Can you experienced nurses shed some light on this assessment parameter so that I might better understand lethargic vs obtunded?
I'm a new RN, and new on a neuro trauma ICU. It is very important that I understand assessment descriptions. My last pt. was an SAH/SDH whose only response was localization to deep (and I mean deep) painful stimuli. No spontaneous movement and follows commands x0. 8 on the GCS. I described her in my assessment as "obtunded".
My preceptor corrected me and pointed out that she was "lethargic".
Lethargic in my mind describes someone who is drowsy but arousable. I think I can describe myself as lethargic at times.
Would love some insight.
Quote from suzanne4
I do not agree with your preceptor. Any time that you really need to physically stimulate a patient to get any type of respnse from them, that is obtunded. If you did nothing, they would be doing nothing.
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.
Quote from alisaf23
Ok technically your patient would be classified as semi comatose or possibly in a stupor.
As an ICU nurse myself if that was my patient I would chart him as being semicomatose.
Clouding of consciousness is a very mild form of altered mental status in which the patient has inattention and reduced wakefulness.
Confusional state is a more profound deficit that includes disorientation, bewilderment, and difficulty following commands.
Lethargy consists of severe drowsiness in which the patient can be aroused by moderate stimuli and then drift back to sleep.
Obtundation is a state similar to lethargy in which the patient has a lessened interest in the environment, slowed responses to stimulation, and tends to sleep more than normal with drowsiness in between sleep states.
Stupor means that only vigorous and repeated stimuli will arouse the individual, and when left undisturbed, the patient will immediately lapse back to the unresponsive state. (caused by narcotics, intoxicants, etc.: )
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.
Coma is a state of unarousable unresponsiveness.
Check out the following Confusion, Delirium, Lethargy & Obtundation video