Awake, alert; oriented to person, place, and time; comprehends spoken and written word; able to express ideas verbally or in writing; responds to all stimuli, including verbal commands
Confusion
Disoriented to person, place and/or time; shortened attention span; memory difficulty; difficulty following commands; may be agitated, restless
Lethargy
Appears oriented to time, place and person; drowsy but makes spontaneous movements; can be aroused with verbal stimuli; slowed and sluggish speech, thought and actions; delayed responses
Obtunded
Responds verbally with a word; arousable with loud verbal or light tactile stimuli; drifts off when not stimulated; appears very drowsy, able to follow simple commands
Stupor
Generally unresponsive; minimal spontaneous movement; must be shaken or shouted at to arouse; incomprehensible verbalization, may open eyes; responds appropriately to painful stimuli
Coma
Appears to be sleeping; cannot be aroused, even with use of painful stimuli; no verbal response; may have some reflex activity (such as gag reflex) depending on the level of coma
Source: Adapted from Hickey, J. V., & Strayer, A. L. (Eds.). (2020). The clinical practice of neurological and neurosurgical nursing (8th ed.). Wolters Kluwer and Hinkle, J. L., Cheever, K. H., & Overbaugh, K. (2022). Brunner & Suddarth's Textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.