A variety of medical conditions and drugs can affect your level of consciousness, from having dementia or lethargy, to being in a coma. Another LOC is lethargy, a level of consciousness marked by drowsiness, listlessness, apathy and a small reduction in alertness. Increases in intracranial pressure (the pressure within the skull) can also cause altered LOC. Explore the meanings of stupor and obtunded. *Patients who are able to spontaneously state their name, location, and date or time correctly are considered oriented X 3. [3] The ACDU scale, like AVPU, is easier to use than the GCS and produces similarly accurate results. Annualized. obtunded: mentally dulled. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Overview of coma and impaired consciousness. Initial treatment often involves the administration of dextrose if the blood sugar is low as well as the administration of oxygen, naloxone and thiamine. J Med Life. Rip vs. Ready? In report you learn the following about your patient: 56 year old female with CKD stage 4, CHF, DM2, and hyperlipidemia. 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Lethargic is someone who is very sleepy, but arouses easily by name calling or just a slight tap, but true physical stimulation needed and that is obtunded. http://www.ncbi.nlm.nih.gov/pubmed/23177603?tool=bestpractice.com He has also been published in "The Philadelphia Inquirer" and "Golf Digest Index." Differential effects of the Glasgow Coma Scale Score and its components: An analysis of 54,069 patients with traumatic brain injury. Clouding of consciousness is a very mild form of altered mental status in which the patient has inattention and reduced wakefulness. Somnolent adjective Sleepy; drowsy; inclined to sleep. 2013 Feb;29(1):101-36. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614410, http://www.ncbi.nlm.nih.gov/pubmed/23177603?tool=bestpractice.com. Somnolent vs. Lethargic: See the Difference | Dictionary.com [6]Lehman RK, Mink J. Altered mental status. Prolonged unconsciousness is understood to be a sign of a medical emergency. It involves impaired cognition (thought processes) and may include: Lethargy and somnolence (sleepiness) involve: A lethargicperson may need a gentle touch or verbal stimulation before they'll respond. Create your account. All references to such names or trademarks not owned by NRSNG, LLC or TazKai, LLC are solely for identification purposes and not an indication of affiliation. World J Emerg Med. i have only ever seen the descriptors used in a handful of books - they have long been replaced with the glascow coma scale simply because they were too confusing. Lethargic vs. Obtunded - What's the difference? | Ask Difference For any urgent enquiries please contact our customer services team who are ready to help with any problems. A urine drug screen may be sent. Is lethargic or somnolent worse? Specializes in critical care; community health; psych. Had I not known how to describe this patients level of consciousness using standardized language, there could have been a huge miscommunication between me and the MD. I'm a new RN, and new on a neuro trauma ICU. Assessing LOC involves determining an individual's response to external stimuli. It can result from traumatic brain injury such as concussion. Levels of Consciousness | NURSING.com Podcast 2017 Jan;35(1):71-6. [9] Usually the first tests in the ER are pulse oximetry to determine if there is hypoxia, serum glucose levels to rule out hypoglycemia. Altered mental status and delirium. Just like on the first day of class, consider these links your syllabus to the Straight A Nursing website. Somnolence (alternatively sleepiness or drowsiness) is a state of strong desire for sleep, or sleeping for unusually long periods (compare hypersomnia). (dated) Causing literal or figurative sleepiness; soporific. http://www.ncbi.nlm.nih.gov/pubmed/27475019?tool=bestpractice.com Somnolence noun. Comatose vs. Obtunded - What's the difference? | Ask Difference People who are obtunded have a more depressed level of consciousness and cannot be fully aroused. [1] People who are obtunded have a more depressed level of consciousness and cannot be fully aroused. If we have a patient who is awake and alert for the 0700 assessment, but becomes lethargic or somnolent as the day progresses, this tells us that something is most definitely NOT RIGHT! Has 3 years experience. Comatose adjective. