Alert but confused

Nurses General Nursing

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I recently charted that a patient was alert, but confused and oriented x 1 to name only. I was told by one of the big wig nurse educators at our hospital that a pt. couldn't be ALERT and CONFUSED, and disoriented, she said that is a contradiction. I have been a nurse for over 25 years, and I was taught that: Alertness is a global observation of level of consciousness, awareness of, and responsiveness to the environment, and this might be described as alert, clouded or drowsy. So to me, as long as a pt isn't comatose and is responding to stimuli, they are alert! I would like to hear your opinion. Do you think a pt. can be alert but confused and disoriented????

Thanks!

"Alert" refers to level of consciousness (on a continuum from comatose to alert)and being (fully) responsive to environmental stimuli. Orientation refers to basic cognitive function -- whether one knows who one is, where one is, what the date/time is, and what situation one is in. You can certainly be alert (awake and responsive) but confused (about where you are, the date/time, even who you are).

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Specializes in Critical Care.

Think this has been handled very well already but I agree with everyone already. You can be alert and confused...most of the federal government has been that way for years!! (Someone had to do it...):cool:

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Specializes in Med Surg, Ortho.

alert |əˈlərt|

adjective

quick to notice any unusual and potentially dangerous or difficult circumstances; vigilant : an alert police officer discovered a truck full of explosives | schools need to be constantly alert to this problem. See note at vigilant .

• able to think clearly; intellectually active : she remained active and alert until well into her eighties.

noun

the state of being watchful for possible danger : security forces were placed on alert.

• an announcement or signal warning of danger : a bomb alert | an alert sounded and all the fighters took off.

• a period of vigilance in response to such a warning : traffic was halted during the alert.

verb [ trans. ]

warn (someone) of a danger, threat, or problem, typically with the intention of having it avoided or dealt with : he alerted people to the dangers of smoking | police were alerted after three men drove away without paying.

PHRASES

on the alert vigilant and prepared : the security forces must be on the alert for an upsurge in violence.

DERIVATIVES

alertly adverb

alertness noun

ORIGIN late 16th cent. (originally in military use): from French alerte, from Italian all' erta ‘to the watchtower.’

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Specializes in Med Surg, Ortho.

I agreed with the OP until I looked it up in the dictionary.

I tend to agree with the poster that suggest using the word awake instead of alert.

Because alert does have the meaning of being able to think clearly. And if one is

confused, they are not able to think clearly.

So the proper wording should be: awake, but confused and oriented to name only

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i wouldn't change a term used for medical charting to match the dictionary.

Everyone except the OP's nurse educator understands what it means and how it is used in a chart.

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Lots of words or phrases have one set of meanings in general conversation, and another, specific, meaning as a medical term. "Alert" is a good example of this. "Alert" has a v. specific meaning in the context of neurological assessment, and, to me, is a much more helpful and specific term than "awake," which can cover a fairly wide range of possibilities. One can easily be awake but not alert (but if you're alert, you're definitely also awake. :))

"Assess the level of consciousness using the AVPU scale; if fully awake and talking to you, they are A (alert). If they respond but appear confused, try to establish whether this is a new or a long-standing problem; causes of recent onset confusion include neurological pathology and hypoxia." (Bolding mine)

http://www.nursingtimes.net/neurological-assessment-assessing-level-of-consciousness/1703021.article

"Other common terms are used to describe assessment of LOC (e.g. alert, drowsy, confused, stuporous, comatose). It is important that the terms used are defined for the practitioners at the bedside and are used consistently. You want a change in terminology to represent a change in the patient, not the practitioner's interpretation of the terminology. At change of shift, perform a neuro exam with the oncoming nurse to ensure clear communication of the patient's previous status.

Examples of Definitions

Alert:

o awake, looks about

o responds in a meaningful manner to verbal instructions or gestures"

http://lane.stanford.edu/portals/cvicu/HCP_Neuro_Tab_4/Neuro_Assessment.pdf

"Neurological assessment is an essential component of early warning scores used to identify seriously ill ward patients. We investigated how two simple scales (ACDU - Alert, Confused, Drowsy, Unresponsive; and AVPU - Alert, responds to Voice, responds to Pain, Unresponsive) compared to each other and also to the more complicated Glasgow Coma Scale (GCS). Neurosurgical nurses recorded patients' conscious level with each of the three scales. Over 7 months, 1020 analysable measurements were collected. Both simple scales identified distinct GCS ranges, although some overlap occurred (p

http://www3.interscience.wiley.com/journal/118744938/abstract?CRETRY=1&SRETRY=0

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vertigo and synchronicity are two more words that have different meanings in general use than in med/psych

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Specializes in rehab.
morte said:
not picking on you, but this sounds like someone trying to fix what aint broke...

Like I said....:twocents:

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Thanks to all of you for replying! I have never had anyone question me because I charted alert but confused before. Apparently it was reviewed by one of our nurse educators and she didn't like that I used the terms alert but confused. The little old man was walking around and was totally alert and responsive, but he was oriented to his name only, and I stand by my term confused; because he was defecating and urinating in trash cans all over the unit! :uhoh3:

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greenbeanio said:
I've always taken alert to mean what you described. There is a reason why we mention both words alert and oriented instead of just one or the other - because they are not synonymous. If they were, we wouldn't need to use 2 different words!

My patient today was very alert, and apparently oriented x3 as far as I could see. I would never have known otherwise except that her son came out of the room distraught because she was "so confused... talking about people who have been dead for years as if they're at home and talking about a house we don't even live in any more". She had been talking about them to me as well, but I had assumed it was all true, because it sounded perfectly reasonable!

Alert..conscious..awake...responsive to stimuli. Confused: so am I...Confused: Does not know person,place or time.

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mytoon38 said:
Thanks to all of you for replying! I have never had anyone question me because I charted alert but confused before. Apparently it was reviewed by one of our nurse educators and she didn't like that I used the terms alert but confused. The little old man was walking around and was totally alert and responsive, but he was oriented to his name only, and I stand by my term confused; because he was defecating and urinating in trash cans all over the unit! :uhoh3:

He was definitley(sp) confused but had to be alert to be walking around defecating in trash cans.:twocents:

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Specializes in Trauma ICU, Peds ICU.

I think I went though most of nursing school alert, confused, and disoriented.

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