Symptom: Drowsiness

Initial Grading Reminder

CTCAE grading of drowsiness:

Grade 1: Mild increased need for sleep
Grade 2: Moderate increased need for sleep
Grade 3: Severe increased need for sleep

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly?

Note: More sudden onset would be suggestive of an endocrinopathy

Grade the symptom

Ask the patient:

How drowsy are you? Do you feel rested when you wake up?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you feel drowsy all day? Do you have severe head pain with vision changes, fever, nausea, and vomiting? Do you have any yellowing of the skin or eyes or any swelling in your abdomen (belly)?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Patients with severe drowsiness should be seen.

    If patients have any of the red-flag symptoms, they should be seen immediately.

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    Nursing Assessment of Potential Causes

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    Differential Diagnosis

    What do you suspect is the cause of the drowsiness?