Alert but confused

greenbeanio · Dec 26, 2009

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!

wooh, BSN, RN · Dec 26, 2009

I laughed one time because I was reviewing an admission database on a neonate, and it had "alert & oriented to person, place & time." I wondered how the nurse had determined that the baby was THAT oriented, hehe!

Gotta agree with you. A patient can definitely be alert and disoriented. Visit the Alzheimer's wing of any nursing home!

oramar · Dec 26, 2009

mytoon38 said:
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!

I agree with you. People can be quite alert and still confused. Some Ivy Tower nurse you got there giving you a hard time. My mother has sever frontal lobe dementia and short term memory loss. Yesterday she went to a Christmas party with me. She made a fuss over the babies. Talked to the other guest greeting them all the while smiling and happy, glad to be out. She actually danced a bit and sang songs. However, sometimes she thinks I am her mother or sister, once in a while she will remember I am her daughter. It has been a year or so since she knew my name. What would you call a person who is dancing and singing songs but doesn't know what the date or time happens to be, BUT alert AND confused. She has no concept of time or place, however she recognizes the faces of her immediate family and feels safe with them. She is alert, oriented to person but not to place or time. That is my call, it would be interesting to hear what other people say.

mamamerlee, LPN · Dec 26, 2009

My MIL has Pick's dementia. She is still ambulatory, but rarely talks, She is definitely alert, but not oriented. She will look at someone who calls her name, she will mimic 'how are you today' but not answer the question. She will sing at times. She can still feed herself, but has to be reminded to keep sitting at the table. But she no longer recognizes her son, not a glimmer in her eyes.

Alert, oriented to name only. Yes, it is very possible to be alert and confused.

webmansx, ASN, RN · Dec 26, 2009

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.... :twocents:

SuesquatchRN, BSN, RN · Dec 26, 2009

Alert and hopefully pleasantly confused.

I had a resident yesterday who was very upset because her mother hadn't come to take her home. The resident is 90. She was alert as all get out, watching for her mother like a hawk.

kathy313 · Dec 26, 2009

She may have had issue with the term "confused" as it was used. I was taught oriented x1-name, x2-name and place, x3-name, place and time. The patient may have been alert to name only, but still able to act/respond somewhat sensibly...an 80 year old knowing that their mother is dead vs. the 80 year old one that is talking to their mother....the new resident in a nursing home can be disoriented waking in the middle of the night to new surroundings vs. a resident who has been in longer who wanders, perhaps can't perform simple tasks is confused.

IlovenursingRN · Dec 27, 2009

SuesquatchRN said:
Alert and hopefully pleasantly confused.
I had a resident yesterday who was very upset because her mother hadn't come to take her home. The resident is 90. She was alert as all get out, watching for her mother like a hawk.

We had an elderly lady in the hospital, she was like 84, she kept saying her Mom was coming to see her and guess what? She did! Her Mom was 97 years old. Alert, orientated and ambulatory!

nyteshade, BSN · Dec 27, 2009

I agree with the OP. The bigwig is wrong! Maybe she needs to be educated as to what alert is???

morte, LPN, LVN · Dec 27, 2009

webmansx said:
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...

systoly · Dec 27, 2009

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.