Okay now, I'm gonna go through
some of the terminology.
We use lots of different terminology
with level of consciousness.
So we're gonna talk about everything
from full consciousness down to comatose.
Now, somebody who's fully conscious
that should be you on a good day,
not after a big nursing school
exam, but on a good day.
You're alert, you're
attentive, can follow commads.
If you're asleep, you would
wake up pretty quickly
and you would be able to follow
what someone asks you to do.
Once we did wake you up,
you'd be able to stay awake.
That should be your everyday person,
walking through everyday life.
Patient's kind of drowsy but they will
awake but not really fully address,
kind of really sleepy but
you have to stimulate them.
So they'll answer questions and follow commands
but they're just really not following you.
Kinda like how you feel after walking out of
a pharmacology final, that's like lethargic.
Okay this person, it's a
lower level than lethargic.
They're much more difficult to arouse, they kinda need
constant stimulation in order to follow simple commands.
They might respond verbally with one or two words
but they're gonna drift back to sleep in between.
You know that feeling when you're
trying to drive and stay awake
and you have to really keep doing something,
roll the window down, cold air, slap your legs,
something to stay awake 'cause
you keep wanting to fall asleep.
That's more along the
lines of obtunded.
Now stuporous takes vigorous and continuous
stimulation, typically a painful stimulus is required.
So we've gone from fully awake and alert and
talking to kinda lethargic and drowsy
to obtunded where you keep falling asleep to stuporous
requires constant stimulation that's painful.
They might moan briefly but doesn't follow commands,
only response after attempt to withdraw from the pain.
So in obtunded, you're really sleepy, you
respond verbally with one or two words
but you kinda go back to sleep.
Stuporous, they're not gonna follow commands, what they
might do in movement as far is to try to get you away,
pull their hands back or do whatever for using
painful stimulus but they're not following commands.
Now the last one is the
saddest one, it's comatose.
We use that term pretty frequently, you
see it on TV and all these medical shows
but when a medical person
uses the word comatose,
that's someone who does not respond
to continuous or painful stimulation.
Now when we say painful stimulation,
acceptable ways to do that in healthcare
is to take the nailbed
and press on it.
Usually we use a pen or something hard,
maybe the end of a reflex hammer
and you press on that nailbed.
When you use something like
a pen, not just my thumb,
but if you just use a pen or the end
of the hammer, that's pretty painful.
I mean go ahead and try it on yourself, take the
pen you have around there, press on your nailbed,
you'll see that it doesn't take pretty much
pressure for you to feel it and want it to stop.
If you do that to a patient who's
comatose, they don't move.
They might maybe reflexively move a little bit
and we'll talk about those types of reflexes
but they don't speak to you, they don't make a
sound and they don't do purposeful movement.
Okay, so we've gone
through five terms.
I want you to pause the video for just a moment
because that was a whole lot of information.
Think through each one of these terms, make any
notes that you think would be helpful to you
and make sure you have a beginning
understanding of the difference between:
full consciousness and stuporous,
full consciousness and lethargic,
make sure that's
clear in your mind.
Now, while you still have there video paused, I want you
to think through a patient that you've had in the clinicals.
Pick which one of these five levels
this patient would have been
and give yourself some reasons on
why you think that to support it.
Alright, so pause the video
and we'll be back shortly.
Okay, I hope you really took advantage
of that opportunity to do that
because that's applying the
information that you're learning.
See, that's why nursing
school tests are so difficult
because the questions are written on an
application and an analysis type level.
So the more you try on applying information
you're learning, as you learn it,
the better it's gonna be encoded in your brain,
the better you're gonna be able to retrieve it
which means you do better on your scores and most
important, take better care of your patients
because it's critically important that you recognize the
smallest neuro and mentation changes in your patient.
Okay, so you wanna
be on top of it.
Now usually the first changes that the patient's
starting to have some neuro problems,
is their personality or behaviors
will start to be a little different.
They might become a
If a family member tells you,
"You know, something's not just quite right about my
mom, my dad, my husband, my wife...", listen to them.
Because those are the first signs
that something could be going wrong.
It might be a neuro problem, it
might be an oxygenation problem
but don't just brush off what someone who
knows your patient outside of the hospital,
when they tell you something
is not right, listen, okay?
So we gave you the definitions of lethargic but
a lot of people interpret them different ways.
You can see it's kind of vague a little
bit, right? It's a little subjective.
So if you look at the term
lethargic, look at our definition.
Patient is drowsy but awakens-although
not fully- to stimulus.
Will answer questions and follow
commands but slowly and inattentively.
Let me tell you what is
I wrote an example down there for you because it's
more useful to your other healthcare team members,
your other fellow nurses, physicians, PA's and nurse
practitioners if you give them a better descrption.
So don't just right one
word, lethargic, right?.
Mr. Johnson appears drowsy and
will respond to verbal stimulus
but has a difficulty with staying
alert and keeping his eyes open.
He does follow simple commands
to squeeze his left hand
and move his left leg but often
requires repeated instruction.
Okay, look how much more helpful that is
than just writing, Mr. Johnson is lethargic.
Okay this tells me when I'm
the next nurse coming on,
I have a much better feel for what Mr. Johnson is like
so I can replicate exactly what the nurse before me did
and see if Mr. Johnson's responding in a way
that's different, if it's better or if it's worse.
So don't take shortcuts
These are things that will help get your patient
get better care, you're a better advocate for them
and heaven forbid, if you ever
had to go to a court for a case,
this is the kind of documentation that you
wanna see up on that wall in the court room.
Something that accurately describes
what you observed with your patient
in clear, concise and
Okay, those are three words
I'd like you to write down.
Clear, concise and objective
those are gonna be your three best friends when it
comes to documenting, delegating or communicating.
Clear, concise and objective
and you'll hear me say that
over and over and over again.
It'll make you a better nurse, it'll help
your patients get more effective care.