Altered mental status classification: Difference between revisions
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==Overview== | ==Overview== | ||
==Classification== | ==Classification== | ||
Scales and terms to classify the levels of consciousness differ, but in general, reduction in response to stimuli indicates an altered level of consciousness: | |||
{| class="wikitable" | |||
|+ '''Levels of consciousness''' | |||
! Level !! Summary (Kruse)<ref name="Porth07"/> !! Description | |||
|- | |||
! [[Conscious]] | |||
| Normal | |||
| Assessment of LOC involves checking [[Orientation (mental)|orientation]]: people who are able promptly and spontaneously to state their name, location, and the date or time are said to be oriented to self, place, and time, or "oriented X3".<ref name="Kruse86"> | |||
{{ | |||
cite book |author=Kruse MJ |title=Nursing the Neurological and Neurotrauma Patient |publisher=Rowman & Allanheld |location=Totowa, N.J |year=1986 |pages= 57–58 |isbn=0-8476-7451-7 |oclc= |doi= |accessdate= | |||
|url= http://books.google.com/?id=3BN3d2Ps8HAC&pg=PA57&dq=%22level+of+consciousness%22#PPA58,M1 | |||
}} | |||
</ref> A normal [[sleep]] stage from which a person is easily awakened is also considered a normal level of consciousness.<ref name="Tindall90"/> "Clouding of consciousness" is a term for a mild alteration of consciousness with alterations in attention and wakefulness.<ref name="Tindall90"/> | |||
|- | |||
! [[Confused]] | |||
|Disoriented; impaired thinking and responses | |||
| People who do not respond quickly with information about their name, location, and the time are considered "obtuse" or "[[confusion|confused]]".<ref name="Kruse86"/> A confused person may be bewildered, disoriented, and have difficulty following instructions.<ref name="Tindall90"/> The person may have slow thinking and possible memory time loss. This could be caused by sleep deprivation, malnutrition, allergies, environmental pollution, drugs (prescription and nonprescription), and infection. | |||
|- | |||
![[Delirium|Delirious]] | |||
|Disoriented; restlessness, hallucinations, sometimes delusions | |||
|Some scales have "delirious" below this level, in which a person may be restless or agitated and exhibit a marked deficit in [[attention]].<ref name="Porth07"/> | |||
|- | |||
![[somnolence|Somnolent]] | |||
| Sleepy | |||
| A ''[[somnolence|somnolent]]''<!--obtunded--> person shows excessive [[drowsiness]] and responds to stimuli only with incoherent mumbles or disorganized movements.<ref name="Kruse86"/> | |||
|- | |||
![[Obtunded]] | |||
|Decreased alertness; slowed psychomotor responses | |||
| In ''[[obtundation]]'', a person has a decreased interest in their surroundings, slowed responses, and sleepiness.<ref name="Tindall90"/> | |||
|- | |||
![[Stuporous]] | |||
| Sleep-like state (not unconscious); little/no spontaneous activity | |||
|People with an even lower level of consciousness, stupor, only respond by [[Facial expression|grimacing]] or drawing away from painful stimuli.<ref name="Kruse86"/> | |||
|- | |||
![[Coma]]tose | |||
| Cannot be aroused; no response to stimuli | |||
| Comatose people do not even make this response to stimuli, have no [[corneal reflex|corneal]] or [[gag reflex]], and they may have no [[pupillary response]] to light.<ref name="Kruse86"/> | |||
|} | |||
===Glasgow Coma Scale=== | |||
{{Main|Glasgow Coma Scale}} | |||
The most commonly used tool for measuring LOC objectively is the [[Glasgow Coma Scale]] (GCS). It has come into almost universal use for assessing people with [[Acquired brain injury|brain injury]],<ref name="Porth07">{{cite book |author=Porth C |title=Essentials of Pahtophysiology: Concepts of Altered Health States |publisher=Lippincott Williams & Wilkins |location=Hagerstown, MD |year=2007 |pages=835 |isbn=0-7817-7087-4 |oclc= |doi= |accessdate=2008-07-03 |url= http://books.google.com/?id=57RQC-3OPtUC&pg=PT858&dq=%22level+of+consciousness%22}}</ref> or an altered level of consciousness. Verbal, motor, and eye-opening responses to stimuli are measured, scored, and added into a final score on a scale of 3–15, with a lower score being a more decreased level of consciousness. | |||
===Others=== | |||
The [[AVPU]] scale is another means of measuring LOC: people are assessed to determine whether they are '''a'''lert, responsive to '''v'''erbal stimuli, responsive to '''p'''ainful stimuli, or '''u'''nresponsive.<ref name="Pollak02"/><ref name="Forgey99"/> To determine responsiveness to voice, a caregiver speaks to, or, failing that, yells at the person.<ref name="Pollak02"/> Responsiveness to pain is determined with a mild painful stimulus such as a pinch; moaning or withdrawal from the stimulus is considered a response to pain.<ref name="Pollak02"/> The ACDU scale, like AVPU, is easier to use than the GCS and produces similarly accurate results.<ref name="Posner07">{{cite book |author= Posner JB, Saper CB, Schiff ND, Plum F |title=Plum and Posner's Diagnosis of Stupor and Coma |publisher=Oxford University Press, USA |location= |year=2007 |pages=41 |isbn=0-19-532131-6 |oclc= |doi= |accessdate=}}</ref> Using ACDU, a patient is assessed for '''a'''lertness, '''c'''onfusion, '''d'''rowsiness, and '''u'''nresponsiveness.<ref name="Posner07"/> | |||
