2.  Consciousness refers to the normal level of wakefulness which is dependent upon the interaction of a functioning cerebral cortex and an intact reticular activating system.

3.  1) Orientation to time, place, and person  2) Alert and awake  3) Awareness to the environment  4) Ability to answer questions appropriately  5) Intact recent and remote memory

4.  Confusion: Loss of the means to think clearly and quickly. Impaired judgement and decision making.  Disorientation: Disorientation to time or place. Impaired memory. Lack of recognition of self. Lethargy Restricted unprompted speech or movement. Easy to arouse by normal speech or touch. Potential disorientation to time, place or person.

5.  Obtundation:  Mild to modest reduction in arousal  Clouding of consciousness.  Constrained responsiveness to surroundings.  Ability to fall asleep easily.  Ability to reply to questions with minimum response.  Stupor:  An excessively long sleep-like state.  A state of deep sleep or unresponsiveness.  Arousable to verbal response only and to vigorous and repeated stimulation, for example, shouting or shaking.  Withdrawal or grabbing response to stimulation.

6.  Coma :  A state of complete unresponsiveness.  Lack of motor or verbal responses to external surroundings or to any stimuli.  No response to noxious stimuli for example, deep pain.  The person cannot be aroused at all by any stimulus.

7.  Seizure  Cerebrovascular causes  Tumour  Cardiac arrest  Heart or lung disease  Asphyxiation  Alcohol  Carbon monoxide  Drugs  Infections

8.  Normal conscious behaviour is dependent on an intact and fully functioning brain  RAS is responsible for arousal from sleep and maintaining consciousness.  RAS includes the mesencephalon (upper pons and mid-brain) and the thalamus  The RAS receives input signals from the senses  Disorders that affect any part of the RAS can produce coma.

10.  Direct compression or destruction of the structures  Decrease in availability of oxygen or glucose  Toxic effects of substances on the structures of the RAS UNCONSCIOUSNESS

11.  Assessment  identification of major etiological factors  history,  neurologic examination,  identification of related signs and symptoms and  significant diagnostic tests

12. Eye response  1.No eye opening  2.Eye opening in response to pain  3.Eye opening to speech  4.Eyes opening spontaneously

13. Motor response  1.No motor response  2.Extension to pain  3.Abnormal flexion to pain  4.Flexion/Withdrawal to pain  5.Localizes to pain.  6.Obeys commands

14. Verbal response  1.No verbal response  2.Incomprehensible sounds  3.Inappropriate words  4.Confused  5.Oriented

15.  Alert: this refers to spontaneous eye- opening, speaking and intact motor functions, for example, able to move limbs  Voice: responds when spoken to. The response may be the spoken word (speech) or a grunt  Pain: responds to pain, for example, the sternal rub  Unresponsive: if no response to pain, such as no eye, voice or motor movement

16.  Ineffective airway clearance  Impaired gas exchange  Alteration in tissue perfusion, cerebral  Sensory perceptual alterations  Alteration in nutrition less than body requirements  Alteration in bowel elimination  Alteration in patterns of urinary elimination  Self care deficit: feeding, bathing, dressing, toileting  Impaired physical mobility  Potential for impaired skin integrity

17.  Assess respiratory status, oral cavity, and oxygen saturation  Oropharyngeal airways  Oxygen therapy  Chest PT  Lateral recumbent position  Suctioning  ET tube insertion and mechanical ventilation

18.  Monitor pulse, B.P  Passive limb movements  I/O chart  Antiembolic stockings  Anticoagulants as ordered

19.  Monitor S. electrolytes  Maintain I/O chart  Monitor urine protein  Sliding scale insulin  Enteral feeding  Parenteral feeding and IVF

20.  Maintain adequate hydration  Monitor bowel pattern, bowel sounds  Maintain I/O chart  Administer laxatives as ordered

21.  Monitor urine out put  Adequate fluid intake  Urinary catheter  Catheter care

22.  Assess skin colour, turgor, and integrity  Change position frequently  Use pressure relieving matresses  Ensure that skin is dry after bed bath  Cut nails short  Oral hygiene  Eye care

23.  Positioning  Maintain body alignment  Lateral recumbent position  Position feet at 90° to the leg  Communication  Reassure the patient  Explain all the procedures  Talk to the patient