A postoperative patient obtained more than 13 points in Glasgow-Coma scale test. After the test, he was tired and partially lethargic. Which of the following elements of communication could be the most effective in conveying a message?

1. A

   Eye contact

2. B

   Silence

3. C

   Voice

4. D

   Gesture

Appeared in: UPUMS Nsg.Officer-2024

Explanation

• The patient's clinical state is 'tired and partially lethargic,' which means they are drowsy and not fully alert.
• For patients with a decreased level of consciousness, hearing is considered the last sense to be impaired.
• Using one's voice provides the necessary auditory stimulus to first arouse the patient from their lethargic state.
• Once aroused, the patient is able to receive and process the verbal message, making voice the most effective element of communication in this scenario.

Why Other Options Were Wrong

• Option A: This is a visual form of communication that requires the patient to be awake, alert, and able to maintain focus. A lethargic patient is drowsy and likely has their eyes closed, making eye contact impossible.
• Option B: Silence is the absence of communication. While it can be a therapeutic technique to allow a patient to rest or process thoughts, it cannot be used to actively convey a message.
• Option D: Like eye contact, gestures are a form of visual communication. They are ineffective if the patient is not visually attentive or has their eyes closed due to lethargy.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Communication with Patients with Altered Consciousness in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• A nurse must always assess a patient's level of consciousness before initiating communication to select the most appropriate method.
• For any patient with altered consciousness, always assume they can hear what is being said. Avoid holding inappropriate conversations in their presence.
• Failing to use the correct communication technique can lead to missed information, patient anxiety, and potential safety risks (e.g., if instructions about movement or medication are not understood).

How to Approach the Question

• First, identify the patient's current clinical state from the stem, which is 'tired and partially lethargic'. This is the most crucial piece of information.
• Recall the definition of lethargy: a state of drowsiness and reduced alertness, where the patient can be aroused by stimuli.
• Analyze the communication options in the context of lethargy. The primary need is to arouse the patient before a message can be delivered.
• Evaluate each option: Visual methods like 'eye contact' and 'gesture' are ineffective if the patient's eyes are closed. 'Silence' does not convey a message.
• Conclude that 'voice' is the only option that provides an auditory stimulus capable of both arousing the patient and delivering the message.

Concept Tested & Keywords

• Concept Tested: Communication with Patients with Altered Consciousness
• Stem keywords: postoperative, Glasgow-Coma scale, lethargic, communication
• Lead-in keywords: most effective
• Clinical cues: The patient's state of being 'tired and partially lethargic' is the most critical cue, indicating a decreased level of consciousness that dictates the communication strategy.
• Negative lead-in flag: false

Question ID

QfVprxMcQ-CHiUSGZHWQlY

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor pp. 940-942, 89-91