Level of Consciousness (LOC) Terminology (Nursing)

00:01 Okay now, I'm gonna go through some of the terminology.

00:04 We use lots of different terminology with level of consciousness.

00:08 So we're gonna talk about everything from full consciousness down to comatose.

00:13 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.

00:20 You're alert, you're attentive, can follow commads.

00:24 If you're asleep, you would wake up pretty quickly and you would be able to follow what someone asks you to do.

00:29 Once we did wake you up, you'd be able to stay awake.

00:32 That should be your everyday person, walking through everyday life.

00:36 Now, lethargic.

00:38 Patient's kind of drowsy but they will awake but not really fully address, kind of really sleepy but you have to stimulate them.

00:45 So they'll answer questions and follow commands but they're just really not following you.

00:50 Kinda like how you feel after walking out of a pharmacology final, that's like lethargic.

00:56 Now obtunded.

00:58 Okay this person, it's a lower level than lethargic.

01:01 They're much more difficult to arouse, they kinda need constant stimulation in order to follow simple commands.

01:09 They might respond verbally with one or two words but they're gonna drift back to sleep in between.

01:14 Now stuporous takes vigorous and continuous stimulation, typically a painful stimulus is required.

01:21 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.

01:33 They might moan briefly but doesn't follow commands, only response after attempt to withdraw from the pain.

01:41 So in obtunded, you're really sleepy, you respond verbally with one or two words but you kinda go back to sleep.

01:47 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.

01:59 Now the last one is the saddest one, it's comatose.

02:04 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.

02:18 Now when we say painful stimulation, acceptable ways to do that in healthcare is to take the nailbed and press on it.

02:26 Usually we use a pen or something hard, maybe the end of a reflex hammer and you press on that nailbed.

02:32 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.

02:40 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.

02:50 If you do that to a patient who's comatose, they don't move.

02:54 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.

03:06 Okay, so we've gone through five terms.

03:09 I want you to pause the video for just a moment because that was a whole lot of information.

03:15 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.

03:31 Now, while you still have there video paused, I want you to think through a patient that you've had in the clinicals.

03:39 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.

03:47 Alright, so pause the video and we'll be back shortly.

03:54 Okay, I hope you really took advantage of that opportunity to do that because that's applying the information that you're learning.

04:02 See, that's why nursing school tests are so difficult because the questions are written on an application and an analysis type level.

04:10 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.

04:33 Okay, so you wanna be on top of it.

04:36 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.

04:43 They might become a little irritable.

04:45 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.

04:54 Because those are the first signs that something could be going wrong.

04:58 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.

05:18 You can see it's kind of vague a little bit, right? It's a little subjective.

05:22 So if you look at the term lethargic, look at our definition.

05:26 Patient is drowsy but awakens-although not fully- to stimulus.

05:30 Will answer questions and follow commands but slowly and inattentively.

05:33 Let me tell you what is better documentation.

05:36 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.

05:49 So don't just right one word, lethargic, right?.

05:52 Try this.

05:54 Mr. Johnson appears drowsy and will respond to verbal stimulus but has a difficulty with staying alert and keeping his eyes open.

06:01 He does follow simple commands to squeeze his left hand and move his left leg but often requires repeated instruction.

06:09 Okay, look how much more helpful that is than just writing, Mr. Johnson is lethargic.

06:15 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.

06:31 So don't take shortcuts in charting.

06:33 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.

06:48 Something that accurately describes what you observed with your patient in clear, concise and objective language.

06:57 Okay, those are three words I'd like you to write down.

07:01 Clear, concise and objective those are gonna be your three best friends when it comes to documenting, delegating or communicating.

07:13 Clear, concise and objective and you'll hear me say that over and over and over again.

07:20 It'll make you a better nurse, it'll help your patients get more effective care.