Unresponsive vs. unconscious

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Hello everyone,

I have a question with this multiple choice question.

21.A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNC) is made for a patient with type 2 diabetes who is brought to the emergency department in an unresponsive state. The nurse will anticipate the need to

a.give 50% dextrose as a bolus.

b.insert a large-bore IV catheter.

c.initiate oxygen by nasal cannula.

d.administer glargine (Lantus) insulin.

B is the answer but my initial answer was initiate oxygen by nasal cannula because the pt is unresponsive. Now I am looking at the word unresponsive and that means the person is not responding to outside stimuli and a person who is unconscious is in a deep coma?

I guess my question is pertaining to the context of what unconscious means in this question?

Regards,

CatnessK

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Specializes in Primary Care, Progressive Care.

You have to assume that all the information you need to answer a question are included in the question.

Why is an HHNC patient unresponsive? The question did not say anything about the patient's oxygen saturation or airway compromise. Do not overthink.

I agree with your definition of unresponsive vs. unconsious though.

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Specializes in Pediatrics, Emergency, Trauma.

I agree with not overthinking the question.

Think about the condition at hand and what interventions are needed; what would you need?

Once you understand what you need, then you will understand the rationale for the best answer, which is B.

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Specializes in Pedi.

Why is a patient with HHNC unresponsive? Does it have anything to do with their oxygen level? Or is it because of something metabolic that will require IV fluids and IV insulin?

Unconscious doesn't mean deep coma though. There are levels of coma/responsiveness and many causes to loss of conscious. Suggest googling "Glasgow Coma Scale."

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I was just looking through my textbook and for the interventions of DKA (which I would assume is pretty similar for HHNC). It had ensure patent airway, administer o2 and then insert a large bore IV catheter. I know I might be thinking way into this, but I remember getting a question on my exam very similar to this and the answer was actually the administration of O2.

https://evolve.elsevier.com/objects/apply/RN/DiabetesTypeI/RN_21_59.jpg

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Specializes in Neuro, Telemetry.
I was just looking through my textbook and for the interventions of DKA (which I would assume is pretty similar for HHNC). It had ensure patent airway, administer o2 and then insert a large bore IV catheter. I know I might be thinking way into this, but I remember getting a question on my exam very similar to this and the answer was actually the administration of O2.

https://evolve.elsevier.com/objects/apply/RN/DiabetesTypeI/RN_21_59.jpg

This is again over thinking. Ensuring patent airway is going to be first for just about everything. However, the question does not mention respiratory distress. The answer you are questioning is about actually administering oxygen to the patient. You don't jsut give every patient who comes in the ER O2. For this question you would need to check airway and only admin O2 if the patient needs it. And that info is not given. Everything you need to answer the question is given. To give the patient O2 you would need to ask what the patients O2 sats are. NCLEX is perfect world, so since O2 sats are not given you can already assume that they are WNL. Next, you know you will need a large bore IV catheter because HHNC will require fluids and IV insulin to correct. Therefore that is the answer.

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Specializes in Neuro, Telemetry.

Also, DKA is only mildly similar to HHNC in that both patients will high blood glucose levels. But the patient will present to the hospital in markedly different conditions and will be treated a little different.

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Specializes in SICU, trauma, neuro.

Per ACLS protocols, supplemental O2 is indicated if the sat is In this case, the pt is not unresponsive r/t a ventilation or oxygenation issue. Putting O2 on might make you feel better, but it's not what the pt needs.

As far as unresponsive vs. unconscious, I don't remember ever hearing "unconscious" being used in the clinical setting. We say "altered LOC," or "GCS of _____" or unresponsive.

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Specializes in PICU.

B is the answer because in anticipation to perform next steps you would need an IV.

Nothing in the statement speaks about respiratory distress/failure. You have to take the statement as if everything else is normal, even though in real world nursing we know this not to be true

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Specializes in Adult and Pediatric Vascular Access, Paramedic.

Here is a guide to different levels of responsiveness - use AVPU

A (Alert) = Alert, eyes are open spontaneously

V (verbal stimuli)= Opens eyes to verbal stimuli (you call there name or ask them to open their eyes, and they do)

P (painful stimuli)= They open their eyes to a sternal rub or other mildly painful stimuli ( this may include opening eyes or just withdrawing from the pain, or in some cases inappropriate flexion.

U (Unresponsive)= They are comatose and will not open eyes or respond to any stimuli

Unconscious simply means they are not alert, unresponsive means they are comatose and not responsive to any outside stimuli.

PLEASE do not mix up unresponsive with non-verbal! I work on the ambulance and we get many calls, especially for elderly folks who are NON-VERBAL because they are septic or otherwise ill, but their eyes are open, etc. People call it in as UNRESPONSIVE because they person is not talking to them, which is not accurate, and unresponsive person is not alert and is completely unresponsive to outward stimuli, in other words they are comatose, not just non-speaking. This drives me crazy!

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