Symptom: Foggy, Feeling

Initial Grading Reminder

CTCAE grading of fogginess:

Grade 1: Mild disorientation
Grade 2: Moderate disorientation; limiting instrumental ADLs
Grade 3: Severe disorientation; limiting self-care ADLs
Grade 4: Life-threatening consequences; urgent intervention indicated
Grade 5: Death

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you ever felt foggy before? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Any new medications (e.g., lorazepam or other benzodiazepines)? Are you taking any OTCs, supplements, or marijuana?

Grade the symptom

Ask the patient:

How disoriented/inattentive do you feel? Does it come and go? Is it affecting your ability to take care of yourself?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Any problems with eating/drinking? Any sores in your mouth? How much fluid are you drinking per day? Do you have any severe head pain with vision changes, fever, nausea and vomiting while feeling confused or tired?

Do you have a headache plus a stiff neck? Have you had any sleepiness, hallucinations, seizures? Is your skin turning yellow or do you have a swollen 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 new-onset moderate or worse (or worsening) fogginess need to be seen.

    Patients with the red-flag symptoms need to 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 fogginess?