| Levels of Consciousness | ||
| *Alert | Normal | *Patients who are alert is awake or easily awakened by voice from a normal sleep stage are considered alert. |
| *Lethargic | *Drowsy | *Patients who awaken briefly and answer questions appropriately but easily fall asleep care considered lethargic. |
| Somnolent | *Very drowsy | *Somnolent patients show excessive drowsiness and respond to stimuli with incoherent mumbles or disorganized movements. |
| Obtunded | Severely decreased alertness; slowed psychomotor responses | *Obtunded patients have decreased interest in their surroundings, very slow responses, and excessive sleepiness. |
| Stuporous | Sleep-like state (not unconscious); little/ no spontaneous activity | *Stuporous patients only respond by grimacing or withdrawing from painful stimuli. |
| Comatose | *Unarousable | *No response to any stimuli |
| *Mental Status | ||
| Oriented | Normal | *Patients who are able to spontaneously state their name, location, and date or time correctly are considered oriented X 3. |
| *Confused | Disoriented | *Patients who are not able to respond quickly with information about their name, location, or time are confused. |
| Delirious | Disoriented, restless, hallucinations, sometimes delusions | *Patients who are confused as well as agitated, restless, or hallucinating are considered delirious. |
Two really important parts of neurological assessment are level of consciousness and mental status. In fact, level of consciousness is THE most basic and sensitive indicator of altered brain function. If we have a patient who is awake and alert for the 0700 assessment, but becomes lethargic or somnolent as the day progresses, this tells us that something is most definitely NOT RIGHT! While Level of Consciousness (LOC) describes how awake the patient is, mental status describes how oriented to their surroundings a patient is. A patient that is
awake, watching TV, and able to state their name, location, and the time accurately is considered awake, alert and oriented X 3 (AAO X 3). This patient’s level of consciousness and mental status are considered normal. What about a patient who is awake but unable to state where they are or what year it is? This patient is alert, but confused to place and location. The Glasgow Coma Scale is the tool we use to assign a numerical value for patients with altered LOC or mental status. It gives us an objective, measurable baseline assessment of the patient’s neuro status so we are able to easily identify and document changes.