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. copyright 2003-2023 Study.com. Let's start with confusion. Finally, there is something called a persistent vegetative state, which is where the person appears to be undergoing sleep and wake cycles but is actually unconscious even when one seems to be awake. Some can be accessed even when your phone is locked. In: Walker HK, Hall WD, Hurst JW, editors. BMJ. Because doctors may not be able to communicate with a patient whose consciousness is altered, family and friends must communicate their knowledge of any drug or alcohol use by the patient. Some drugs, and even minor physical ailments such as dehydration, can cause elderly persons to become stuporous, but altered consciousness has dozens of possible causes for people of any age. No content on this website is intended to guide nursing practice and does not supersede any individual healthcare providers scope of practice or any nursing school curriculum. Someone who has overdosed on drugs, for example, may be obtunded but able to communicate. [12] Reflexes, such as the cough and gag reflexes, are also means of judging LOC. I do not agree with your preceptor. To. exposure to poisons or intoxicants), insufficient oxygen or blood flow in the brain, and excessive pressure within the skull. Comatose adjective. awake, watching TV, and able to state their name, location, and the time accurately is considered awake, alert and oriented X 3 (AAO X 3). As an ICU nurse myself if that was my patient I would chart him as being semicomatose. If youre interested in getting your CRNA someday, you might find this article fascinatingI know I certainly did! Chapter 57. With over 2,000+ clear, concise, and visual lessons, there is something for you! A concussion, which is a mild traumatic brain injury (MTBI) may result in decreased LOC. Etiologies and delirium rates of elderly ED patients with acutely altered mental status: a multicenter prospective study. Strip. 2016 Aug;34(3):649-65. Annualised vs. Lethargic adjective. My last pt. A lethargic patient will be sleepy but easy to arouse with verbal commands or light touch. 3rd edition. 2018;56(10):890-897. Lethargy is a state of tiredness, weariness, fatigue, or lack of energy. She follows some basic commands, and is slow to respond. The most commonly used are lethargic, obtunded, delirium, stupor, and comatose. The Glasgow Coma Scale is the tool we use to assign a numerical value for patients with altered LOC or mental status. According to the NIH, patients in stupor will, unless stimulated, lapse back into an unresponsive state. A lowered level of consciousness indicate a deficit in brain function. Someone in a coma doesn't respond to any stimuli. Altered level of consciousness. He/she, Coma is a state of unarousable unresponsiveness.. [3]Xiao HY, Wang YX, Xu TD, et al. More serious than lethargy is obtundation, a moderate reduction in alertness. Infiltration: Causes, Symptoms & Treatment. This article is about the medical concept. Accomplish the following goals while you work through the lesson on the levels of consciousness: To unlock this lesson you must be a Study.com Member. Delirium. Additionally, no content on this website is intended to be a substitute for professional medical advice, diagnosis or treatment. Text is available under the Creative Commons Attribution/Share-Alike License; additional terms may apply.See Wiktionary Terms of Use for details. [5] Thus it is a valuable measure of a patient's medical and neurological status. Dr Gary Blanchard would like to gratefully acknowledge Dr David Dosa, a previous contributor to this topic. Stupor is a deep level of impaired consciousness where individuals only briefly regain consciousness after repetitive stimulation. Stupor is a decreased level of consciousness in which a patient requires vigorous physical stimuli to awaken. Sometimes impaired consciousness is reversible, while other times it is not. Confusion describes disorientation that makes it difficult to: Delirium is a term for an acute confused state. Angela Morrow, RN, BSN, CHPN, is a certified hospice and palliative care nurse. The National Institute of Health classifies obtundation as similar to lethargy and describes an obtunded patient as having lessened interest in the environment and slower responses to stimulations. When in a stupor, deep physical stimuli are required to awaken a patient while a comatose patient is unresponsive to all stimuli. At 0900, you bring in your patients medications. So where does "somnolent" fit in this hierarchy of rousability? I think everyone has slightly different ideas on what those descriptors mean. What about a patient who is awake but unable to state where they are or what year it is? This article covers normal and altered states of consciousness as well as coma classifications. This patient is alert, but confused to place and location. *Patients who awaken briefly and answer questions appropriately but easily fall asleep care considered lethargic. [9] Exposure to drugs (e.g. What is stupor? ____________________________________________________________. (Eds), Handbook of Metamemory and Memory. However, these terms are imprecise. 