Difference Between Lethargic And Obtunded

Can you experienced nurses shed some light on this assessment parameter so that I might better understand lethargic vs obtunded? Specialties Neuro Article

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Difference Between Lethargic And 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.

Understanding Lethargic vs Obtunded

suzanne4 said:
I do not agree with your preceptor. Any time that you really need to physically stimulate a patient to get any type of response 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.

alisaf23 said:
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.

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wonderbee

About wonderbee, BSN, RN

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Specializes in ICU.

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/art.asp?articlekey=4614

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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.

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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.

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Specializes in critical care; community health; psych.

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!

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The terminology goes like this (in this order of progression) confusion=> lethargy=> obtunded=> stupor=> coma

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Specializes in ICU, Education.

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).

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Specializes in Intensive Care Unit.

What do you mean by the abbreviation SAH/SDH

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SAH=subarachnoid hemorrhage

SDH=subdural hemorrhage;)

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Specializes in Intensive Care Unit.

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 ???

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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 .......:lol2:

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So where does "somnolent" fit in this hierarchy of rousability?

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