This chart highlights the six stages of altered arousal. An alert patient responds to voice and exhibits purposeful movement and appropriate spontaneous activity.
Stage | Manifestations |
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Confusion | - Loss of ability to think rapidly and clearly
- Impaired judgment and decision making
|
Disorientation | - Beginning of loss of consciousness
- Disorientation to time progressing to disorientation to place
- Impaired memory
- Lack of recognition of self (last)
|
Lethargy | - Limited spontaneous movement or speech
- Easily aroused by normal speech or touch
- Possible disorientation to time, place, or person
|
Obtundation | - Mild to moderate reduction in arousal
- Limited responsiveness to environment
- Ability to fall asleep easily without verbal or tactile stimulation
- Minimum response to questions
|
Stupor | - State of deep sleep or unresponsiveness
- Arousable with difficulty (motor or verbal response only to vigorous and repeated stimulation)
- Withdrawal or grabbing response to stimulation
|
Coma | - No motor or verbal response to external environment or any stimuli
- No response to noxious stimuli such as deep pain
- Not arousable by any stimulus
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