Is the Patient Confused, Lethargic, or Disoriented?
This is the second question to be asked at decision point B. Again the concern is whether the patient is demonstrating an acute change in level of consciousness. Patients with a baseline mental status of confusion do not meet level-2 criteria. • Confused: Inappropriate response to stimuli, decrease in attention span and memory. • Lethargic: Drowsy, sleeping more than usual, responds appropriately when stimulated. • Disoriented: The patient is unable to answer questions correctly about time, place or person. Examples of patients who are confused, lethargic, or disoriented: • New onset of confusion in an elderly patient. • The 3-month-old whose mother reports the child is sleeping all the time. • The adolescent found confused and disoriented. Each of these examples indicates that the brain may be either structurally or chemically compromised.
