訪問看護で使えるフィジカルアセスメント④～意識～
訪問看護で使えるフィジカルアセスメント④～意識～
訪問看護で使えるフィジカルアセスメント④は意識のアセスメントについてです。
意識とはなにか、また評価のポイントについてお伝えします。
意識を構成する2大要素とは
意識は2つの重要な要素から成り立っています。意識を構成する2大要素は、覚醒と認識です。
覚醒とは、目が覚めていて認識ができることです。認識とは、周囲で起きている事を正しく理解できることです。また反応できることでもあります。
脳中枢神経系などが正常に機能していれば、覚醒も認識も行えます。しかし、このどちらかが正しく行われていない時を意識が悪い（意識障害）と呼びます。
意識障害の例
例えば、大きな声をかけても目を覚まさないのは、覚醒が悪い意識障害です。目が覚めているが、辻褄の合わない言動がみられるときは、認識が悪い意識障害です。
目が覚めていなければ（覚醒していない）、必然的に認識も出来ません。目が覚めないというのは、誰がみても分かる意識障害ですが、認識が悪いのは意識障害として見落とされがちなので注意が必要です。ちなみに見当識障害は認識が悪い意識障害です。
例外として、目が覚めてないが正常な状態があります。これは睡眠で意識障害ではありません。
意識障害の評価
意識障害が出現していないのかを評価するのは、一般的には評価ツールを用います。メジャーな評価ツールはGCSやJCSがあります。
なんとなく意識が悪いではなく、ツールを使用したほうが客観的に評価できますし、共通言語になります。よって評価ツールを使うことをおすすめします。
「いつもしっかりしている患者さんが、今日は名前も生年月日も言えないです。」でも伝わりますが、JCSⅠ‐３ですの方が共通認識しやすいです。
意識障害の原因
意識障害の原因は多岐に及びます。原因のアセスメントにはAIUEOTIPSがおすすめです。
意識障害を伴い緊急性があるものとしては、脳卒中・ショックなどがあります。脳卒中は血圧が上がっていることがほとんどです。意識障害を伴うショックは血圧が著しく低下しています。
重篤な意識障害がある時は、呼吸や脈が触れるのかを確認することが必要となります。
最後までお読みいただきありがとうございます。
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