Alert but confused - page 2

by mytoon38 18,703 Views | 44 Comments

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... Read More


  1. 1
    I agree with the OP. The bigwig is wrong! Maybe she needs to be educated as to what alert is???
    mamamerlee likes this.
  2. 3
    Quote from webmansx
    I think Alert in itself means watchful, promt, quick to percieve and act...in order to be alert one must be oriented as well. These days (according to some recent documentation books anyway) we are encouraged to write awake...not alert. The fact that the patient is responding and eyes are open etc does not mean they are alert. So it is a contradiction when you write alert and confused....
    not picking on you, but this sounds like someone trying to fix what aint broke...
    dudette10, mamamerlee, and SuesquatchRN like this.
  3. 3
    Kinda makes you wonder about the educator's LOC. Should make for interesting charting 'though. "The confused, semi comatose patient ran down the hall".
    My problem is: if my patient is not alert I have a heck of a time figuring out whether they are confused or oriented.
    Mollypita, midinphx, and SuesquatchRN like this.
  4. 13
    "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).
    ~*Stargazer*~, sharpeimom, GrnTea, and 10 others like this.
  5. 1
    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...)
    systoly likes this.
  6. 0
    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.’
  7. 0
    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
  8. 4
    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.
    dudette10, systoly, Up2nogood RN, and 1 other like this.
  9. 3
    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/neurolog...703021.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/cvi...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 < 0.001). Median GCS scores associated with AVPU were 15, 13, 8 and 6 and for ACDU were 15, 13, 10 and 6. The median values of ACDU were more evenly distributed than AVPU and may therefore be better at identifying early deteriorations in conscious level when they occur in critically ill ward patients."

    http://www3.interscience.wiley.com/j...TRY=1&SRETRY=0
    ~*Stargazer*~, Up2nogood RN, and wooh like this.
  10. 1
    vertigo and synchronicity are two more words that have different meanings in general use than in med/psych
    wooh likes this.


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