious state, akinetic mutism, and delirium. These may be caused by head trauma or conditions causing a decreased oxygen supply in the brain. Certain medicines, drugs, and alcohol may also have effects on the brain and may affect consciousness.
  • Signs and symptoms will depend on how bad the patient's consciousness is affected. As time passes, the patient may shift from one state of consciousness to another. Other signs and symptoms may also be present pointing to the cause of the condition. A detailed health history of the patient and a complete physical exam is needed to diagnose a disorder of consciousness. Blood tests, urine tests, and different imaging tests may also be needed. Treatment will depend on the cause of the disorder of consciousness. This may include medicines and other measures to support the patient. With treatment and care, further problems may be prevented.

CARE AGREEMENT:

You have the right to help plan your family member's or significant other's care. To help with this plan, you must learn about his health condition and how it may be treated. You can then discuss treatment options with his caregivers. Work with them to decide what care may be used to treat your family member or significant other. You have the right to refuse treatment.

RISKS:

Disorder of consciousness is an emergency situation that may lead to death. Early diagnosis and treatment is very important. Problems causing a disorder of consciousness can affect a person physically, mentally, or emotionally. Long-term problems, such as speaking or trouble moving the arms or legs, may occur. The sooner treatment begins, the better chance the patient has of returning to normal. Talk to caregivers if you have any questions about the patient's condition, medicine, or care.

WHILE YOU ARE HERE:

Informed consent:

You have the right to understand your family member's or significant other's health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat his condition. Caregivers should also tell you about the risks and benefits of each treatment. Since your family member or significant other is unable to give consent, you may be given permission to sign a consent form for him. You may be asked to sign this form that gives caregivers permission to do certain tests, treatments, or procedures. A consent form is a legal piece of paper that tells exactly what will be done to your family member or significant other. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Diet and nutrition:

The patient may be fed by an IV or a nasogastric (NG) tube. An NG tube is put in through the nose and goes down into the stomach. The tube may also go directly from the outside of the body into the stomach. This is called a gastrostomy tube.

Medicines:

The patient may be given any of the following:

  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  • Anticonvulsant medicine: This medicine is given to control seizures. Take this medicine exactly as directed.
  • Blood pressure medicine: This medicine may be given to lower the blood pressure and keep it as close to normal as possible.
  • Other medicines: Other medicines may be given to treat the problem causing the patient's condition. Some may be given to relieve symptoms or prevent further problems from occurring.

Monitoring:

  • Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on the chest or different parts of the body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of the heart. The heart monitor may help caregivers see problems with the way the heart is beating. Do not remove any wires or sticky pads without asking his caregivers first.
  • Neurologic signs: These are also called neuro signs, neuro checks, or neuro status. Caregivers check the eyes, memory, and how easily he wakes up. Hand grasp may also be tested. These help tell caregivers how the brain is working after an injury or illness. Neuro signs may need to be checked often.
  • Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in the blood. A cord with a clip or sticky strip is placed on the ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if more oxygen is needed.
  • Vital signs: These include taking the temperature, blood pressure, pulse (counting his heartbeat), and respirations (counting his breaths). To take the blood pressure, a cuff is put on the arm and tightened. The cuff is attached to a machine which gives the blood pressure reading. Vital signs are taken so caregivers can see how your family member or significant other is doing.

Tests:

  • Blood and urine tests: Different tests, such as sugar check, electrolytes, blood counts, and blood gases may be done. Blood tests to check for the function of different organs, such as the liver and kidneys, may also be done. A sample of the patient's urine may also be sent to the lab for tests. Blood and urine may both be used to look for signs of infection.
  • Electroencephalogram: This test is also called an EEG. Many small pads or metal discs are put on the patient's head. Each has a wire that is hooked to a machine. This machine prints a paper tracing of brain wave activity from different parts of the brain. Caregivers look at the tracing to see how the brain is working.
  • Evoked potential test: These are also called evoked-response test or event-related potential studies. A special machine is used to measure how the nerves and brain react to sound or touch.
  • Imaging tests: Certain tests use a special dye to help the brain and other structures show up better. Tell caregivers if the patient is allergic to iodine or shellfish (lobster, crab, or shrimp) as he may also be allergic to this dye.
    • Chest x-ray: This is a picture of the lungs and heart. Caregivers use it to see how the lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection or collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
    • Computed tomography scan: This is also called a CT scan. A special x-ray machine uses a computer to take pictures of the brain. It may be used to look at bones, brain tissue, and blood vessels. Before taking the pictures, a dye may be given through an IV.
    • Magnetic resonance imaging: This test is called MRI. During the MRI, pictures are taken of the patient's head. An MRI may be used to look at the brain, bones, or blood vessels. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury.
    • Positron emission test: This is also called a PET scan. The test looks at different parts of the body to see how they are working. It can also find tumors.

Treatment options:

Treatment will depend on the cause of the disorder of consciousness. Supportive treatment may be given as needed.

  • Diet and nutrition: The patient may be fed through an IV or a nasogastric (NG) tube. An NG tube is put in through the nose and goes down into the stomach. The tube may also go directly from the outside of the body into the stomach. This is called a gastrostomy tube.
  • Respiratory support:
    • Oxygen: Extra oxygen may be needed to help your family member or significant other breathe easier. It may be given through a plastic mask over the mouth and nose. It may also be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside the nose. Ask caregivers before taking off the oxygen. Never smoke or let anyone else smoke in the same room while the oxygen is on. Doing so may cause a fire.
    • Ventilator: A ventilator is a special machine that can breathe for your family member or significant other if he cannot breathe well on his own. He may have an endotracheal tube (ET tube) in his mouth or nose. A tube called a trach may go into an incision (cut) in the front of his neck. The ET tube or trach is hooked to the ventilator.
  • What a family member or significant other can do to help with care: A family member or significant other may be able to help with positioning, range of motion exercises, skin care, and bowel and bladder care. Ask your family member's or significant other's caregiver for information about what you can do to help with care.

© 2016 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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