What do you consider to be "obtunded"?

[solneeshka, BSN, RN]

This question came up at work last night and I'm curious as to what you all think. Some thought of it as snowed, blotto. Essentially, drunk or high. Others thought of it as one step away from a coma. We had a pt on psych meds and guaifenesin whose VS were normal but as for alertness was out of it. Did not arouse to voice, required touch and voice. Even when awakened, didn't really wake up all the way. You could wake him up but you couldn't have had a conversation with him. Most people are little out of it when you wake them up in the middle of the night - this was beyond that. Like someone who was, well, snowed. He knew who he was, where he was, there did not seem to be an issue of orientation, just LOC. "Obtunded"? Or no?

[GilaRRT]

It literally means to be mentally dulled. This is much too general of a term to utilise in actual practice. Stick to charting specific signs and symptoms.

[gwapo]

This question came up at work last night and I'm curious as to what you all think. Some thought of it as snowed, blotto. Essentially, drunk or high. Others thought of it as one step away from a coma. We had a pt on psych meds and guaifenesin whose VS were normal but as for alertness was out of it. Did not arouse to voice, required touch and voice. Even when awakened, didn't really wake up all the way. You could wake him up but you couldn't have had a conversation with him. Most people are little out of it when you wake them up in the middle of the night - this was beyond that. Like someone who was, well, snowed. He knew who he was, where he was, there did not seem to be an issue of orientation, just LOC. "Obtunded"? Or no?

yes, your patient was obtunded. if he arouses but could not say a word, or just mumbles/ incomprehensible sounds and then falls right back to sleep, then he is stuporous. next to that is coma.

[SusanKathleen, RN]

This is why I like the Modified Ramsay Sedation Scale. Specific enough to describe the behaviors well. Obtunded to me means 'comatose', but I discovered that vague terms, like 'comatose' or 'obtunded' don't relay accurate information.

[RNperdiem, RN]

You can arouse him briefly but he does not stay awake/focused to answer questions, than he is obtunded.

If he is not closely monitored, watch out for his airway and breathing.

[canoehead, BSN, RN]

Just note the Glasgow Coma Scale, or sedation scale, or write what you see. Words like obtunded, stuporous, and lethargic can mean different things to different people, and it's wise to just describe the situation objectively.

[rotteluvr31, ADN, RN]

our computer charting includes lethargic, obtunded, stuperous and comatose for assessment choices for LOC. I believe the reference text describes obtunded as being, among other things, difficult to rouse and falling asleep while speaking.