Brain damage and coma are two conditions that usually have extremely dangerous consequences. Having some similar symptoms and affecting the same organs, these two states are often mixed up confusing healthcare providers. For this reason, nurses as primary healthcare givers should be aware of both states to be able to differentiate one from the other and act accordingly.
The most important aspect that should be mentioned is that both coma and brain death have similar symptoms. These two conditions affect the brain so that people do not show actual manifestation of life. Patients with both conditions are physically unconscious or, in more accurate terms, have depressed consciousness. The reality is that in these states no interventions are considered to be helpful (Young, 2009). For this reason, the only things nurses can do are providing basic care (creating proper environment) and helping in doing diagnostic tests.
Coma is regarded as “a state of unarousable unconsciousness” (Young, 2009). Healthcare providers usually use some stimuli as injections, stressors, or heart stimulation, but they do not bring the patient back to consciousness. Young (2009) states that a person in comatose state can show some motor response to the stimulation, but, in fact, the condition does not change. Coma can be either reversible or irreversible as the patient can recover or his/her brain would be critically damaged leading to brain death. There is the third option as well. Someone in coma can remain in such vegetative condition for the rest of his/her life.
Coma should be properly diagnosed. The most essential thing nurses should do is gathering the anamnesis (Young, 2009). People with cases of reversible coma, brain cancer, recent febrile illness, epilepsy, diabetes, cardiac problems, impaired immunity, hypertension, renal impairment, hepatic failure, and other conditions comprise risk group as they are more prone to getting into coma (Young, 2009). People that tried to commit suicide, had some behavioral changes, and took some medications also belong to the risk group. Coma is hard to diagnose since absence of eye movement or inadequate breathing can be the signs of other conditions (Young, 2009). Thus, careful examination for visible characteristics and various tests for inner symptoms are needed to diagnose coma. Nursing coma management includes sustaining patient’s life (ventilation, intravenous drugs and fluids transmission, maintenance of adequate blood pressure and temperature, and others) and treatment of condition that caused coma (Young, 2009).
Brain death is regarded as the deepest irreversible coma caused by preceding brain damage (Busl & Greer, 2009, p. 276). Major symptoms are absence of movement or breathing (in some cases, inadequate breathing and heart beat can remain for a little while), unresponsiveness to stimuli, and absence of brain activity – brainstem reﬂexes (Busl & Greer, 2009, p. 276). The last characteristic makes brain death different from coma. Machado (2010) states that three signs of brain death are “coma, absence of brainstem reflexes, and apnoea”. For this reason, healthcare providers need to make many tests to examine brain activity as two other signs can indicate comatose state. If tests show that there is no brain activity at all, including brainstem reflexes, the patient is diagnosed with brain death and is considered to be dead. Life-sustaining functions (breathing and heart beating) can be supported with the help of mechanical interventions, but the person will never recover (Machado, 2010). Since no recovery is possible, nurses can only ensure mechanical life support until the relatives’ agreement or organ transplantation.
In conclusion, brain death and coma can have similar manifestation but are different conditions. Brain damage is the sign of death that is characterized by irreversible coma, apnoea, and absence of brainstem reflexes. If a person preserves brain activity, he/she can be in reversible coma. Therefore, nurses should pay much attention to making a proper diagnosis and consequential care. They should pay particular attention to gathering the anamnesis, observing all indicators of a patient’s state (heartbeat, blood pressure, temperature, breathing, and others), and doing necessary tests to detect presence or absence of brain activity in order to make the correct diagnosis. After the condition is determined, nurses must ensure that a proper care is provided to the patient, including all necessary procedures (lung ventilation, intravenous injections, and others).
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