Alert but confused

Nurses General Nursing

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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 am a student and am attempting to write my final care plan for this semester. However, I am not sure what/how to write the alert and oriented statement. My patient is in her 90's and has dementia (unspecified), but seems to have more short-term memory loss than dementia related problems. She forgets who you are after an hour or so, asked my name about 5 times in 4 hours (and had to read my badge to understand my name), asked me when I was graduating about 4 times in 20 minutes...Yet, she knew who her normal CNA was (not sure of name but responded to and talked to her as if she was used to her care) and she spoke of her children who are still alive and one that passed away. Then she would have periods where she thought she was being punished when she had done nothing wrong, she would regress back to times of slavery (client is an African American female and lived through this time period) or complain that her meals were not the same size as the other residents... I am not sure how to write the A&O statement as the client seemed alert when speaking with her and she knew where she was, who she was, and most of what was going on around her, just not all of it...she was confused. Also, how does alert and oriented work if they forget the information in 10-20 minutes? At the time they know what is going on. Any advice?

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\ said:

I am a student and am attempting to write my final care plan for this semester. However I am not sure what/how to write the alert and oriented statement. My patient is in her 90's and has dementia (unspecified), but seems to have more short-term memory loss than dementia related problems. She forgets who you are after an hour or so, asked my name about 5 times in 4 hours (and had to read my badge to understand my name), asked me when I was graduating about 4 times in 20 minutes...Yet, she knew who her normal CNA was (not sure of name but responded to and talked to her as if she was used to her care) and she spoke of her children who are still alive and one that passed away. Then she would have periods where she thought she was being punished when she had done nothing wrong, she would regress back to times of slavery (client is an African American female and lived through this time period) or complain that her meals were not the same size as the other residents... I am not sure how to write the A&O statement as the client seemed alert when speaking with her and she knew where she was, who she was, and most of what was going on around her, just not all of it...she was confused. Also, how does alert and oriented work if they forget the information in 10-20 minutes? At the time they know what is going on. Any advice?

I will write Awake Alert Oriented x 2, with conversational confusion. I might also chart Awake Alert Oriented with Short Term Memory impairment. Resident able to recall ... however will state "I am a slave" during the conversation. You might also completely document AO like this... Resident AOx3, able to recall name, place and date. Resident able to perform simple math and stated that six quarters totaled 1.50. Resident unable to name current President and at times will state she is a slave in Skewed Southern State. Resident has poor short term recall and is only able to recall one item (Apple) out of three ( Apple, car, ball). Resident is aware of current situation and health status.

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interesting article if i was documenting i would tend to use a gcs value as we do this for every pateint with a descriptor to e/v/m and verbal would get narrative accounts. i dislike avpu as its too vague.

i nursed many confused due to dementia patient most have a sleep wake cycle can sing eat etc but for example dress themselves in the right order, need residental care cause they wander at night as they cant find the was home. my own mother has mild cognitive impairment is alert but sruglles with task etc and is easily disorinetated to confused as times.

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Where is this woman from that she was a slave? We got rid of that quite a long time ago here.....

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I suppose I would just not use the word "alert" in this case if that's what The Powers That Be really want. Picking your battles and all that.

Maybe just chart that the pt responds to questions and obeys simple commands, but is not alert to place or time.

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Specializes in Med-Surg.
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Where is this woman from that she was a slave? We got rid of that quite a long time ago here.....

LOL thank you! I saw that and wondered just how old this woman was if she lived through slavery(if she grew up in north America of course)!

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Specializes in long term care Alzheimers Patients.
\ said:
Where is this woman from that she was a slave? We got rid of that quite a long time ago here.....

I was thinking the same thing

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I dislike avpu as its too vague.

AVPU describes levels of Responsiveness. If you have a patient that is Awake and Alert, then the AVPU scale is unnecessary. You may have a patient that may respond to LOUD Verbal stimulus, Painful stimulus or not Respond (Unresponsive) at all. It is used in conjunction with GCS, but not as a way to describe levels of alertness.

You can have someone who is Awake, Alert but not Oriented, or you can have someone who is Awake, NOT Alert, NOT Oriented, as in someone who is in a catatonic state.

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JessiG said:
I am not sure how to write the A&O statement as the client seemed alert when speaking with her and she knew where she was, who she was, and most of what was going on around her, just not all of it...she was confused. Also, how does alert and oriented work if they forget the information in 10-20 minutes? At the time they know what is going on. Any advice?

I would document (from your description) "Awake and alert, intermittently oriented to person and place (not date/time), alternating with episodes of confusion."

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Big wig nurse educator needs some edumacation.! Feel free to do so.

Interesting that your thread is on the same page as Mad Wife's "Admitting when You're Wrong " article.

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Specializes in ICU.

I have been charting "alert, knows name, blah blah blah, confused to place, situation, time, blah blah." Nobody has ever said it was incorrect. Of course you can be alert, but confused. I am all the time, ha ha!

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Specializes in Med Surg.
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!

The big wig nurse educator is incorrect.

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