State of consciousness

In the patient may develop varying degrees of disorders of consciousness that manifests his/her oppression (catatonic, soporific state, coma) or initiation CNS (delusions, hallucinations).

Clear conscience it is a complete safety consciousness, active waking, literal perception of oneself and the environment. The patient fully understands the environment, clear answers to the asked questions.

Catatony (moderate stun) -partial depression of consciousness. The patient is poorly focus in time and space, but the orientation of self-identification and the surrounding persons saved. Characteristic of high exhaustion, lethargy, slight increase in facial expressions, drowsiness. Motor reaction to pain is active and purposeful. Voice contact retained, hearing speech opens his/her eyes, but answers are slow in monosyllables, sometimes beside the point. Control over the functions of the pelvic organs retained.

Sopon - deep depression of consciousness. The patient is in a state of hibernation: indifferent, eyes closed, voice contact is not possible, commands does not executed, motionless. Only in response to a loud shout or painful impact (injection, pinching, etc) are aimed at their elimination by coordinated movement of limbs, the patient turnes over on the other side, may groan. Possible short-term exit from pathological drowsiness. Control functions of the pelvis broken. Vital functions retained or moderately changed one parameter.

Coma - complete loss of consciousness. The patient no reaction to noxious and sound stimulus, reflexes are absent. Characterized by impairment of respiratory rate and depth, low blood pressure, cardiac rhythm disturbance, impaired thermal regulation. Eyes narrowed, the reaction to light is missing. Coma reflects the severity of the disease, as a result deep in the cortex due to acute circulatory disorders develops in the brain, head injuries, inflammations (with encephalitis, meningitis, malaria), and also as a result of poisoning (barbituates, carbon monoxide, etc.), in case of diabetes, uremia, hepatitis (uremic, hepatic coma).

Delirium is false, not resolve judgment, accompanied by disordered thinking, rambling speech. Can occur in somatic patients with a high temperature of the body (e.g. in infectious diseases), most often with mental disorder. There are muttering and violent delirium. When violent delirium patients are extremely excited, jump out of bed, and in this state can be harmful to both yourself and others. For the care and monitoring of these patients is being organized the individual nursing post.

Hallucinations false perceptions of what there is in reality. Hallucinations are auditory, Visual, olfactory, tactile. When auditory hallucinations patient talks to himself or with imaginary interlocutor. The visual hallucinations patients see what's actually there. Such hallucinations are common in patients with chronic alcoholism. Olfactory hallucinations are accompanied by the patient the feeling of unpleasant smells, change in taste. Tactile hallucinations is a crawling sensation on the skin of insects, microbes, etc.

4. Types of patient's position in the bed

Ø Active position — patient easily and freely self-produced (active) movements based on their needs, moves in bed without third-party assistance, walks. The active position peculiar to patients with relatively mild disease or at the early stages of severe diseases.

Ø Passive position - the patient is motionless, due to sharp weakness cannot change his/her position, could not self-produced movements: the head and the limbs hang over the force of gravity, etc. Appear with unconscious state or in cases of extreme weakness and exhaustion of patients. The patient should be given a position that will help proper breathing and blood circulation.

Ø Forced position - the patient takes the pose to ease his/her condition. A feature of the disease makes a patient to take this position. With meningitis patient is forced to "pose a gun-dog" is on your side with knees bent hip and knee joints feet and thrown back head (fig. 35).

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Picture 35.

Forced position with meningitis

The forced sitting position-orthopnoea often take patients with cardiac decompensation: the patient is sitting on bed, leaning forward, his/her feet are omitted (pic. 36).

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Picture 36.

Orthopneic position with cardiac decompensation

In this position patients breathe easier, because of easy movement of the diaphragm, chest pressure decreases, lung excursion increases, gas exchange improves, there is venous blood outflow from the brain and reduces the number of circulating blood: part of blood lingers in the lower limbs, and the heart and the small circle of blood circulation is being unloaded.

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