Help with words? "Nodding off"

[Raviepoo]

I'm looking for a medically appropriate way to say, "nodding off." I want to describe a patient who would repeatedly become lethargic for a few seconds at a time after taking a narcotic. Any suggestions?

[NICU Guy, BSN, RN]

Somnolent= excessive drowsiness and responds to stimuli only with incoherent mumbles.

Obtunded= decreased interest in their surroundings, slowed responses, and sleepiness

[mluvsgnc]

"S/S of excessive sleepiness AEB frequent head bobbing, closing of eyes, mumbling, etc."

or

"The pt. appeared soporific" (which, as an adjective, means to induce drowsiness or sleep).

[AnnieOaklyRN, BSN, RN, EMT-P]

That is a good question...

[caliotter3]

I've used somnolent before but usually describe the appearance like mluvsgnc does. Haven't seen anyone that I wanted to call obtunded yet.

[anon456, BSN, RN]

I've used somnolent before but usually describe the appearance like mluvsgnc does. Haven't seen anyone that I wanted to call obtunded yet.

Off topic, but I use obtunded often to describe patients who are neurologically devastated at baseline. I also mention that they are at baseline (for the ones I know well and come in often).

Getting back to OP's question, I might say something like one or more of the following: "appears to be sleeping between cares, mildly lethargic for approximately one hour after (specific med) is administered, arouses briefly to touch/voice/with cares." You can't state what they are themselves feeling, but you can say what it looks like.

[applewhitern, BSN, RN]

We try to avoid using the word "appears" but rather chart exactly what we see. We also don't chart "sleeping, or asleep, etc." If your patient died shortly thereafter it would look like he was actually dead when you thought he was sleeping. I use "eyes closed, resp. even and unl; skin warm to touch" to indicate the patient is asleep, but obviously alive. Just chart "lethargic but easily aroused" if he is simply falling asleep from a narcotic.

[Anna Flaxis, BSN, RN]

"Drowsy but rouses to voice"

[Raviepoo]

Hmmmm. All good suggestions. My patient was A&O x4 but had intermittent, very brief spells of somnolence after getting his meds. He would fall asleep, and then wake, sometimes with a startle. I have experienced something like that when exhausted and also observed it in recreational drug users. I want to capture the fact that it was brief and intermittent.

Did I miss something with him? The idea terrifies me. I work in LTC with people who are stable. I'm in my last semester of RN school, only just starting to work with medically complicated patients. The staff nurse was in and out of the room constantly and I told her and my instructor about the episodes. I hope he's OK.

[Esme12, ASN, BSN, RN]

Hmmmm. All good suggestions. My patient was A&O x4 but had intermittent, very brief spells of somnolence after getting his meds. He would fall asleep, and then wake, sometimes with a startle. I have experienced something like that when exhausted and also observed it in recreational drug users. I want to capture the fact that it was brief and intermittent.

Did I miss something with him? The idea terrifies me. I work in LTC with people who are stable. I'm in my last semester of RN school, only just starting to work with medically complicated patients. The staff nurse was in and out of the room constantly and I told her and my instructor about the episodes. I hope he's OK.

First of all....this is a perfectly normal response to receiving IV narcotics...as long as they are breathing they are fine.

Sep 28 by Raviepoo

I'm looking for a medically appropriate way to say, "nodding off." I want to describe a patient who would repeatedly become lethargic for a few seconds at a time after taking a narcotic. Any suggestions?

After rx for pain...Patient observed...eyes closed, resp. even and unlabored; skin warm to touch, color good. Arouses to verbal/tactile stimuli.

The immediate "nodding off" is a perfectly acceptable response to IV narcs and noting to be concerned over as long as they are breathing with a good O2 sat and is no cause for alarm.

[firstinfamily, RN]

I would describe what you are seeing, vital signs along with overall appearance. You could describe it as increased lethargy noted after medication(name) administration and if the response is to voice, tactile or pain stimulation. Also, is the patient sleeping at night? Most have disturbed sleep when they are in any facility, so you might want to initiate a sleep log that would record when the pt is actually sleeping. Perphaps they are only sleeping around 4 hours a night etc which would cause them to be a little drowsy during the day and moreso after a narcotic medication. Does the narcotic dose need to be reduced?

[anon456, BSN, RN]

We try to avoid using the word "appears" but rather chart exactly what we see. We also don't chart "sleeping, or asleep, etc." If your patient died shortly thereafter it would look like he was actually dead when you thought he was sleeping. I use "eyes closed, resp. even and unl; skin warm to touch" to indicate the patient is asleep, but obviously alive. Just chart "lethargic but easily aroused" if he is simply falling asleep from a narcotic.

Interesting how it differs from place to place. We have a place to actually check "appears asleep." I was told that saying they actually are asleep is an accusation!