Alert but confused

8 I recently charted that a patient was alert, but confused and oriented x 1 to name only. I was told by one of the big wig nurse educators at our hospital that a pt. couldn't be ALERT and CONFUSED, and disoriented, she said that is a contradiction. I have been a nurse for over 25 years, and I was taught that: Alertness is a global observation of level of consciousness, awareness of, and responsiveness to the environment, and this might be described as alert, clouded or drowsy. So to me, as long as a pt isn't comatose and is responding to stimuli, they are alert! I would like to hear your opinion. Do you think a pt. can be alert but confused and disoriented????

Thanks!
I've always taken alert to mean what you described. There is a reason why we mention both words alert and oriented instead of just one or the other - because they are not synonymous. If they were, we wouldn't need to use 2 different words! My patient today was very alert, and apparently oriented x3 as far as I could see. I would never have known otherwise except that her son came out of the room distraught because she was "so confused... talking about people who have been dead for years as if they're at home and talking about a house we don't even live in any more". She had been talking about them to me as well, but I had assumed it was all true, because it sounded perfectly reasonable!

I laughed one time because I was reviewing an admission database on a neonate, and it had "alert & oriented to person, place & time." I wondered how the nurse had determined that the baby was THAT oriented, hehe! Gotta agree with you. A patient can definitely be alert and disoriented. Visit the Alzheimer's wing of any nursing home!

Quote from mytoon38I recently charted that a patient was alert, but confused and oriented x 1 to name only. I was told by one of the big wig nurse educators at our hospital that a pt. couldn't be ALERT and CONFUSED, and disoriented, she said that is a contradiction. I have been a nurse for over 25 years, and I was taught that: Alertness is a global observation of level of consciousness, awareness of, and responsiveness to the environment, and this might be described as alert, clouded or drowsy. So to me, as long as a pt isn't comatose and is responding to stimuli, they are alert! I would like to hear your opinion. Do you think a pt. can be alert but confused and disoriented????Thanks!

My MIL has Pick's dementia. She is still ambulatory, but rarely talks, She is definitely alert, but not oriented. She will look at someone who calls her name, she will mimic 'how are you today' but not answer the question. She will sing at times. She can still feed herself, but has to be reminded to keep sitting at the table. But she no longer recognizes her son, not a glimmer in her eyes. Alert, oriented to name only. Yes, it is very possible to be alert and confused.

I think Alert in itself means watchful, promt, quick to percieve and act...in order to be alert one must be oriented as well. These days (according to some recent documentation books anyway) we are encouraged to write awake...not alert. The fact that the patient is responding and eyes are open etc does not mean they are alert. So it is a contradiction when you write alert and confused....

Alert and hopefully pleasantly confused.I had a resident yesterday who was very upset because her mother hadn't come to take her home. The resident is 90. She was alert as all get out, watching for her mother like a hawk.

She may have had issue with the term "confused" as it was used. I was taught oriented x1-name, x2-name and place, x3-name, place and time. The patient may have been alert to name only, but still able to act/respond somewhat sensibly...an 80 year old knowing that their mother is dead vs. the 80 year old one that is talking to their mother....the new resident in a nursing home can be disoriented waking in the middle of the night to new surroundings vs. a resident who has been in longer who wanders, perhaps can't perform simple tasks is confused.

Quote from SuesquatchRNAlert and hopefully pleasantly confused.I had a resident yesterday who was very upset because her mother hadn't come to take her home. The resident is 90. She was alert as all get out, watching for her mother like a hawk.

Quote from IlovenursingRNWe had an elderly lady in the hospital, she was like 84, she kept saying her Mom was coming to see her and guess what? She did! Her Mom was 97 years old. Alert, orientated and ambulatory!

I agree with the OP. The bigwig is wrong! Maybe she needs to be educated as to what alert is???

Quote from webmansxI think Alert in itself means watchful, promt, quick to percieve and act...in order to be alert one must be oriented as well. These days (according to some recent documentation books anyway) we are encouraged to write awake...not alert. The fact that the patient is responding and eyes are open etc does not mean they are alert. So it is a contradiction when you write alert and confused....

Kinda makes you wonder about the educator's LOC. Should make for interesting charting 'though. "The confused, semi comatose patient ran down the hall". My problem is: if my patient is not alert I have a heck of a time figuring out whether they are confused or oriented.