Levels of Consciousness

Alert

awake and aware of environment; follows directions

Clouding of consciousness

a very mild form of altered mental status in which the patient has inattention and reduced wakefulness

Confusional state

more profound deficit that includes disorientation, bewilderment, and difficulty following commands

Lethargy

severe drowsiness in which the patient can be aroused by moderate stimuli and then drift back to sleep

Obtundation

state similar to lethargy in which the patient has a lessened interest in the environment, slowed responses to stimulation, and tends to sleep more than normal with drowsiness in between sleep state

Stupor

only vigorous and repeated stimuli will arouse the individual, and when left undisturbed, the patient will immediately lapse back to the unresponsive state

Coma

state of unarousable unresponsiveness. Noxious stimuli used to test clients in coma or stupor

Minimally conscious vegetative state

coma with irregular sleep wake cycles, VS stable

Persistent vegetative state

coma 1 year after TBI or 3 months after anoxic brain injury