2017 Jan;35(1):71-6. http://www.ncbi.nlm.nih.gov/pubmed/27765479?tool=bestpractice.com. I think I can describe myself as lethargic at times. The AVPU scale is another means of measuring LOC: people are assessed to determine whether they are alert, responsive to verbal stimuli, responsive to painful stimuli, or unresponsive. Somnolent: sleepy. [1] A mildly depressed level of consciousness or alertness may be classed as lethargy; someone in this state can be aroused with little difficulty. Terminology for the Levels of Consciousness - Study.com That helps improve communication among healthcare providers and aids in research. BIBA yesterday for SOB, currently on 6L oxygen. A stuporous patient refers to someone with a decreased level of consciousness. Updated June 2019. But in between consciousness and unconsciousness, there are many other levels of consciousness. Fainting is more formally called syncope, and as you probably know, it is a brief loss of consciousness. To compare obtunded vs. lethargic, the obtunded patient will require more forceful stimuli to awaken. An obtunded patient will prefer to sleep and easily fall back asleep after waking. Stimuli isthen be applied; if the patient reacts, consciousness is not severely affected. This whole topic of consciousness is so incredibly interesting, especially as it relates to anesthesia. Clin Pediatr Emerg Med. Nervous system examination Flashcards | Quizlet DD declares that he has no competing interests. The National Institute of Health classifies obtundation as similar to lethargy and describes an obtunded patient as having lessened interest in the environment and slower responses to stimulations. Lethargy noun. Obtunded: difficult to arouse. I described her in my assessment as "obtunded". Lethargy is a level of consciousness less severe than obtunded. According to the Merck online medical library, the term "obtunded," a form of obtundation, is an imprecise way to describe someone whose alertness or consciousness is moderately reduced 3. inclined to or marked by drowsiness; slumberous (or slumbrous) eyes `slumbery' is archaic the sound had a a somnolent effect. For example, I had a patient recently who was stuporous upon arrival to the ICU, but quickly became unresponsive, requiring immediate intervention in order to keep the patient safe. Please check with the appropriate physician regarding health questions and concerns. 8 on the GCS. The patient has a more profound deficit than clouding of consciousness that includes, The patient has severe drowsiness. Causes can include severe illnesses or infections, recreational drugs, and organ failure. Pat McCaw MD is a family physician and author. There are multiple terms for decreased level of consciousness. (3) On the other hand, the patient was noticed lethargic and showed parkinsonism i.e., rest tremor, cog-wheel rigidity, and hypokinesia. As with any altered LOC, lethargy has many potential causes, including anemia, an underactive thyroid and cancer. http://www.medterms.com/script/main/art.asp?articlekey=4614. A lethargic patient will be sleepy but awaken easily to verbal stimuli or prodding. Fundamentally, mental status is a combination of the patient's level of consciousness (i.e., attentiveness) and cognition (i.e., mental processes or thoughts); patients may have disorders of one or both. Maiese K. Overview of coma and impaired consciousness. Mental Status Flashcards | Quizlet (informal) Drowsy or lethargic. 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With a patient like this, you might anticipate the MD ordering an ABG at some pointdont be surprised if it comes back acidotic. 2012;3(4):270-7. Obtundation is sometimes defined as a moderate reduction in alertness, while lethargy is a level of consciousness marked by drowsiness, listlessness, apathy and a small reduction in alertness. When she does answer questions, she mumbles and is clearly confused. 