Difference Between Lethargic And Obtunded Difference Between Lethargic And Obtunded | allnurses

Difference Between Lethargic And Obtunded

  1. 2 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.

    Best Answers
    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
    Last edit by Joe V on Dec 8, '16
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  2. 16 Comments

  3. Visit  gwenith profile page
    #1 3
    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.

    dictonary definition

    obtunded: mentally dulled. a person may be obtunded due to head trauma. to obtund is to dull or blunt. from the latin obtundere, to blunt.

    http://www.medterms.com/script/main/...rticlekey=4614
    an alert patient is vigilantly attentive and keen. a lethargic patient is dull, sluggish and appears half asleep. an obtunded patient opens their eyes, responds slowly to questions, is somewhat confused, and has a decreased interest in their environment. a stuporous patient is near unconscious with apparent mental inactivity and reduced ability to respond to stimulation. comatose patients are unconscious and unresponsive.
    http://endeavor.med.nyu.edu/neurosur...inimental.html


  4. Visit  suzanne4 profile page
    #2 5
    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.
  5. Visit  EricJRN profile page
    #3 1
    I think everyone has slightly different ideas on what those descriptors mean. While I would agree with you, it's probably better to stick to more objective stuff, like GCS as Gwenith suggests. If you tell us that the pt withdraws an extremity with painful stimuli, then we're all pretty much on the same page.
  6. Visit  wonderbee profile page
    #4 1
    Thanks for the replies and advice. I did as was suggested on my shift yesterday. When charting, I avoided the whole word descriptor altogether and stuck with more objective information. So much to learn!
  7. Visit  valene profile page
    #5 4
    The terminology goes like this (in this order of progression) :spin: confusion=> lethargy=> obtunded=> stupor=> coma
  8. Visit  dorimar profile page
    #6 1
    Gesparis says it's better to be obtunded then sturporous. Obtunded, you are very difficult to arouse, but when you do arouse you talk clearly (even if only for 10 secs) and then you're out again. Stuporous you are very difficult to arouse and when you are aroused it is slurred garbled nonsense then you are out again. At least that's what I got from her CCRN tapes. (Lethargy is just mildl diffiuclty to arouse, like really drowsy).
  9. Visit  leggendario profile page
    #7 0
    What do you mean by the abbreviation SAH/SDH
  10. Visit  valene profile page
    #8 2
    SAH=subarachnoid hemorrhage
    SDH=subdural hemorrhage
  11. Visit  leggendario profile page
    #9 0
    Thanks for the reply,
    As for the new definition by the word obtuned. I think being in an obtuned state it is more likely similar to being in a state of drowsiness. What do you think guys ???
  12. Visit  treefish profile page
    #10 2
    When stimulating patients such as waking etc or assessing them , its preferable to use the word 'rouse' or 'roused' rather than 'aroused' as they can have quite different meanings.
    Though most pt's might prefer the latter .......
  13. Visit  speechpathologist profile page
    #11 0
    So where does "somnolent" fit in this hierarchy of rousability?
  14. Visit  nurseap profile page
    #12 0
    I'm a student practicing for the nclex and came across this description of the difference between certain terms:

    The patient is obtunded if he can be aroused with stimulation. If the patient shows no verbal or motor response to noxious stimuli, he’s comatose. If the patient remains in a deep sleep and only responds to vigorous and repeated stimulation, he is stuporous. If the patient has limited spontaneous movement and sluggish speech, he’s lethargic.

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