Questions about neuro assessment

  1. 2
    Hello, I am a new grad RN and I am super duper confused on Neuro Assessment. I think it is best to ask neuro ICU nurse about neuro assessment

    My questions are:

    1. Is there a difference between alert, awake and arouse? To my understanding, a patient is considered normal when a patient is arousal (alert and awake) and aware. Confused state is when patient is arousal but not aware. Lethargic is when patient less alert and aware? Am I on the right track? Someone please explain further about these descriptions.

    2. I am confused between alert and lethargic. For example: if a patient is easily aroused and startled as she/he awakens when I call his/her name, but patient falls asleep almost instantly. As I continue to call his/her name, he/she is able to answer all orientation questions, is this patient considered as lethargic? How about pretty much the same one but this patient fall asleep not instantly but after few questions?
    Last edit by Joe V on Jun 25, '12 : Reason: spacing
    Blanca R and Joe V like this.
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  3. 9 Comments so far...

  4. 0
    I am almost a new grad (6 more weeks!) and I definitely find this confusing. Here is my understanding; someone please correct me if I am wrong because I have been struggling to figure it out!

    Lethargic: Sleepy, slowed thought & speech but still oriented, minimal movement, falls asleep but can be roused with light stimulation (ex. saying the patient's name or a light touch)

    Obtunded: Sleeps unless stimulated vigorously (loudly repeating name, painful stimuli), not very oriented, maybe says a word or just mumbles

    Stuporous: Doesn't wake up despite vigorous stimulation, only withdraws from pain

    Coma: No response to any stimuli, including pain

    Also, your use of the term "arousal" here is incorrect. It would make more sense to just say "the patient is awake" or "alert."
  5. 0
    Quote from Candyn
    Hello, I am a new grad RN and I am super duper confused on Neuro Assessment. I think it is best to ask neuro ICU nurse about neuro assessment

    My questions are:

    1. Is there a difference between alert, awake and arouse? To my understanding, a patient is considered normal when a patient is arousal (alert and awake) and aware. Confused state is when patient is arousal but not aware. Lethargic is when patient less alert and aware? Am I on the right track? Someone please explain further about these descriptions.

    2. I am confused between alert and lethargic. For example: if a patient is easily aroused and startled as she/he awakens when I call his/her name, but patient falls asleep almost instantly. As I continue to call his/her name, he/she is able to answer all orientation questions, is this patient considered as lethargic? How about pretty much the same one but this patient fall asleep not instantly but after few questions?
    1. Yes. You can be awake but not alert though if you are alert, you are awake. Think about it... if you are in the most boring lecture of your life and struggling to keep your eyes open after having gotten only 3 hours of sleep last night, are you alert? No, but you are awake. "Arouse" is not a level of consciousness.

    2. Alert is when the patient is awake, sharp and appropriately responsive. Lethargic is when the patient is sluggish, drowsy/sleepy [inappropriately so, someone asleep at 2am is not lethargic], slow to respond, etc. Lethargy does not necessarily indicate a decreased level of awareness or orientation. Someone can be lethargic but still oriented x 3.
  6. 1
    Hey fellow new nurses, I'm in the process of making a head-to-toe assessment guide for myself just to have as a reference while I'm caring for my patients and here are the definitions/explanations of the levels of consciousnesses (LOC) that I have been using on my sheet (coming from the Nursing Made Easy Assessment series) which should help you with your Neuro assessments.

    ALERT
    – AWAKE AND ABLE TO FULLY RESPOND WITH SPONTANIOUS EYE OPENING AND NORMAL SPEECH.
    LETHARGY
    – ROUSABLE TO SPEECH BUT REMAINS DROWSY/FALLS ASLEEP EASILY.
    OBTUNDATION
    – ROUSABLE TO PHYSICAL STIMULI BUT MAY BE CONFUSED/SLOW TO RESPOND.
    STUPOR
    – RESPONDS ONLY TO PAINFUL STIUMLI, MAY NOT BE ABLE TO RESPOND VERBALLY.
    COMA
    – NO RESPONSE TO REPEATED PAINFUL STIMULI, ABNORMAL POSTURING PRESENT.

    Sorry the definitions are in all caps (I copy/pasted it from my document and it got stuck in all caps). Hopefully you find that helpful!

    !Chris
    Last edit by cjcsoon2brn on Jun 28, '12
    Esme12 likes this.
  7. 0
    Thank you so much for the response.
    So what do you say about the patient I listed above? Lethargic????
  8. 0
    Quote from Candyn
    Thank you so much for the response.
    So what do you say about the patient I listed above? Lethargic????
    I would say that the patient you listed above would be considered lethargic. If you are trying to wake up the patient and ask questions during the middle of the night then this would be an expected finding but otherwise I would say the patient is lethargic. If this patient is also orientated to person, place and time then I would say the patient is "lethargic and oriented X3".

    !Chris
  9. 0
    Not that I am a WIKI fan but there is a nice chart and descriptions.......
    Altered level of consciousness - Wikipedia, the free encyclopedia

    Classification of Altered Levels of Consciousness
    Altered Levels of Consciousness - Nursing Link
  10. 0
    this was always confusing for me too! great replies! thanks!
  11. 0
    arouse is not the word you want to use, it would be rouse. and not quite in the way you did. It would be asleep, but rousable.
    Quote from Candyn
    Hello, I am a new grad RN and I am super duper confused on Neuro Assessment. I think it is best to ask neuro ICU nurse about neuro assessment

    My questions are:

    1. Is there a difference between alert, awake and arouse? To my understanding, a patient is considered normal when a patient is arousal (alert and awake) and aware. Confused state is when patient is arousal but not aware. Lethargic is when patient less alert and aware? Am I on the right track? Someone please explain further about these descriptions.

    2. I am confused between alert and lethargic. For example: if a patient is easily aroused and startled as she/he awakens when I call his/her name, but patient falls asleep almost instantly. As I continue to call his/her name, he/she is able to answer all orientation questions, is this patient considered as lethargic? How about pretty much the same one but this patient fall asleep not instantly but after few questions?
  12. 2
    i utilize these deffinitions based on hickey's " the clinical practice of neurological and neurosurgical nursing"

    full consciousness

    patient is awake, alert and oriented to time, place and person. they are able to comprehend the spoken and written word and express ideas either verbally or in writing. patient demonstrates socially responsible and acceptable behavior.

    confusion

    patient is disoriented to time, place, or person. they have a shortened attention span and memory difficulties. in addition, they may have difficulty following commands and easily become agitated, restless, and irritable. there may be nocturnal confusion.

    lethargy

    patient is oriented to time, place, and person; however, speech, mental processes, and motor activities are slower than expected.

    obtundation

    patient can only be aroused with tactile stimulation and usually responds verbally to these stimuli with only one or two words. this patient can follow simple commands only when stimulated.

    stupor

    stupor is defined as a minimal spontaneous movement of the patient except when vigorous and constant stimuli are applied. the patientís verbal response only consists of moaning or groaning. when noxious stimuli are applied to the patient, they will respond purposefully.


    coma

    coma is defined as the total absence of awareness of self and environment. coma patients do not exhibit any response to external stimulation or internal needs. patients may appear to be sleeping with no response noted to verbal stimuli. patients can exhibits purposeful or non-purposeful movement, or be completely unresponsive. patients in this category have a glasgow coma scale (gcs) rating less than 8. brainstem reflexes such as the cough and gag reflex are weakened.
    Candyn and machaix like this.


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