A coma is a state of unconsciousness that renders a person unresponsive to any stimulation from his or her environment. Several conditions can lead to coma including stroke, brain injury, diabetes, tumor, swelling of brain tissue, oxygen deprivation, seizures, infection, toxins, drug abuse, and alcohol intoxication among others.
Attending to a patient in a coma requires a lot of patience and genuine concern on the part of the relatives and caregivers. As a caregiver, you need to attend to your patient’s basic and personal needs such as meal preparation, grooming, medicine administration, and repositioning.
A patient who is in a coma can no longer voice his or her concerns and discomfort. That’s why as a caregiver, you need to be on the constant lookout for the following complications that comatose patients might develop due to prolonged immobility:
Deep Vein Thrombosis. Being in a coma means that your patient is incapable of doing any form of voluntary movement. Movement is essential to keep the blood flowing properly, especially in your limbs. In a coma patient, the blood flowing through the veins becomes sluggish, increasing the likelihood of blood clot formation. These abnormal blood clots are known as thrombosis. If a clot is dislodged (now known as an embolus), it might travel through the bloodstream to the lungs, causing pulmonary embolism. A pulmonary embolism is fatal and can severely diminish your patient’s oxygenation.
Contractures. A contracture is characterized by stiffening and shortening of muscles, tendons and connective tissues. It might lead to deformity and rigidity of joints. Contractures happen due to immobility and decreased the range of motion. Gently doing some range of motion exercises of your patient’s joints could help prevent the development of this complication.
Dehydration, overhydration and vitamin deficiency. A patient in a coma can no longer control their oral intake. They are usually being fed through a nasogastric tube (NGT). Some patients might even have intravenous fluid. Dehydration or overhydration might occur if the IV fluid is not properly regulated or if the patient is not given adequate fluid. As a caregiver, you should properly monitor your patient’s intake and output because this parameter could tell you about the hydration status of your patient.
Lung irritation and damage. If your patient is being mechanically or artificially ventilated, he or she might sustain a certain degree of damage to the lungs. This could happen if the volume of air being pushed into the lungs is too much for the alveoli to handle, leading to overdistention (enlarged due to internal air pressure) of the lungs.
Malnutrition. Patients in a coma are sometimes dependent on intravenous fluid for nourishment. If your patient has an NGT, then they are dependent on you to provide them with the nutrition they need. If not done correctly, your patient might become malnourished or undernourished. It is also important to check if your patient’s NGT is properly placed in the stomach before feeding. A dislodged NGT might result in aspiration pneumonia.
Pressure sores. Lying in bed for long periods of time can put prolonged pressure on internal tissues, restricting blood flow to the area. Skin breakdown may happen, leading to pressure sores or bedsores. It is important to turn and reposition your patient every 2 hours (right side lying, flat on the bed, left side lying) to prevent pressure sores. Using medical air mattresses can also relieve pressure by alternately filling and decompressing the mattress’ air-filled channels, regularly redistributing your patient’s weight and improving their blood circulation.
Upper respiratory tract infection (URTI). Due to prolonged immobility, a coma patient cannot expel secretions from his or her lungs. Because of this, he or she might develop upper respiratory tract infection. Regular turning and back tapping could help dislodge the thick secretions in your patient’s respiratory tract.
Urinary tract infection (UTI). If your patient has a urinary catheter, it could be because he or she is having difficulty to pass urine or his or her fluid intake and output needs to be monitored regularly. Prolonged use of a urinary catheter can predispose your patient to develop a UTI. Since one end of the catheter rests inside your patient’s bladder itself, it can facilitate a more direct entry for pathogens. To prevent this, you have to ensure that your patient’s catheter and urine bag are clean at all times.
The recovery and prognosis of coma patients depend on their underlying disease conditions and the quality of care that they receive from healthcare providers. Meticulous care and genuine concern for a coma patient can go a long way.
If you see signs of these complications, report your observation to your patient’s attending physician for further assessment and medical intervention.