The [[Grady Coma Scale]] classes people on a scale of I to V along a scale of confusion, stupor, deep stupor, [[abnormal posturing]], and coma.<ref name="Tindall90"/> | |||
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Revision as of 01:13, 25 February 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]
Overview
Classification
Scales and terms to classify the levels of consciousness differ, but in general, reduction in response to stimuli indicates an altered level of consciousness:
| Level | Summary (Kruse)[1] | Description |
|---|---|---|
| Conscious | Normal | Assessment of LOC involves checking orientation: people who are able promptly and spontaneously to state their name, location, and the date or time are said to be oriented to self, place, and time, or "oriented X3".[2] A normal sleep stage from which a person is easily awakened is also considered a normal level of consciousness.[3] "Clouding of consciousness" is a term for a mild alteration of consciousness with alterations in attention and wakefulness.[3] |
| Confused | Disoriented; impaired thinking and responses | People who do not respond quickly with information about their name, location, and the time are considered "obtuse" or "confused".[2] A confused person may be bewildered, disoriented, and have difficulty following instructions.[3] The person may have slow thinking and possible memory time loss. This could be caused by sleep deprivation, malnutrition, allergies, environmental pollution, drugs (prescription and nonprescription), and infection. |
| Delirious | Disoriented; restlessness, hallucinations, sometimes delusions | Some scales have "delirious" below this level, in which a person may be restless or agitated and exhibit a marked deficit in attention.[1] |
| Somnolent | Sleepy | A somnolent person shows excessive drowsiness and responds to stimuli only with incoherent mumbles or disorganized movements.[2] |
| Obtunded | Decreased alertness; slowed psychomotor responses | In obtundation, a person has a decreased interest in their surroundings, slowed responses, and sleepiness.[3] |
| Stuporous | Sleep-like state (not unconscious); little/no spontaneous activity | People with an even lower level of consciousness, stupor, only respond by grimacing or drawing away from painful stimuli.[2] |
| Comatose | Cannot be aroused; no response to stimuli | Comatose people do not even make this response to stimuli, have no corneal or gag reflex, and they may have no pupillary response to light.[2] |
Glasgow Coma Scale
The most commonly used tool for measuring LOC objectively is the Glasgow Coma Scale (GCS). It has come into almost universal use for assessing people with brain injury,[1] or an altered level of consciousness. Verbal, motor, and eye-opening responses to stimuli are measured, scored, and added into a final score on a scale of 3–15, with a lower score being a more decreased level of consciousness.
Others
The AVPU scale is another means of measuring LOC: people are assessed to determine whether they are alert, responsive to verbal stimuli, responsive to painful stimuli, or unresponsive.[4][5] To determine responsiveness to voice, a caregiver speaks to, or, failing that, yells at the person.[4] Responsiveness to pain is determined with a mild painful stimulus such as a pinch; moaning or withdrawal from the stimulus is considered a response to pain.[4] The ACDU scale, like AVPU, is easier to use than the GCS and produces similarly accurate results.[6] Using ACDU, a patient is assessed for alertness, confusion, drowsiness, and unresponsiveness.[6]
The Grady Coma Scale classes people on a scale of I to V along a scale of confusion, stupor, deep stupor, abnormal posturing, and coma.[3]
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- ↑ 1.0 1.1 1.2 Porth C (2007). Essentials of Pahtophysiology: Concepts of Altered Health States. Hagerstown, MD: Lippincott Williams & Wilkins. p. 835. ISBN 0-7817-7087-4. Retrieved 2008-07-03.
- ↑ 2.0 2.1 2.2 2.3 2.4 Kruse MJ (1986). Nursing the Neurological and Neurotrauma Patient. Totowa, N.J: Rowman & Allanheld. pp. 57&ndash, 58. ISBN 0-8476-7451-7.
- ↑ 3.0 3.1 3.2 3.3 3.4 Invalid
<ref>tag; no text was provided for refs namedTindall90 - ↑ 4.0 4.1 4.2 Invalid
<ref>tag; no text was provided for refs namedPollak02 - ↑ Invalid
<ref>tag; no text was provided for refs namedForgey99 - ↑ 6.0 6.1 Posner JB, Saper CB, Schiff ND, Plum F (2007). Plum and Posner's Diagnosis of Stupor and Coma. Oxford University Press, USA. p. 41. ISBN 0-19-532131-6.