Oriented X 3

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    How do you all check orientation in the elderly in LTC. Most of them are oriented to self, but what is the best way to check time and place. Do we really expect them to know the date, even the month when every day to them is the same routine. and how about place? Do you know where you are? What are the questions you ask?

    Bea
    somenurse likes this.
  2. 9 Comments so far...

  3. 1
    For place, I say, "do you know what kind of place this is? A church, a nursing home, a school?" Or time, I do month or season. I don't expect everyone to know the date, I barely do.
    somenurse likes this.
  4. 0
    For place I ask "can you tell me where we are"? If the answer is correct regardless of what it is, such as "in my room...in my bed...if they name the town or building name....or even if they simply say which state we are in..., etc., then I consider them oriented. This shows they have properly perceived the question and answered to the best of their ability.
  5. 1
    Ask them about their birthday - they usually remember that one. Also if I comment about obvious seasonal/holiday decorations to see if they can connect pumpkin (Halloween) and Santa (Christmas). Older men can often recall military service esp if they have the old tattoos. I then proceed accordingly to the answers I get.
    somenurse likes this.
  6. 0
    Such a great question, just posting to follow, as a person can be partially oriented, or intermittently oriented. And even when a person IS ox3, they can still not be 'right' or safe to be alone.
    And, like someone said above, one can not be able to tell the date, etc, yet, could be super oriented!! could be your coworker!

    The better you know a person, the easier it is to assess their neuro and cognitive status, imo. I never much ask the date or day for some patients.

    My own dad, in his later years, would always ace any orientation test you gave him, yet, made exxxxtremely poor decisions, was a danger to his own self, based on a type of confusion caused by his deteriorating mental status, and was NOT safe alone, yet, was def Ox3....most of the time.
    Examples, he would embellish doctors orders to the point they were no longer anything much like what the doctor advised, he'd forget things, like to take off his old nitro patch when he applied a new one, (ended up in ER with 8 nitro patches on)
    or, double up on meds cuz he thought "If one pill is good, two must be better" (no matter how many times we tried to teach this to him)
    light candles and leave the room, leave the oven on, (for days), overdo things (all the time) become victim of scams, super vulnerable to infomercials, ordering things he had no need of, did odd and goofy things financially and medically, as well as severely forgetful beyond words. He was very difficult to teach things, required repeated advice and instruction, yet, still would do stuff that made me gasp sometimes, even after being taught how/what to do. He wasn't exactly "noncompliant" as he wanted to do right thing, but, he no longer had the mental capacity to do the right thing.

    He was still sweet, adorable man, everyone adored him, he just was no longer completely safe alone anymore.
    As a younger man, he was quite sharp, but, as an oldster, he was no longer safe alone....yet, he WAS technically oriented...he just had an ever growing cognitive deficit and forgetfulness..

    He was also fragilely orientated, like many oldsters, he was more oriented in his home, but lost it in hospitals with all the stimulation. He was a notorious sundowner if not at home. And yes, he ended up with one of us always with him, 24.7, in final years.

    To detect the kind of mental deterioration that my own dad suffered with, one had to have a fairly indepth conversation, cuz he sure could pass an orientation test. Of course, having an indepth conversation with every patient, is not feasible.
    Last edit by somenurse on Feb 10, '13
  7. 1
    Quote from MarggoRita
    For place I ask "can you tell me where we are"? If the answer is correct regardless of what it is, such as "in my room...in my bed...if they name the town or building name....or even if they simply say which state we are in..., etc., then I consider them oriented. This shows they have properly perceived the question and answered to the best of their ability.

    Yeah that answer would get more probing from me. Patients sometimes know theyre not quite right and try to cover up their confusion by stating "in my room", so I would ask in your room where? Granted I work in a hospital and the focus is a bit different from a nursing home I try to ask pretty specific questions. The only one im leniant on is the specific day, it gets confusing, as long as they are close.
    somenurse likes this.
  8. 1
    Half of our residents are able to state exactly where they are, the other half have varying degrees of dementia, and we are rural with many of our residents not from our area, so as long as they are not claiming to be in school or on a cruise ship... And their answer is correct... I have to give them credit for being as oriented as their circumstances allow. They do not get out, do not travel into the city, do not necessarily have anything to link their whereabouts to since usually when they are new arrivals they are ill and confused, after that they are simply home with us...often having never been to our town before. Without stimuli of normal life routines, it is easy to lose grasp of your exact whereabouts just as it is to lose grasp of the exact date.
    somenurse likes this.
  9. 1
    Once upon a time, I screened applicants for Medicaid long term care to determine if they met the medical/nursing criteria. I was accompanied by social workers, who performed psycho-social assessments, including orientation. Some SWs would ask the specific date, which hardly anyone would know. I would laugh to myself b/c I wouldn't know 1/2 the time if I didn't have my laptop fired up. Did that mean I wasn't A&O x 3? Here's what the more seasoned SWs would ask the elderly clients:
    -What is your full name?
    -Where are you right now?
    -What year is it? What month is it? What day of the week is it?
    They would also ask leading questions to help people out who seemed to feel put on the spot, but fully capable of answering the questions.
    I just don't think it's reasonable to expect someone who hasn't needed to know the date in years and has the same routine every day to know the exact date.
    somenurse likes this.
  10. 1
    There's lots of questions you can ask if you're trying to gauge how "with it" residents are.

    And after you really get to know your residents, you know exactly which questions to ask to be able to determine if something's "off". For example, some of my demented residents never know where they are. They certainly don't know what year it is, or who the president is. That's their baseline. However, most of these residents do know who *I* am. So I'll ask "Do you know who I am?" if they don't recognize me, I know something's changed.

    When you're trying to determine a change in LOC in a resident who was *already* confused to begin with, the "A and O x3" we learned in nursing school is pretty much useless.
    somenurse likes this.
  11. 1
    Quote from beatrice1
    How do you all check orientation in the elderly in LTC. Most of them are oriented to self, but what is the best way to check time and place. Do we really expect them to know the date, even the month when every day to them is the same routine. and how about place? Do you know where you are? What are the questions you ask?

    Bea
    @JeanMarie
    Thank you for sharing your personal experience with your Dad. It was very insightful and also reminded me how to consider the change in routine/place can make them appear to be disoriented or disoriented more than usual, and more conversation may be needed.
    somenurse likes this.


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