Definition of Coma
Coma is a state of prolonged unconsciousness in which the patient can’t be aroused (awakened) even with painful stimuli.
Causes of coma:
A. Primary brain lesion:
► Intracranial heamorrhage: traumatic or non-traumatic.
► Intracranial infections: as meningitis, encephalitis, brain abscess.
► Other brain lesions: such as brain tumor, cerebral infarction, status epilepticus.
B. Secondary Brain lesion (encephalopathy):
► Endogenous encephalopathy:
– Coma results from diabetic ketoacidosis, metabolic acidosis, severe dehydration, acute hepatic failure or acute renal failure.
► Exogenous encephalopathy:
Coma due to poisoning.
► Hypoxic encephalopathy:
– Coma results from shock, hypoxia and severe anemia.
Nursing Assessment of Coma:
– Glascow Coma Scale: it consists of 3 assessment parts (eye opening, verbal response, and motor response)
– Numeric values of 1 through 5 are assigned to the level of response in each category.
– The sum of the numeric values provides an objective measure of the child’s level of consciousness (LOC).
– The total score is 15 (4+5+6).
– A child with an unaltered LOC would score the highest 15.
– A score of 8 or below is generally accepted as a definition of coma.
– The lowest score 3 indicates deep coma.
– The lower the score the deeper the coma.
– The nurse must remember that verbal response can not be assessed in intubated and ventilated patients and that eye opening can’t be assessed if the eyes are swollen and closed from trauma.
Diagnostic Tests Of Coma
► Laboratory tests: as blood glucose, urea nitrogen, and electrolyte (PH, Sodium, potassium, chloride, calcium, and bicarbonate), complete blood count, hematocrit, and clotting time, liver function tests, and blood culture.
► Computed tomography (CT) and magnetic resonance imaging (MRI).
► Cerebro-spinal fluid examination.
Nursing care of Child with Coma
► Nursing Diagnosis of Coma
1. High risk for injury related to physical immobility, depressed sensorium, intracranial pathology.
2. High risk for suffocation (aspiration) : ineffective airway clearance related to depressed sensorium, impaired motor function.
3. High risk for impaired skin integrity related to immobility, bodily secretions, invasive procedures.
4. Family (patient) process altered related to a hospitalized child.