2007 Apr 21;334(7598):842-6. http://www.ncbi.nlm.nih.gov/pubmed/17446616?tool=bestpractice.com. Stupor and coma in adults - UpToDate Lethargy noun. It gives us an objective, measurable baseline assessment of the patients neuro status so we are able to easily identify and document changes. Any time that you really need to physically stimulate a patient to get any type of response from them, that is obtunded. Can you experienced nurses shed some light on this assessment parameter so that I might better understand lethargic vs obtunded? 2008;9:68-75. [12] Hypo- or hypernatremia (decreased and elevated levels of sodium, respectively) as well as dehydration can also produce an altered LOC. She drifts off again once no longer stimulated. 2017;48(9):1932-1943. doi:10.1016/j.injury.2017.05.038. Its like a teacher waved a magic wand and did the work for me. Vasilevskis EE, Chandrasekhar R, Holtze CH, et al. Angela Morrow, RN, BSN, CHPN, is a certified hospice and palliative care nurse. However, more frequently patients exhibit altered levels of consciousness plus cognition: for example, with delirium, a relatively common and sometimes fatal cause of AMS. A person who is active, walking, and talking has a full normal level of consciousness. Clin Geriatr Med. a very sleepy state; sleepiness causes many driving accidents. About 40% of patients were ages over 60 years. Clinical Methods: The History, Physical, and Laboratory Examinations. It differs from a coma, from which a person cannot be aroused. Delirium in older people. As adjectives the difference between obtunded and somnolent is that obtunded is describing someone who is far from alert or oriented to time and space, and exhibits other signs being confused, a state just short of frank delirium while somnolent is drowsy or sleepy. Altered mental status and delirium. QOD 33: Implementing Evidence-based Practice (Fundamentals/Management of Care), Aspart, Lispro, Glulisine Insulin (rapid acting): Novolog, Humalog, Apidra (antidiabetics, hormones), 5 Tips for Surviving Your First Clinical in Nursing School (Guest Post by Sam Akers) | NURSING.com, Just 5 Minutes for an Accurate Head to Toe Nursing Assessment | NURSING.com, Finding Balance in Nursing School | NURSING.com, Patient Positioning Pictures Cheat Sheet for Nursing Students | NURSING.com, How Not To Feel Overwhelmed In Nursing School | NURSING.com. Delirious: disoriented; restless, hallucinating, sometimes delusional. When documenting your patients level of consciousness, youll notice you have a LOT of options to choose from. 2,212 Posts. There is a spectrum of impaired consciousness that goes from full arousal to complete unresponsiveness. See a comparison between obtunded, stuporous lethargic, and comatose. Because doctors may not be able to communicate with a patient whose consciousness is altered, family and friends must communicate their knowledge of any drug or alcohol use by the patient. The term obtundation is not very precise, as it is sometimes defined as greatly reduced levels of consciousness. [4] A decreased level of consciousness correlates to increased morbidity (sickness) and mortality (death). [1] [2] Those who are not able to be aroused from a sleep-like state are said to be stuporous. Any time that you really need to physically stimulate a patient to get any type of respnse from them, that is obtunded. Level of Consciousness (LOC) Medical Term Meaning - Verywell Health Sponsored Links Possible answer: D R Somnolence vs. Lethargy - Difference Between Stuporous you are very difficult to arouse and when you are aroused it is slurred garbled nonsense then you are out again. If someone has had an accident or a head injury, they might have an altered level of consciousness that suggests brain damage. Lethargic vs. Somnolent - Difference Wiki Lethargic: reduced level of alertness with decreased interest in the surrounding environment. Cleveland Clinic. Alzheimer disease and other kinds of dementia: what treatments work? *Stuporous patients only respond by grimacing or withdrawing from painful stimuli. Semi comatose An imprecise term for a state of drowsiness and inaction, in which more than ordinary stimulation may be required to evoke a response, and the response may be delayed or incomplete. lessons in math, English, science, history, and more. A patient that is. What does Obtunded mean in nursing? Somnolent vs. Obtunded - What's the difference? | Ask Difference http://www.ncbi.nlm.nih.gov/pubmed/17446616?tool=bestpractice.com
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